Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.
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Overview
The Pan-Canadian Patient Summary (PS-CA) is an adaptation of the International Patient Summary, which defines the patient summary as a standardized set of basic clinical data, which includes the most important health and care related information about the patient, such as medications they are taking, any allergies or intolerances they have and their key medical issues. This summarized version of a patient’s clinical data provides health professionals the essential information needed at the point of care. It represents a minimal and non-exhaustive set of clinically relevant standardized patient data, which is specialty-agnostic and condition-independent, but readily usable by patients and authorized health care providers.
The PS-CA addresses Canada’s unique healthcare delivery models, ensuring consistent and secure access to patient information within and across provinces and territories. This customization aims to enhance care continuity and accessibility within the Canadian healthcare landscape. Developed in collaboration with jurisdictions and their clinicians, PS-CA outlines the critical high priority data clinicians want, the data standards (data language) all systems need to speak to exchange the data and standardized methods to exchange the data, such as CA:FeX (Canadian FHIR exchange).
The Patient Summary will be instrumental in supporting patients and their health care providers by ensuring that the patient’s most important health care information, such as medications, allergies or intolerances, and key medical issues, is available at the point of care. For example:
- During unexpected or unscheduled situations, such as emergencies where the health care provider may not have any information about the patient.
- During transitions of care, such as moving between care settings—whether from a hospital to home or between health care providers.
- Supporting planned care situations, such as care coordination across multiple providers.
National and International Collaboration
Infoway works closely with Canadian jurisdictions to prioritize data domains (e.g., Medications, Problems, etc.) and define requirements for the PS-CA. This initiative started by incorporating all required IPS data domains, along with selected recommended and optional domains. However, not all IPS data domains currently have profiles ready for implementation.
The IPS maintains a “general roadmap” for updates and new content additions. Infoway actively participates in the global IPS community to ensure ongoing alignment and integration with international standards.
The Joint Initiative Council for Global Health Informatics Standardization (JIC) promotes health informatics standards to enable interoperability across health domains, support efficient and high-quality health service delivery, and facilitate global markets for health information systems. In their recent discussion paper on the IPS, The Future of IPS as a Global Public Good, it is acknowledged that:
“Local adaptation of the IPS suite may at times be necessary, a shared objective is that local variations have minimal impact on technical implementation and global use of the instances of personal health data conforming to the IPS suite.”
Infoway shares this objective and continues to work with global IPS communities to stay aligned and contribute to IPS developments.
There is a growing desire within the community for the IPS to support planned healthcare, such as in cases of citizen movements or cross-organizational care paths. While the IPS has primarily focused on unscheduled, cross-border care, Canada has defined use cases to support transitions and continuity of care across local borders. Other countries are adopting similar approaches.
As the healthcare landscape evolves, Infoway remains committed to advancing the PS-CA and ensuring its adaptability to both local needs and global standards. By continuing to foster national and international collaboration, we are helping to create a future where seamless, patient-centered care is accessible no matter where individuals travel or where they receive care. This collective effort will drive the progress needed to make connected care a global reality.
Key Benefits of the Patient Summary
PS-CA is a stepping-stone towards the future. It allows access to the most critical patient data now, while allowing the room to build out modern, “just in time”, secure and access-controlled ecosystems that respect patient privacy while allowing citizens to participate in the delivery of their own care. Common standards for Patient Summary including the way in which it’s exchanged, can realize multiple benefits to different stakeholders, including the ability for a single longitudinal patient record.
Patients
- Improved Experience: Efficient and comprehensive data sharing between providers leads to better health outcomes.
- Access to Information: Patients can access and share their personal health information.
Health Care Funders
- Cost and Time Reduction: Implementing patient summary and interoperability solutions is more cost-effective and quicker due to reusable data content and technical profiles.
- Reliable Reporting: Automated reporting helps target health care spending more effectively.
Jurisdictions
- Reduced Implementation Burden: Centralized expertise and reusable profile components lower resource demands.
- Simplified Processes: Coordinated approach reduces complexity and resource requirements.
- Global Standards Alignment: Supports international vendors by eliminating the need for Canada-specific solutions.
Vendors
- Standardized Components: Reuse of standardized components across jurisdictions reduces variability and implementation time.
- Scalability and Enhancements: Easier scalability and future enhancements with minimal effort, allowing vendors to incorporate new elements without jurisdictional oversight.
Clinicians/Health Care Providers
- Enhanced Communication: Improved coordination and transitions of care through better communication between health providers.
- Improved Provider Experience: More accessible and organized patient information saves time and reduces administrative burden, improving workflow and preventing burnout.
- Better Data Quality: Consistent records of past tests and results reduce redundant testing and improve patient safety.
- Support for Virtual Care:: Consistent access to health information across different modalities and solutions.
- Better Health Outcomes: Consistent access to health information aids decision-making and supports proactive health management, improving patient safety and care effectiveness.
Specification Feedback
FHIR Implementation Guide Focus Areas for Feedback: Implementers are encouraged to provide broad feedback as well as to review the Known Issues & Future Development for technical areas that this specification is specifically targeting feedback on.
How to submit your feedback: A full list of instructions for submitting feedback is available on the PS-CA Release Information. Each release will include details about how to provide feedback. In the PS-CA Releases table, click on the Release Title for which you wish to provide feedback on.
Conclusion
In conclusion, the Pan-Canadian Patient Summary (PS-CA) represents a significant advancement in the standardization and accessibility of patient health information across Canada. By adapting the International Patient Summary (IPS) to meet the unique needs of Canada’s healthcare system, the PS-CA ensures that essential health data is consistently available at the point of care, enhancing patient outcomes and care coordination.
Through national and international collaboration, Infoway and its partners are driving the development and implementation of the PS-CA, aligning with global standards while addressing local requirements. This initiative not only supports emergency and transitional care but also facilitates planned care, ensuring that patients receive comprehensive and continuous care regardless of where they are.
The PS-CA’s benefits extend to all stakeholders in the healthcare ecosystem, from patients and providers to funders and vendors, by improving data sharing, reducing costs, and enhancing the quality of care. As the healthcare landscape continues to evolve, the PS-CA stands as a cornerstone for future innovations, paving the way for a more connected, patient-centered healthcare system.
By fostering ongoing collaboration and leveraging standardized data exchange methods, the PS-CA is poised to play a key role in making connected care a reality, ensuring that patients’ health information is accessible, secure, and actionable whenever and wherever it is needed.
Defined Terms
The following table provides a list of terms and acronyms that you may encounter throughout the pan-Canadian interoperability specifications (e.g. PS-CA, CA:FeX) and/or in the prototyping and validation information.
| Term / Acronym | Meaning |
|---|---|
| ATNA | The Audit Trail and Node Authentication (ATNA) Profile specifies the foundational elements needed by all forms of secure systems: node authentication, user authentication, event logging (audit), and telecommunications encryption. It is also used to indicate that other internal security properties such as access control, configuration control, and privilege restrictions are provided. Source: https://profiles.ihe.net/ITI/TF/Volume1/ch-9.html |
| Author (e.g., PS-CA Author) | A health care provider who authors and/or curates clinical data (e.g. Patient Summary). |
| Business Requirements: Non-Testable | Business requirements that are not directly traceable to an IHE profile in the PS-CA specifications (e.g., provided for consideration and to support and provide guidance to implementers of the PS-CA). |
| Business Requirements: Testable | Business requirements that are directly traceable to an IHE profile in the PS-CA specifications. |
| Business/Legal Interoperability Requirements | Requirements that enable independent organizations to execute a collaborative process or service. |
| CA:FeX | The CA:FeX Interoperability Specifications (Canadian FHIR Exchange (CA:FeX)) seek to promote FHIR RESTful exchange patterns, developed by industry-leading FHIR standards that can be applied on top of an existing non-FHIR infrastructure just as easily as it can be applied on top of FHIR servers. |
| CA:FMT | Canadian Formatting Service (CA:FMT) is a Canadian Integration Specification that provides formatting support services. It provides support for transformation of documents between different formats (e.g. from FHIR to PDF, CDA, etc.). |
| CCDD | The Canadian Clinical Drug Data Set (CCDD) is the drug terminology for use in digital health solutions such as electronic prescribing in Canada. |
| Central Infrastructure | A Central Infrastructure collects health information from participating organizations and stores the information in a centralized place. The Infrastructure also provides access control. Typically, the Central Infrastructure is under jurisdictional control. |
| Clinical Data Repository (Local or Central) | A Clinical Data Repository (i.e., Clinical data repository) is a shared storage space for clinical data that can be hosted locally (e.g., at the data producer) or at the Central Infrastructure and can be accessed by authorized users. |
| Clinical Solution | Any combination of health information technology assets and processes that enables clinical data to be communicated, managed, and dispositioned between a Producer and a Consumer. Clinical Solutions can be comprised of various Producer and Consumer systems including: EMR, HIS, CIS, PHR, EHR or any combination of these systems |
| Conformance Testing | Conformance testing is a formal process of assessment focused on ensuring clinical solutions and systems accurately implement a particular specification (e.g. PS-CA Specifications) by ensuring there is conformance to the stated parameters that are being claimed in the standard. |
| Consumer (e.g., PS-CA Consumer) | A health records system (e.g., EMR, HIS, CIS, PHR, Patient Portal or EHR) that enables access to or receipt of a clinical document (e.g. PS-CA) by an authorized health care provider or the subject of care/patient. |
| Cross Border, Scheduled Care | Scheduled care of a resident of Canada that is delivered in/by another country. |
| Cross Border, Unscheduled Care | Unscheduled care of a resident of Canada that is delivered in/by another country. |
| CT | The Consistent Time Integration Profile (CT) provides a means to ensure that the system clocks and time stamps of the many computers in a network are well synchronized. This profile specifies synchronization with a median error less than 1 second. This is sufficient for most purposes. |
| DIN | A Drug Identification Number (DIN) is a computer-generated eight digit number assigned by Health Canada to a drug product prior to being marketed in Canada. |
| Document Repository (Local or Central) | See Clinical Data Repository (Local or Central) |
| DPD | The Drug Product Database (DPD) is used to find drugs authorized for sale by Health Canada. The DPD is updated nightly and includes availability of the drug in Canada. |
| Electronic Health Record (EHR) | The EHR represents the Clinical Solution that contains a secure and private collection of a patient's health information in a digital format, which is shareable across different health care settings / clinical solutions that are integrated. The EHR facilitates better sharing and interpretation of health information among the health care professionals involved in the care of the patient. For example:CareConnect is British Columbia's secure, view-only EHR solution. It offers healthcare providers access to an integrated, provincial view of patient-centric information available 24/7 to support the delivery of patient care. HEALTHe NL is the Newfoundland & Labrador provincial EHR. HEALTHe NL will provide more accurate and reliable data to support improved health care delivery, decision-making and policy and create improved accountability, stability and efficiency in the provincial health care system. Netcare is Alberta's name for all the projects related to the provincial EHR - a secure and confidential electronic system of Alberta patients’ health information: a single, comprehensive, and integrated patient record. Other clinical systems: In some health authorities, other clinical systems may act as an EHR, holding the patient summary information. |
| Extensible PS-CA Dataset | Extensible PS-CA Dataset: PS-CA content that can be extended for use in a PS-CA use case scenario that complements the primary PS-CA use cases.Note: Extensible PS-CA Dataset refers to the addition of data domains such as Family History. |
| FHIR® Repository | A FHIR repository is a clinical data repository built around the HL7® FHIR® standard used for storing clinical data. |
| Gazelle | Gazelle is a suite of virtual tools, developed by IHE Europe used to support interoperability testing. Gazelle will allow jurisdictions and vendors an opportunity to validate the role they will be playing in an ecosystem and ensure they are able to satisfy the interoperability requirements. Gazelle offers several self-serve, self-test and innovation opportunities for jurisdictions and vendors to test their alignment to the represented integration profiles. |
| HCP | Health Care Provider |
| Health Information Access Layer (HIAL) | An interface specification for the EHR infostructure that defines service components, service roles, information model and messaging standards required for the exchange of EHR data and execution of interoperability profiles between EHR services.(Source:https://www.infoway-inforoute.ca/en/component/edocman/resources/technical-documents/391-ehrs-blueprint-v2-full ; Page.340) |
| Health Records System | A health records system may include an electronic medical records system, a hospital information system, a clinical information system, an electronic health records system or a personal health records system. The term is broadly used to describe system actors that may produce and/or consume a PS-CA. Jurisdictional implementation patterns will determine which systems are used to create, access, consume and manage patient summaries. |
| HIS | Health Information System |
| Health Level 7 (HL7®) | Founded in 1987, HL7 is a not-for-profit standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services (Source: http://www.hl7.org/about/index.cfm?ref=nav) |
