Home > Introduction

Introduction

Overview

This implementation guide provides guidance for Health Information Custodians using FHIR R4 to leverage the enhanced Publish/Subscribe (Pub/Sub) capabilities introduced in FHIR R5. By utilizing the R5 Subscription Backport Implementation Guide, you can adopt the more robust and feature-rich R5 Pub/Sub model without requiring a full upgrade to R5.

Digital Health Information Exchange (DHIEX)

On January 1, 2021, Ontario Regulation 329/04 ("O. Reg. 329/04") under the Personal Health Information Protection Act, 2004 (PHIPA), was amended to provide a regulatory framework for Ontario Health, as directed by the Minister of Health (“the minister”), to establish, maintain and amend interoperability specifications. This regulatory framework, as set out in sections 26 to 34 of O. Reg. 329/04, is referred to by Ontario Health as the Digital Health Information Exchange (DHIEX) framework.

Ontario Health guides and supports the adoption of modern interoperability specifications applicable to digital health assets as defined in s. 26 of O. Reg. 329/04. A health information custodian (HIC) is required to ensure that every digital health asset that it selects, develops or uses complies with every applicable interoperability specification, as it may be amended from time to time, within the time period set out in the specification.

Compliance with the requirements of the DHIEX framework does not relieve a HIC of its obligation to comply with the other provisions of PHIPA and its regulations.

Ontario Health is required to consult with and consider the recommendations of the Information and Privacy Commissioner of Ontario (where a specification relates to the confidentiality of personal health information, the privacy of individuals or the rights of individuals to access or correct records of their personal health information) prior to providing the specification to the Minister of Health for review and approval.

Ontario Health is also required to consult with any health care provider organizations, individuals, stakeholders and other parties as appropriate, in order to inform its decisions concerning the establishment, maintenance or amendment of interoperability specifications.

Why R5 Pub/Sub?

FHIR R5 significantly improves the Pub/Sub framework with:

  • SubscriptionTopic Resource: Enables the definition of reusable topics, promoting modularity and better organization of subscriptions.
  • SubscriptionStatus Resource: Provides detailed status information about subscriptions, including delivery attempts and errors.
  • Enhanced Filtering: Offers more advanced filtering options with comparators and modifiers.
  • Standardized Notification Bundles: Delivers notifications in a consistent Bundle format, supporting various payload types.

Benefits of Using the Backport

  • Improved Efficiency: Leverage the R5 Pub/Sub features for more efficient and targeted event notifications.
  • Reduced Complexity: Simplify subscription management with well-defined topics and clear status tracking.
  • Future-Proofing: Prepare your systems for a smoother transition to FHIR R5 in the future.
  • R4 Compatibility: Maintain compatibility with your existing R4 environment while adopting R5 features.

Content and Organization

The implementation guide is organized into the following sections:

Dependencies

This implementation guide relies on the following other specifications:

  • FHIR R4 - The current official version of FHIR as of the time this implementation guide was published.
  • CA Core+ v1.1.0 - This specification is a key input into the design the Subcription profiles.

It is assumed that the reader of this specification has the following knowledge:

  • An understanding of the FHIR standard
  • Knowledge of RESTful API architectures

This specification is fully copyright protected by the owner. The owner has the exclusive right to make copies of this specification. No alterations, deletions or substitutions may be made without the prior written consent of the owner. No part of it may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, email or any information storage and retrieval system, without the prior written consent of the owner.

This specification contains information for which copyright is held by Health Level Seven Inc. Implementors of the standards (those developing software or otherwise making use of the specification) are required to be members of either Health Level Seven Inc., HL7 Canada or one of the other HL7 affiliates. There is no such membership requirement for individuals and organizations which merely install or use software with built-in HL7 interfaces.

HL7® and FHIR® are registered trademarks of Health Level Seven, Inc. (https://www.hl7.org).

LOINC® is a registered trademark of the Regenstrief Institute, Inc. (http://regenstrief.org)

This material includes SNOMED Clinical Terms® (SNOMED CT®) (https://www.snomed.org/snomed-ct/) which is used by permission SNOMED International. All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists.

“SNOMED” and “SNOMED CT” are registered trademarks of SNOMED International (https://www.snomed.org/).

Pursuant to O. Reg. 329/04, Ontario Health is required to, subject to the review and approval of the Minister, establish, maintain and amend interoperability specifications. The Minister may direct Ontario Health to establish or amend interoperability specifications, and Ontario Health is required to comply with such direction. In accordance with O. Reg. 329/04, Ontario Health makes the interoperability specification most recently approved by the Minister available to the public by posting it on Ontario Health’s website or by such other means as Ontario Health considers advisable.

As the Minister may direct Ontario Health to amend the interoperability specifications from time-to-time, Ontario Health advises the public and any other users of information concerning interoperability specifications to regularly review Ontario Health’s website where the interoperability specifications are posted, or such other means Ontario Health considers advisable, in order to confirm that they are accessing the interoperability specifications most recently approved by the Minister.

You understand and agree that: (i) This specification is provided “AS IS” without any warranties or representations of any kind, express or implied, in fact or in law; (ii) Ontario Health is not responsible for your use or reliance on the information in this specification or any costs associated with such use or reliance; and (iii) Ontario Health has no liability to any party for that party’s access, use or reliance on this specification or any of the information contained in it.


Document Control

The electronic version of this specification is recognized as the only valid version.

Approval History

APPROVER(S) APPROVAL STATUS APPROVED DATE
Ontario DHISC Balloted Draft YYYY-MM-DD