This is the current version of the PS-CA Implementation Guide. Other releases of the PS-CA Implementation Guide may be found at Guides.
Terminology
The profiles in this specification leverage value sets from both the IPS-UV guide as well as value sets that have been developed according to the principles identified in the Terminology Approach.
Usage Guidance:
Several ValueSets are not available at their canonical URL (e.g., CVC published value sets) or on the terminology servers used in implementation guide publication (i.e., tx.fhir.org).
Primarily, this impacts validation against Canada Health Infoway-hosted ValueSets during the development of derived Implementation Guides. This does not affect deployed systems as these instances will be validated against loaded terminology.
For several of these ValueSets, "stub" resources have been created to stand-in for the unresolvable ValueSets. These stub ValueSets include pointers to the locations where the full value sets can be downloaded.
Current guidance is to manually download the value sets from, for example, the Terminology Gateway or Canadian Vaccine Catalogue. When terminology is not readily available as FHIR® Release 4 ValueSets or CodeSystems, implementers should work with terminology producers to identify options.
Terminology owners often evolve their code systems and value sets over time: retiring concepts, adding new ones, modifying relationships, etc. Terminology content should be "current at time of use," except when specific versions of CodeSystems or ValueSets are identified within PS-CA.
Production implementations should be cautious of recognizing only the terminology in effect at the time of publication of the PS-CA Implementation Guide, or only the terminology in effect at time of system implementation. PS-CA Patient Summary documents should use current-at-time-of-creation terminology. However, since Patient Summary documents may have an extended life, recipient systems should be lenient in accepting out-of-date codes.
Note: The FHIR ValueSet files for the Proposed Pan-Canadian Value Sets in the PS-CA do not include a code system version, rather they point to the subset defining url in the hosting system (e.g., Terminology Gateway). For Projectathon testing of PS-CA v1.0.0 TI, vendors are expected to implement, at a minimum, the version of the terminology that was published at the time of release, but that vendors are encouraged to keep up to date with the most recent releases of terminology as described above.
Value Sets
The table below indicates the various levels of terminology included in PS-CA. Value sets are grouped under three columns:
Global Value Sets: These are value sets that are either required by the HL7® FHIR® specification or are proposed by the IPS-UV specification due to their increased likelihood to be recognized/accessible internationally.
HL7: Value sets required for data to be exchanged in FHIR are indicated by an (*). In cases where the value is captured from a different terminology, the captured terminology would be supplied as an alternative coding
IPS: Value sets proposed by the IPS that leverage existing multilingual, globally accessible terminologies that are intended to facilitate interoperable international exchange. IPS defines SNOMED CT as a primary terminology, but also applies other international terminologies (LOINC, EDQM, etc.) in cases where they are deemed more appropriate for progressing the goals of the IPS. Implementers are encouraged to review IPS General Principles.
Note: IPS is currently evolving its approach to modeling desired terminology that has been identified by the international specification. This change is expected to result in the addition of an extension and the removal of terminology slices of the next release of IPS to allow implementers more flexibility in defining the terminology that is most appropriate in the given context of the implementation. Because this specification is being released before the next published IPS version, this specification has pre-empted some of these changes (e.g., improving slice modeling) but will not be incorporating the IPS additional binding extension until it has stabilized further.
Proposed Pan-Canadian Value Sets: These are value sets that are proposed by the PS-CA as the national standardized terminologies that implementers are encouraged to align to. SNOMED CT Canadian Edition (SNOMED CT-CA) is the terminology generally recommended for use in Canada, but in some cases the PS-CA will also propose the use of other terminologies (e.g., CVC, CCDD, etc.) that have widespread adoption across Canada.
- Note: The Pan-Canadian value sets are identified as the preferred value sets for this release (except where another value set is required by HL7 FHIR). While adoption of the global value sets is critical for global interoperability, recent feedback from participating jurisdictions has outlined the need to prioritize domestic jurisdictional exchange over global exchange in early versions of the specification. Implementers should align to the proposed pan-Canadian value sets with an understanding that later releases of PS-CA and IPS may apply unique terminology preferences and expectations for systems acting as gateways or portals for international exchange.