| HL7® Fast Healthcare Interoperability Resources (FHIR®) | Expected to be a next-generation standards framework created by HL7. FHIR® combines the best features of HL7’s Version 2, Version 3, and product lines while leveraging the latest web standards and applying a tight focus on implementability. (Source: HL7 FHIR) |
| Information/Semantic Interoperability Requirements | Requirements for syntax and semantics such that data exchanged between health record systems can be interpreted and the meaning of the data ascertained. |
| Integrating the Healthcare Enterprise (IHE) | IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively. (Source: IHE) |
| IHE Actor | IHE Actors are responsible for producing, managing and/or acting on information in the context of an IHE Profile (e.g., Primary Care Provider, EMR, EHR, etc.). (Source: IHE Actors) |
| IHE Domain | IHE Domains are responsible for the development and maintenance of the IHE Technical Frameworks that document the Integration Profiles. Each Domain manages Integration Profiles in a particular part of healthcare (e.g., Virtual Care). (Source: IHE Domains) |
| IHE Integration Profiles | IHE Integration Profiles provide a solution to the interoperability challenges which have arisen in daily clinical work, as described in the Use Cases. Integration Profiles include detailed technical specifications for the use and implementation of relevant standards, ensuring an uninterrupted flow of information between different healthcare IT applications in support of the specific use case. (Source: IHE Europe) |
| IHE Transactions | IHE Transactions are interactions between actors that communicate the required information through standards-based messages (e.g., patient look-up query, send patient summary information, etc.). (Source: IHE PCC) |
| International Patient Summary (IPS) | The IPS is a minimal, non-exhaustive set of data elements defined by ISO/EN 17269 and realized by HL7 in both CDA and FHIR. The IPS is a snapshot clinical document that can be used for planned or unplanned care of a person locally or across borders. It emphasizes the data required and the necessary conformance of the use cases for an international patient summary. (Source: IHE IPS) |
| Interoperability | Interoperability enables information to flow seamlessly between different solutions and devices. When different parts of the health system are interoperable with each other, they can “speak the same language.” Interoperability improves continuity of care, collaboration between health providers, and patient access to their health information. By breaking down data silos, it also reduces inefficiencies and redundancies within the health system. |
| IUA | The Internet User Authorization (IUA) Profile provides support for authorizing network transactions when using HTTP RESTful transports. IHE has authorization profiles for the Web Services and SOAP-based transactions, and this profile provides an authorization profile for the HTTP RESTful transactions. (Source: IHE IUA) |
| Local, Scheduled Care | Scheduled care of a resident of Canada that is delivered in/by the Canadian healthcare system. This includes care provided in federal, provincial, and territorial jurisdictions, as well as cross-jurisdictional care. |
| Local, Unscheduled Care | Unscheduled care of a resident of Canada that is delivered in/by the Canadian healthcare system. This includes care provided in federal, provincial, and territorial jurisdictions, as well as cross-jurisdictional care. |
| Longitudinal Electronic Health Record | A longitudinal electronic health record is a single comprehensive patient record comprised of data from numerous data sources across the healthcare continuum. |
| Medical Home | The College of Family Physicians of Canada describes the Medical Home as: "The Patient’s Medical Home (PMH) is a family practice defined by its patients as the place they feel most comfortable—most at home—to present and discuss their personal and family health and medical concerns. It is the central hub for the timely provision and coordination of a comprehensive menu of health and medical services patients need." (Source: CFPC PMH) |
| MHD | The Mobile access to Health Documents (MHD) Profile defines one standardized interface to health document sharing (a.k.a an Application Programming Interface (API)) for use by mobile devices so that deployment of mobile applications is more consistent and reusable. (Source: IHE MHD) |
| On-Demand | Refers to the capability to generate a patient summary at the time it is requested. This means retrieving a patient’s most current health data from available sources (e.g., CDR, EHR) when needed, ensuring timely access to information for clinical decision-making and patient care. |
| Patient Portal | A patient portal is a web-based access point that enables secure patient access to personal health information and other self-serve health IT services. For example, a patient portal can be hosted on an EMR solution. |
| Patient Proxy | An individual or entity that has the authority to act on behalf of a subject of care/patient. Proxies can include parents of dependent children, parents of dependent adults, powers of attorney, etc. |
| Patient Summary-CA (PS-CA) | An electronic patient summary for use at the point of care comprised of, at minimum, the required elements of the Patient Summary-CA data set and specifications. The PS-CA is a health record extract, at a snapshot in time, comprised of a standardized collection of clinical and contextual information (retrospective, concurrent, prospective), including the minimum necessary and sufficient data to inform a patient's treatment at the point of care. |
| PDQm | The Patient Demographics Query for Mobile (PDQm) Profile defines a lightweight RESTful interface to a patient demographics supplier leveraging technologies readily available to mobile applications and lightweight browser-based applications. (Source: IHE PDQm) |
| PIXm | The Patient Identifier Cross-reference for Mobile (PIXm) Profile provides RESTful transactions for mobile and lightweight browser-based applications to create, update and delete patient records in a Patient Identifier Cross-reference Manager and to query the Patient Identifier Cross-reference Manager for a patient’s cross-domain identifiers. (Source: IHE PIXm) |
| PMIR | The Patient Master Identity Registry (PMIR) Profile supports the creating, updating and deprecating of patient master identity information about a subject of care, as well as subscribing to changes to the patient master identity, using the HL7 FHIR standard resources and RESTful transactions. (Source: IHE PMIR) |
| Producer (e.g., PS-CA Producer) | A health records system (e.g., EMR, HIS, CIS, PHR, or EHR) that creates/produces a clinical document (e.g., PS-CA) in response to a request from an authorized health care provider, the subject of care, or another authorized health records system. |
| Projectathon | A Projectathon is an important step and a best-practice approach in testing and validation of a specification package, where implementers collaborate to test their solutions using methodology and tools that accelerate interoperability. A Projectathon provides an opportunity for participants to test their systems among themselves and against a reference environment. It is also an opportunity to collaborate among peers to enable hands-on knowledge exchange. |
| PS-CA Solution | Any combination of health information technology assets and processes that enables a Patient Summary-CA to be created, communicated, managed and dispositioned between a PS-CA Producer and a PS-CA Consumer. Patient Summary-CA Solutions can be comprised of various Producer and Consumer systems including: EMR, HIS, CIS, PHR, EHR or any combination of these systems. |
| PS-CA Specifications | Pan-Canadian Patient Summary Interoperability Specifications: The pan-Canadian Patient Summary Interoperability Specification is an implementable, testable specification, based on the IHE International Patient Summary specification and the HL7 IPS Implementation Guide. |
| PT | Provinces and Territories |
| RA | The Reference Architecture (RA) is intended as an evolving blueprint of service availability that supports a broader interoperability landscape, not limited to patient summaries. Its purpose is to facilitate multi-stakeholder dialogue, collaboration and convergence towards common, open standards. It is a conceptual technical view that provides a common vocabulary and a set of actors and transactions representing typical components in a digital health ecosystem (public and private sector solutions). It is a combination of building blocks adopted from international standards development bodies and Canadian developed implementation patterns. |
| Shareable Health Link (SHL, SHLink) | A secure, standardized link that enables patients to share their clinical health information (e.g., patient summaries) with healthcare providers. SHLs can be shared via QR codes or other secure electronic methods (e.g., email). SHLs are designed to facilitate the smooth exchange of health data, allowing information to travel with patients wherever they might be, supporting the continuity of care. SHL is based on HL7 SMART Health Links and generally can be used interchangeably. |
| SUT | System Under Test |
| SVCM | Sharing Valuesets, Codes and Maps (SVCM) defines a lightweight interface through which healthcare systems may retrieve centrally managed uniform nomenclature and mappings between code systems based on the HL7 Fast Healthcare Interoperability Resources (FHIR) specification. (Source: SVCM) |
| Technical Interoperability Requirements | Requirements for one health record system to send data to another health record system and for the receiving system to acknowledge receipt of the data payload. |
| Terminology | Collection of uniquely identifiable concepts with associated representations, designations, associations and meanings. |
| XDM | Cross-Enterprise Document Media Interchange (XDM) provides document interchange using a common file and directory structure over several standard media types. This permits the patient to use physical media to carry medical documents. This also permits the use of person-to-person email to convey medical documents. XDM supports the transfer of data about multiple patients within one data exchange. (Source: XDM) |
| XDS | The Cross-Enterprise Document Sharing (XDS) IHE Integration Profile facilitates the registration, distribution and access across health enterprises of patient electronic health records. (Source: XDS) |