Home > Scope
Scope
This Implementation Guide (IG) will provide comprehensive guidance on leveraging the advanced Publish/Subscribe (Pub/Sub) capabilities of FHIR R5 within an existing FHIR R4 infrastructure. Specifically, the IG will focus on the use of the R5 Subscription Backport to enable Health Information Custodians (HICs) in Ontario to implement real-time, event-driven data exchange notifications using FHIR. This approach allows for the adoption of key R5 features, such as SubscriptionTopic and SubscriptionStatus resources, enhanced filtering, and standardized notification bundles, without requiring a full migration to R5.
In Scope
IG is focused on use cases, system interactions and FHIR profiles for integration between Point of Care (PoC) such as EMRs, HIS, Clinical Portals, and Ontario Health Enterprise Publish and Subscribe Service in support of Subscription management and retrieval of event notifications from OH digital health assets.
Out of Scope
Following items are excluded from the scope of this IG and shall not be a concern for the system integrators:
The creation of subscription topics and publishing of events to the Subscription Service by OH digital health assets.
Creation of inbound subscriptions, where Publisher is outside of Ontario Health ecosystem (not OH digital health assets).
The guidance will be tailored to the Ontario healthcare context, addressing relevant provincial standards, policies, and use cases. This IG aims to empower stakeholders in the Ontario healthcare ecosystem to enhance the efficiency, reliability, and interoperability of their FHIR-based solutions through the adoption of R5 Pub/Sub capabilities.
Applying the Ontario Health HL7 FHIR Subscription IG
Ontario Health will be establishing the HL7 FHIR Subscription IG as an interoperability specification under Ontario’s Digital Health Information Exchange (DHIEX) framework.
The following information is provided in accordance with O. Reg. 329/04 under Personal Health Information Protection Act (PHIPA), 2004, section 28 Application of Specifications.
| Requirement | Details |
|---|---|
| Specification effective date (Note: This is the date by which all applicable HICs are required to be compliantly contributing and/or consuming the approved interoperability specification. OH will work with the applicable HICs to establish the implementation plan in order to meet the effective date.) | N/A - Balloted Draft |
| Name, description, or class of Health Information Custodians that must select, develop, or use digital health assets that comply with the specification: | Health Information Custodians that implement the pan-Canadian HALO Specification and utilize the SMART on FHIR Accelerator functionality as defined in HALO: - A person or entity that provides primary care nursing services, maternal care or inter-professional primary care programs and services as per The People's Health Care Act, 2019, S.O. 2019, c. 5 - Bill 74. - Hospitals as per the Public Hospitals Act, R.R.O. 1990, Reg. 965. Health Information Custodians that are the recipient of the clinical data delivered by OntarioMD Health Report Manager: - A person or entity that provides primary care nursing services, maternal care or inter-professional primary care programs and services as per The People's Health Care Act, 2019, S.O. 2019, c. 5 - Bill 74. - A health facility, including a community surgical and diagnostic centre, in which one or more members of the public receive services for or in respect of which facility costs are charged or paid, as per Integrated Community Health Services Centres Act, 2023, S.O. 2023, c. 4, Sched. 1. Health Information Custodians that are using the Provincial Care Coordination Gateway: - A person or entity that provides primary care nursing services, maternal care or inter-professional primary care programs and services as per The People's Health Care Act, 2019, S.O. 2019, c. 5 - Bill 74. - A health facility, including a community surgical and diagnostic centre, in which one or more members of the public receive services for or in respect of which facility costs are charged or paid, as per Integrated Community Health Services Centres Act, 2023, S.O. 2023, c. 4, Sched. 1. |
| Types of digital health assets to which the specification applies. | Digital health assets used by Health Information Custodians for the following purpose: - Point of Care systems used by the HICs above that subscribe to Ontario Health Enterprise Publish and Subscribe service for receiving notifications |
| Circumstances, if any, when a Health Information Custodian may be exempted from the requirement to select, develop or use digital health assets that comply with the specification: | TBD |
This guide covers:
- Backport Overview: Introduction to the R5 Subscription Backport Implementation Guide.
- SubscriptionTopic Implementation: Guidance on defining and using SubscriptionTopics in R4.
- SubscriptionStatus Utilization: How to leverage SubscriptionStatus for monitoring and troubleshooting.
- Advanced Filtering: Examples and best practices for using R5 filtering capabilities in R4.
- Notification Handling: Processing standardized notification bundles in R4 clients.
- Security Considerations: Best practices for securing Pub/Sub interactions.
This guide will empower you to:
- Unlock the power of R5 Pub/Sub in your R4 environment.
- Improve the efficiency and reliability of your FHIR-based event notifications.