Identifying Gaps in iGuides
As more jurisdictions onboard to pan-Canadian specifications they will likely uncover barriers to alignment with the specification rules - expected that some would need to be addressed through governed change control.
These barriers can include the loosening of cardinality on a Required element or section slice in specification, prohibiting the inclusion of Required or MustSupport elements, and/or changing a binding on a value set that is Required by specification or FHIR.
Impact
- Additional effort for customization of products from vendors which leads to the situation of effectively undercutting the value they receive from jurisdictions harmonizing around the pan-Canadian specification
- These customizations unintended rigidity that makes scaling/phasing more costly
- Introduces the risk of homogenizing the type of vendor that are able to effectively reply to the request-for-proposals put forward by jurisdictions.
- Prevents inter-jurisdictional data exchange, limiting the exchange of data to the jurisdictional pilot environment
How to Identify Gaps
When a jurisdiction is writing specifications for an implementation guide, they may not always be able to align to the pan-Canadian standards. These differences could stem from differences in specific workflows that are present within that specific jurisdiction or the that the clinician working group had identified to be included with that jurisdictional iGuide.
The following steps are recommended to help the iGuide author identify gaps:
- Differences in nuances, such as required jurisdictional valueSets or bindings not identified within the pan-Canadian specifications
- Business case analysis to determine gaps in required workflow or actor/system interactions not present
How to Address Gaps
When a jurisdiction identifies an implementation nuance (that must be expressed in a profile) that would bring them out of alignment there are three ways to resolve:
- Change management/assessment of other ways to resolve the gap,
- Modification of the pan-Canadian profile (and potentially international profiles) if deemed appropriate,
- Acceptance of misalignment, including a formal process for claiming variance, and if temporary, remediating gaps.
Resolution needs to be logical and driven through a centralized change request process to ensure variances are known and assessed for the right method to bridge the gap.