General Principles and Design

Intent

Develop PS-CA as a nationally localized version of the International Patient Summary (IPS) that supports the cross-border exchange use cases outlined in the International Patient Summary, while also customizing it to include additional pan-Canadian concepts where appropriate so that it might serve as a base for Canadian jurisdictions to begin implementing patient summaries.

High Level Design Principles for the Pan-Canadian Patient Summary (PS-CA)

The following principles were developed and approved by the Pan-Canadian Interoperability Coordinating Table to guide the development of the PS-CA Specification:

  • Be based on a consensus driven, co-design approach with jurisdictions, providers and other key stakeholders
  • Be patient- and provider-centered, with considerations for clinician and patient needs and expectations, and with consideration for the impacts to clinician workflow and clinical processes
  • Promote efficiency for vendors with respect to solution investment and testing, and incorporate vendor community needs
  • Be inclusive and mindful of the change management considerations of the Patient Summary
  • Be based on one data model for national use, that allows for jurisdictional implementation guides which clarify provincial use (e.g., support jurisdictional code/value sets)
  • Consider the four use case scenarios associated with the IPS (scheduled and unscheduled local care; scheduled and unscheduled cross-border care)
  • Be based on iteration to occur over time, in a series of versions
  • Consider the design of extensions (including those planned by jurisdictions) in a manner that enables adoption at the pan-Canadian level

Alignment with the International Patient Summary and Other Pan-Canadian Specifications

The PS-CA FHIR® profile set will be as closely aligned to the HL7® IPS specification as possible in order to allow vendors in Canada to implement patient summaries aligned with local needs. This means that every effort will be made to adopt the international specification and analyze its constraints with practical implementations in mind.

The PS-CA specification attempts to profile in a way that allows the patient summaries (instances) to be conformant to the IPS-UV specification and the Canadian Baseline specification without having to formally derive from the profiles in either specification.

What this means is that instances should be able to conform to the IPS specification (IPS-UV) even if the generating implementation does not fully meet the IPS-UV expectations for being able to generate all optional slices, demonstrate support of all Must Support elements, etc.

In places where profiling of the PS-CA uncovers challenges with the CA Baseline (e.g., CA Baseline requiring an element as Must Support that is not in the PS-CA or IPS-UV) these challenges are noted but should be resolved at the CA Baseline level.

Aligning to Work Underway with Jurisdictions

Some jurisdictions may already be undergoing their work on their own jurisdictional content. Both PS-CA and jurisdictional content should be informed by the same high-level principles from the Pan-Canadian Coordinating Table.

However, jurisdictional content may also include jurisdiction specific implementation content that goes beyond the minimum shared expectations.

In the cases where jurisdictions have begun profiling work, PS-CA should look to what has been done and provide a second line of review to identify any areas that need to be relaxed in the national profile/resolved further.

Jurisdictional Patient Summary Content

Implementers are encouraged to review the additional constraints and localizations published by jurisdictions: