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Welcome to the CA:FeX Implementation Guide.

The Canadian FHIR Exchange (CA:FeX) Interoperability Specifications promote standardized FHIR RESTful exchange patterns that can be used across existing infrastructure or directly with FHIR servers. This guide focuses on both document-based and individual resource exchanges, offering implementation options ranging from foundational patterns to more sophisticated exchange workflows.

CA:FeX aims to help implementers navigate these options by clarifying available FHIR patterns and providing guidance grounded in international best practices (e.g., IPA, QEDm, US Core, IPS), tailored to the Canadian context. While developed primarily for greenfield implementations, CA:FeX also supports broader interoperability goals.

CA:FeX offers guidance in three key areas:

• Single Resource Exchange
  Defines RESTful capabilities (read, search, create, update, delete) and identifies FHIR resource types expected in individual resource exchanges.

• Document Exchange
  Describes how to exchange grouped resources as documents and standardizes search parameters for document-sharing use cases.

• Extending APIs with FHIR Operations
  Highlights functional FHIR Operations that simplify client implementation by abstracting multi-step workflows into single API calls.

The CA:FeX specification is a foundational building block in Canada’s digital health ecosystem. It supports vendors in aligning to baseline expectations across jurisdictions and defines “Interaction Support” for all ecosystem participants. CA:FeX will continue to evolve with its roadmap, Canadian priorities, and international FHIR exchange developments.

Intended Audience

The intended audience of the CA:FeX Interoperability Specifications includes, but is not limited to:

• Those interested in integrating healthcare information systems and workflows
• IT departments of healthcare institutions
• Technical staff of clinical solution vendors
• Experts involved in standards development and
• Software developers.

Defined Terms

For additional defined terms please go to the Infoscribe page here.

Table of Contents

• Business Context
• Project Background
• Scope
• Relationship to Other Specifications
• Use Cases
• Technical Context
• Overview
• FHIR Exchange Paradigms
• Sequence Diagrams
• Actor Mapping to Interoperability Specification
• Security
• Actor and Conformance Options
• Technical Actors
• Actor Options
• Conformance Requirements
• FHIR Artifacts
• Profiles and Extensions
• Search Parameters
• Operations
• Capability Statements
• Change Log
• Change Log

Feedback

To provide feedback on the CA:FeX specification, please review the following page to obtain access to the Jira project: pan-Canadian Interoperability Specifications Feedback - Pan Canadian Interoperability - InfoScribe (infoway-inforoute.ca)