Local Value Sets: These are examples of value sets and local terms or non-standardized value sets that were noted in use within the participating jurisdictions. While implementers are encouraged to align to the proposed pan-Canadian value sets, they should be aware that patient summaries may contain concepts from these terminologies.
- Note: This column excludes terminologies that have established mappings to proposed value sets (e.g., DIN codes included in CCDD, or First Data Bank codes mapped to CCDD as part of established workflows) as well as terminologies that are considered local terms/non-standardized value sets. Jurisdictions that require assistance in hosting their local value sets in a location that vendors and implementers can easily review should reach out to standards@infoway-inforoute.ca.
Bolded notes are used in the below to relay where value sets included in previous releases have been folded into an existing slice.
| Profile | Element | Global Value Sets (if applicable) | Proposed Pan-Canadian Value Sets | Local Value Sets |
|---|---|---|---|---|
| AllergyIntolerance (PS-CA) | clinicalStatus |
AllergyIntoleranceClinicalStatusCodes* (HL7) (Required) | AllergyIntoleranceStatusCode (SNOMED CT-CA) (Slice) | v3.ActStatus (HL7 v3) (Slice) |
| AllergyIntolerance (PS-CA) | verificationStatus |
AllergyIntoleranceVerificationStatusCodes* (HL7) (Required) | AllergyIntoleranceStatusCode (SNOMED CT-CA) (Slice) | - |
| AllergyIntolerance (PS-CA) | code |
NoAllergiesInfoUvIps (IPS) (Slice), Note A, Note B | SubstanceAndPharmaceuticalBiologicProductCode (SNOMED CT-CA) (Preferred Slice) | ICD10CAAllCode (ICD-10 CA) (Slice) |
| AllergyIntolerance (PS-CA) | reaction.manifestation |
Note B | ClinicalFindingCode (SNOMED CT-CA) (Preferred Slice) | - |
| Condition (PS-CA) | severity |
ProblemSeverityUvIps (IPS/LOINC) (Slice) | SeverityCode (SNOMED CT-CA) (Preferred Slice) | - |
| Condition (PS-CA) | code |
NoProbsInfoUvIPS (IPS) (Slice), Note B | ClinicalFindingCode (SNOMED CT-CA) (Preferred Slice) | ICD9CMAllCode (ICD-9 CM) (Slice), ICD10CAAllCode (ICD-10 CA) (Slice), BC Health Concerns and Diagnosis Value Set uses values covered under SNOMED CT, ICD-9 CM, ICD-10 CA slices |
| Condition (PS-CA) | bodySite |
- | AnatomicalOrAcquiredBodyStructureCode (SNOMED CT-CA) (Preferred Slice) | - |
| Immunization (PS-CA) | vaccineCode |
Vaccines - SNOMED CT IPS Free Set (IPS Free Set) (Slice), WhoAtcUvIps (IPS/WHO) (Slice), NoImmunizationInfoUvIPS (IPS) (Slice), Note B | CVCTradename (CVC) (Preferred Slice) OR CVC Generic (CVC) (Preferred Slice) | - |
| Immunization (PS-CA) | site |
TargetSiteUvIps (IPS/SNOMED CT) (Slice) | CVCAnatomicalSite (CVC) (Preferred Slice) | HumanSubstanceAdministrationSite - V3 (HL7 v3) (Slice) |
| Immunization (PS-CA) | route |
MedicineRouteOfAdministrationUvIps (IPS/EDQM) (Slice) | CVCRouteOfAdmin (CVC) (Preferred Slice) | v3.RouteOfAdministration (HL7 v3) (Slice) |
| Immunization (PS-CA) | protocolApplied .targetDisease |
Vaccine Target Diseases - SNOMED CT IPS Free Set (IPS Free Set) (Slice), Note B | CVCDisease (CVC) (Preferred Slice) | - |
| Medication (PS-CA) | code |
WhoAtcUvIps (IPS/WHO) (Slice), Medications - SNOMED CT IPS Free Set (IPS Free Set/SNOMED CT) (Slice) | PrescriptionMedicinalProduct (PrescribeIT/CCDD) (Preferred Slice) | HCNPN (Health Canada) (Slice). Use of DIN, FDB (HICL/HIC4/SEQN), etc. is covered under CCDD, BC Medication Superset still in development |
| Medication (PS-CA) | form |
MedicineDoseFormUvIps (IPS/EDQM) (Slice) | PharmaceuticalDoseFormCode (SNOMED CT-CA) (Preferred Slice) | PrescriptionDrugForm (PrescribeIT/HL7 v3) (Slice) |
| Medication (PS-CA) | ingredient .itemCodeableConcept |
Note C | DrugOrMedicamentSubstanceCode (SNOMED CT-CA) (Preferred Slice) | Use of DIN, FDB (HICL/GCN), etc. which is covered under CCDD |
| MedicationRequest (PS-CA) | medicationCodeableConcept |
- | PrescriptionMedicinalProduct (PrescribeIT/CCDD) (Preferred Slice) | - |
| MedicationRequest (PS-CA) | dosageInstruction.route |
MedicineRouteOfAdministrationUvIps (IPS/EDQM) (Slice) | RouteOfAdministration (SNOMED CT-CA) (Preferred Slice) | PrescriptionRouteOfAdministration (PrescribeIT/HL7 v3) (Slice) |
| MedicationStatement (PS-CA) | medicationCodeableConcept |
AbsentOrUnknownMedicationUvIps (IPS) (Extensible Slice) | Note D | HCNPN (Health Canada) (Slice). Use of DIN, FDB (HICL/HIC4/SEQN/GCN), etc. is covered under CCDD |
| MedicationStatement (PS-CA) | dosage.route |
MedicineRouteOfAdministrationUvIps (IPS/EDQM) (Slice) | RouteOfAdministration (SNOMED CT-CA) (Preferred Slice) | PrescriptionRouteOfAdministration (PrescribeIT/HL7 v3) (Slice) |
| Patient (PS-CA) | contact.relationship |
PatientContactRelationship (HL7) (Extensible), PersonalRelationshipUvIps (IPS) (Slice) | - | - |
| Procedure (PS-CA) | code |
AbsentOrUnknownProceduresUvIps (IPS) (Slice), Note E | ProcedureCode (SNOMED CT-CA) (Preferred Slice) | CCIAllCode (Slice), ICD9CMAllCode (ICD-9 CM) (Slice), ICD10CAAllCode (ICD-10 CA) (Slice) |
Note A The AllergyIntoleranceSubstanceConditionUvIps value set put forth in IPS-UV was not included in the table above because it is made up of SNOMED CT values are included in the SNOMED CT-CA slice
Note B This guide previously socialized GPS terminology alongside IPS SNOMED CT CA slices to align to earlier versions of IPS. IPS has since moved away from the use of GPS for the purposes of clearly recommending the IPS SNOMED Free Set which was developed and maintained for international use. In places where the IPS Free Set conflicts or is subsumed by the SNOMED CT CA slice - it has been removed
Note C The MedicineActiveSubstancesUvIps value set put forth in IPS-UV was not included in the table above because it is made up of SNOMED CT values are included in the SNOMED CT-CA slice
Note D The AbsentOrUnknownMedicationUvIps value set put forth in IPS-UV is carried over on MedicationCodeableConcept for alignment purposes. Because the IPS-UV value set on this slice is extensible, it can be used to supply other medication codes when only a simple code is available (e.g., a medication resource is not possible). See list of value sets used for medication.code
Note E The ProceduresSnomedCtUvIps value set put forth in IPS-UV was not included in the table above because it is made up of SNOMED CT values are included in the SNOMED CT-CA CTCA slice
Code Systems
The following code systems were developed in the PS-CA Implementation Guide:
Additional Terminology Resources
Concept Maps
Implementers are encouraged to review the ConceptMaps defined in the IPS-UV Implementation Guide: