DFT - The specification is currently in development and subject to change. For a full list of available versions, see the Directory of published versions

Extensions

Extensions Defined in This Guide

These define extensions to FHIR resources created for use within the Resource Profiles defined in this guide. There may be additional extensions used from external sources such as the HL7 Extension Registry which are referenced in CA:eReC Resource Profiles

Extension	Description	Related Profile(s)
Appointment Virtual Service	The extension is used to represent the Appointment R5 virtual service element which is of the new type VirtualServiceDetail.	Appointment (CA:eReC): Appointment.extension
BusinessStatusReason	The extension provides a reason for why the business status is as it is.	Task (CA:eReC): Task.businessStatus.extension
Communication Barrier	The extension is required to identify if the patient speaks/understands an official language (English/French), or if she/he does not an interpreter is required.	Patient (CA:eReC): Patient.extension
CopiedParticipants	The extension is used to copy updates to the ServiceRequest in cases of forwarding referrals.	ServiceRequest (CA:eReC): ServiceRequest.extension
DARC	The extension is required to identify the dates affecting a patient's readiness to consult.	ServiceRequest (CA:eReC): ServiceRequest.extension
DART	The extension is required to identify the dates affecting a patient's readiness to treat.	ServiceRequest (CA:eReC): ServiceRequest.extension
HealthCardNumberVersionCode	An assigned sequence code, uniquely identifying a Health Card issued (or potentially issued) to a Registered Person	Patient (CA:eReC): Patient.identifier.extension
PatientNeedsToBeSeen	A boolean value (True or False) indicating if a patient needs to be seen, when a Performer (Specialist) responds to a consult request suggesting an eReferral.	Task (CA:eReC): Task.extension
PatientPresentLocation	Extension is used to communicate the present location of the patient if it is different than the patient's home address.	ServiceRequest (CA:eReC): ServiceRequest.extension
PerformerIdentifier	This extension allows additional identifiers to be included under ServiceRequest.performer.	ServiceRequest (CA:eReC): ServiceRequest.performer.extension
RoutingOptions	This is an extension required for Referral Source Type identification. Only one referral routing object expected.	MessageHeader (CA:eReC): MessageHeader.extension ServiceRequest (CA:eReC): ServiceRequest.extension
ServiceProviderPreference	Indicates preferences related to provider and service location.	ServiceRequest (CA:eReC): ServiceRequest.extension
ServiceRequesterDelegate	Identifies the person or provider that is a delegate for a service request.	ServiceRequest (CA:eReC): ServiceRequest.requester.extension

Note: Extensions applied to the HealthcareService payload (e.g., AccessInstructions, DeliveryMethod, Facet, IsPrimary, Media, UsageLicense) have not been included in this version of the guide. Future versions may expand the guidance related to interacting with endpoints and payloads for HealthcareService information (either as a section in this guide or through a separate guide). In the meantime, implementers in need of further guidance on the HealthcareService characteristics and design practices should refer to the HealthcareService Directories Section under the Business Rules page the Ontario eServices v0.11.1 Guide.

Extensions Defined Externally

These define extensions to FHIR resources created for use within the Resource Profiles defined in this guide.

Gender, Birth Sex, & Gender Identity Business Rules

Patient.gender is to be used to specify the observed patient gender at the time of the referral (regardless of the gender presentation at birth). This is also referred to as "administrative gender", which is the gender that the patient is considered to have for administration and record keeping purposes. This property is often used as an input to patient matching algorithms.

Due to its importance in patient matching algorithms, gender is a must support element, although it is not mandatory (0..1) on the profile. In the case where a referral does not need to know gender, set "Patient.gender" = "unknown". If sending an administrative gender that is not in the value set (e.g. "X" non-binary), that MAY be sent as "Other" with an appropriate extension sent with the proper value.​

Note that the FHIR Patient resource documentation discusses patient.gender in depth.

Regarding more detailed tracking of gender identity there are ongoing discussions in the standards community, this implementation guide is waiting on a community consensus. The HL7 Gender Harmony IG project provides in-depth guidance on recording sex and gender. If more detailed gender values are required, an implementer may consider using the FHIR individual-genderIdentity extension. To specify birth sex, consider using the US Core birthSex extension or the CIHI IRRS FHIR Implementation Guide.