This is the current version of the PS-CA Implementation Guide. Other releases of the PS-CA Implementation Guide may be found at Guides.
IPS
This project leverages the ongoing effort from the IPS project which has an established content and data model informed by FprEN 17269:2019 from CEN/TC 251 which uses both the HL7® CDA and HL7® FHIR® standards.
However, the PS-CA Use Cases and the implementation ecosystem are not identical to IPS. For example, the PS-CA specification has to account for jurisdictional differences in the following: system capabilities, established charting practices, and change management capacity. Notably, the PS-CA also has to account for creation of Canadian patient summaries through provider-generated summaries (as a result of an encounter to provide a snapshot of the patient's health care), as well as machine-generated summaries (created automatically by provincial electronic health records).
As a result, the PS-CA has applied a slightly different approach in implementing the data model from the original IPS project. While the elements within the IPS data model remain the same, the expectations for when and how the elements are implemented require a more nuanced approach.
The Pan-Canadian Patient Summary project leverages an iterative, consensus-driven, version-based approach for publishing specification content. For more information on the development process and roadmap, implementers are encouraged to review PS-CA Specification Preface.
Alignment with the International Patient Summary Global Specification (IPS-UV)
As one of the early national adopters of IPS using FHIR, PS-CA (and its jurisdictional implementation - PS-ON) have worked extensively with the International Patient Summary FHIR working group to ensure the newest release of the IPS-UV specification adequately reflects expectations that are consistent and feasible for early implementers. See Profiling Conventions and Approach.
Part of this effort involved working with IPS-UV to provide more clarity in their mustSupport definitions as well as working with IPS-UV to be more regimented in where MS flags were applied. Over thirty Must Support flags were removed from IPS-UV as part of the efforts to refine it based on implementer feedback.
With these changes, only a handful of elements remain that are marked as Must Support in the IPS-UV that could not be marked as Must Support in PS-CA v1.0.0 TI. These elements are described in the section below and will be considered for tightening of constraints in PS-CA v2.0.0.
Differences between the IPS-UV and PS-CA
Differences between the IPS-UV and PS-CA are largely limited to areas where further localization was required as well as a handful of areas where the PS-CA needed to relax system conformance expectations in the first version to align to "current state" jurisdictional capabilities.
Differences between this IPS-UV August 2022 CI Build profiles and the PS-CA profiles are noted on the respective profiles pages and summarized below.
Must Support Differences
Elements that IPS-UV considers Must Support that are not Must Support in PS-CA v1.0.0 TI:
- CodeableConcept.coding,
- Patient.telecom,
- Patient.address,
- Patient.generalPractitioner,
- AllergyIntolerance.type,
- AllergyIntolerance.reaction.severity,
- Condition.category,
- Condition.severity,
- Medication.ingredient (backbone)
- Medication.ingredient.strength
- MedicationStatement.dosage.timing
- MedicationRequest.dosageInstruction.timing
Terminology Approach Differences
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.
Domain Prioritization Differences
Jurisdictional prioritization of certain domains over others in the initial trial implementation is also a driver of differences between the two specifications.
Given the aggressive timelines of the first phase of the Patient Summary project, and input from detailed consultation with participating jurisdictions, a national FHIR profile set that covers a subset of data domains was recommended for PS-CA version 1.0.0. PS-CA profiles were developed for this subset with the intent of developing the remaining PS-CA profiles in a later release.
This staggered approach has had a significant impact on how constraints are applied to the sections of the PS-CA Composition resource. Notably, IPS-UV applies Must Support flags to all its sections, whereas the PS-CA has only applied Must Support flags to the header section and recommended sections (Medication Summary, Allergies & Intolerances, Problem List, Immunization, History of Procedures) noted in the diagram below.
In order to maintain compliance with the IPS-UV, the PS-CA Composition has maintained the required cardinality on Medication Summary, Allergies & Intolerances, and Problem List sections. However, it provides clear guidance to implementers for what should be included within the section.entry element if:
- for a given patient, no information exists for that section, or
- the implementing system can not produce the section (due to lack of capability, jurisdictional restrictions, etc.).
Domain/Profile Additions
Additionally, to support the emerging needs of jurisdictions to pilot Patient Summary sections that do not have an IPS-UV profile developed for them yet, this guide has developed two new profiles that it will propose to IPS-UV following successful pilots.
The two profiles below were developed to meet the needs of an initial piloting jurisdiction and while they are informed by the modeling of similar international and Canadian profiles, they have not gone through the same number of public review cycles as the other profiles in this specification. For this reason, the status on these profiles is still considered Draft.
- Observation Social History (PS-CA): A higher level parent profile meant to house a broader set of social history observations, and to house coded and non-coded lifestyle risk factors (e.g., alcohol use details, amount of exercise, etc.)
- Family Member History (PS-CA): A profile intended convey details and notes regarding the relevant family member conditions that recorded for a patient.