Project Background

Virtual Care Project Background

The acceleration in the use of virtual care and digital health tools has created a new urgency to address several common barriers to effective digital health, including:

  • Siloed information and a lack of interoperability, including lack of semantic interoperability as many EMR systems do not encode clinical data elements, which will be a major gap when transitioning towards international vocabulary standards
  • Constrained values (value sets) that are challenging for clinicians, voiced by jurisdictions and vendors
  • Aging and disconnected digital health systems and infrastructures that cannot easily communicate with one another
  • Messaging solutions that are not integrated into provider systems or workflows and are not user-friendly

Virtualization of care has heightened the need for safe and efficient electronic communication, collaboration and sharing of information across the circle of care. The COVID-19 pandemic has accentuated the importance of interoperability.

In support of provinces and territories, Canada Health Infoway is facilitating a national collaborative effort to advance interoperability in two priority areas identified through extensive consultations:

  • Secure sharing of patient summaries across different solutions to support transitions of care and cross-jurisdictional patient flows
  • Secure messaging between solutions to enable safer and more efficient collaboration across the circle of care (e.g., provider to provider secure electronic communication)

Virtual Care Project Objective

Collaborative development of implementable standards and specifications will achieve the following business objectives:

  • Savings in time and effort by conducting a pan-Canadian process, as opposed to multiple provinces and territories conducting similar individual efforts concurrently
  • Increased interest and engagement from vendors to collaborate and embrace harmonized, pan-Canadian specifications, as opposed to proceeding with proprietary or jurisdictional specifications
  • Creation of the pre-conditions for accelerated and cost-effective implementation, conformance and adoption of requirements across all Canadian jurisdictions (although, wide-scale implementation is beyond the scope of this initiative due to time and funding constraints)
  • Improved access to information, tools, and services, resulting in healthier Canadians; and
  • Improved workflow for clinicians

Patient Summary Workstream

The Patient Summary workstream will focus on the interoperability challenge of sharing patient summaries across different solutions using the International Patient Summary (IPS) as the base standard, to support transitions of care and cross-jurisdictional patient flows.

Infoway is currently developing, reviewing, and publishing the following artefacts as part of the Pan-Canadian Patient Summary Interoperability Specifications :

  • Pan-Canadian Patient Summary Interoperability Specifications
  • Pan-Canadian Patient Summary - Companion Guide to Use Cases & Definitions
  • Pan-Canadian Patient Summary - Companion Guide to Reference Architecture
  • Pan-Canadian Patient Summary – FHIR Implementation Guide (this guide)

For additional information, please email standards@infoway-inforoute.ca.

Patient Summary Background & Progress

  • Information Collection & Discovery Period: Jurisdictional Patient Summary Use cases and Business requirements were shared to Infoway by jurisdictional leads. Data Dictionaries/Minimum Data Sets (MDS) were also collected from participating jurisdictions and organizations (e.g., CIHI).

  • Baseline Pan-Canadian Use Cases, Business Requirements and MDS: Pan-Canadian Use Cases, Business Requirements and MDS were identified by Infoway based on jurisdictional alignment to allow jurisdictions and vendors in Canada to implement and share Patient Summaries aligned with local needs and priorities. These artefacts served as the baseline to guide the development of profiles of the HL7® FHIR® standard.

  • HL7 FHIR Profiles: General Principles and Design Guidelines for the HL7 FHIR Profiles, along with the Profiling Conventions and Approach were drafted and approved by the Pan-Canadian Interoperability Coordinating Table to guide the development of the Pan-Canadian Patient Summary Specification. In order to standardize the Pan-Canadian Patient Summary Specification as the minimum data set to be used at a pan-Canadian level; syntactic and semantic interoperability will be achieved over time, by leveraging existing IPS-UV HL7 FHIR and CA Baseline profiles, with a multi-year roadmap for full HL7 FHIR capabilities was developed with specific priorities in scope for Version 1.0 and Version 2.0.

    For more information on the alignment of the PS-CA Profiles with the International Patient Summary (IPS-UV) and other pan-Canadian Specifications (CA-Baseline), along with the scope of coverage for Version 1.0 (e.g., data domains and cardinality constraints) please refer to the General Principles and Design page.

  • Feedback, Review & Collaboration: Once the Patient Summary-CA Specification is developed, Infoway will publish the artefacts and collaborate with co-developers, including jurisdictions, technical SMEs, vendors, organizations and broader stakeholder community to develop and refine the HL7 FHIR Profiles for Patient Summaries by collecting feedback into the artefacts during engagement workshops and testing sessions (e.g., Table Top Testing). In the event that misalignments are identified, issues be brought to the Coordinating Table to find a mitigation or resolution that can work for all. In the event that a decision cannot be made at the Coordinating Table, the table will raise the decision to the Executive Table.

  • Recommendation & Approval: Once the artefacts have gone through review and collaboration stages, they will be shared here.

  • Continuous Iteration: The HL7 FHIR Profiles will continue to go through rounds of iteration and refinement as per testing events, and based on jurisdictional and vendor priority evolution the interoperability roadmap (e.g., Version 2.0, etc.).