Overview and Maintenance
The section details the terminology that is used in the Messaging Standard. The migration from the CPHA standard to FHIR will impose some changes in terminology (field values); however values will only change when necessary in order to be conformant with the FHIR standard and to ensure that there is synchronization with other FHIR standards within the same domain in Canada.
The FHIR Profiles will identify terminology bindings for data elements that specify a data type of "code" or "codeable concept". For example, the Patient.gender field has a binding to the HL7 value set,called Administrative Gender (http://hl7.org/fhir/ValueSet/administrative-gender)and the link to the value set is found in the profile.
Bindings (found in the profiles) are always to a "value set", which can be made up of values from multiple "code sets". It is the "code system" that is specified in the message. For example, we can create a value set called "PrescriptionMedicinalProduct" that can include values from the DIN, CCDD and NPN code sets. In the message instance, where medication codes are sent, the code is specified along with the code "system" as this combination ensures global uniqueness.
Binding Strengths are an important concept to understand in FHIR. Required bindings do not allow any codes to be added to the code set. The official definitions for Binding Strengths are found here for those interested.
.
Terminology Maintenance Process
Terminology, also known as "vocabulary" or "field value sets" will change from time to time in some cases. A terminology maintenance process will be put into place to ensure that all implementers have access to terminology updates on a timely basis. More common updates will include error codes, service codes and DINs/CCDDs.
It is important to note that terminology can be updated without updating the messaging standard. It will be rare, if ever that a terminology update will trigger a new "version" of the message specification. The "publication" will be updated but the message version will remain unchanged. For example, if an error code is added, there will be an updated specification but it will not cause an update to the message structure and is considered a "non-substantive" change.
This project will not publish DIN updates as Pharmacy vendors are aware of updates to this code set as they are published by the source, Health Canada.
The table below identifies the owner of the code set. Some code sets are owned and managed by PCS FHIR, such as the ones that have been inherited from CPHA3. Others are managed externally by HL7, Canada Health Infoway or other parties such as Health Canada or SNOMED.
Summary of Code Systems - Maintenance Required
| Value Set | FHIR Profile | Binding | Owner | Maintenance Requirements | Code System | Fixed Value? |
Notes |
|---|---|---|---|---|---|---|---|
| Assigning Authorities | Claim.prescriber | Extensible | CPHA | Medium | |||
| Adjudication Category | ClaimResponse.item.adjudication.category | extensible | CPHA | low | http://pharmacyeclaims.ca/FHIR/CodeSystem/adjudication-category-codes | ||
| Alert Codes | Response.detectedIssue.code | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/alert-codes | ||
| Coverage Benefit Type | Coverage | Extensible | CPHA | Low | TBD | No | |
| Daily Totals Response Status | parameter.responseStatus | Required | CPHA | None | |||
| Dispense Type | dispense.type | extensible | HL7 | Low | http://terminology.hl7.org/CodeSystem/v3-ActCode | Yes | |
| Dispense PharmaService codes | Claim.item.detail.code | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/dispense-pharma-service | ||
| Diagnosis Code Systems | Diagnosis Code | Required | CPHA | Low | |||
| Dispensed Quantity Unit | Dispense.quantity, Claim.item.quanti | Extensible | CPHA | low | http://pharmacyeclaims.ca/FHIR/CodeSystem/IE-assigning-authority-protocol | ||
| DUR Codes | DetectedIssue.code | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/DUR-codes | ||
| New/Refill Code | MedicationDispense.type | Extensible | CPHA | Low | |||
| Error Codes | ClaimResponse.error.code | Extensible | CPHA | Medium | |||
| Event Code | MessageHeader.code | Extensible | PCS | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/event-code | ||
| Gender | Patient.gender | Required | HL7 | None | |||
| Intervention & Exception | Claim.item.modifier | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/intervention-codes | ||
| Intervention U Codes | Claim.detectedIssue.Mitigation.code | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/mitigation-codes | ||
| Intervention C Codes | MedicationDispense..notPerformedReason | Extensible | CPHA? | Medium | |||
| Message Version | MessageHeader.meta.tag | Extensible | PCS | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/message-version | ||
| Not Performed Reason Intervention C |
Claim.item.modifier | Extensible | CPHA | Low? | http://pharmacyeclaims.ca/FHIR/CodeSystem/intervention-codes http://pharmacyeclaims.ca/FHIR/CodeSystem/intervention-not-performed-reason |
||
| Level of Service Codes | ? | Extensible | CPHA | Deprecate? | |||
| Medication Codes | Health Canada | Extensible | CPHA External | TBD | |||
| New Refill Code | Claim.type | Extensible | External | Low | http://terminology.hl7.org/CodeSystem/v3-ActCode | ||
| Note Type | tbd | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/note-type | ||
| Note Language | ClaimResponse.processNotes.language | extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/note-language | ||
| OrderableDrugForm | Claim.item.quantity TBD | extensible | Infoway | Low | http://hl7.org/fhir/v3/orderableDrugForm https://fhir.infoway-inforoute.ca/CodeSystem/snomedctcaextension |
||
| Payee type Code | Claim.payee? | Extensible | HL7 | Low | http://terminology.hl7.org/CodeSystem/payeetype | ||
| Provider Software ID | MessageHeader.software | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/provider-software-codes | ||
| Program Type | ClaimResponse - extension | Extensible | CPHA & Adjudicators | Medium | No centralized code system; will be published in PCS | ||
| Prescriber ID Reference | Practitioner.identifier.system | Extensible | Infoway /CPHA |
Low | |||
| Product Selection | Claim.supportingInfo:ProductSelection | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/product-selection | ||
| PriorClaimInterventionCode | Extensible | CPHA | Low | ||||
| Relationship Code | Coverage.relationship | Required | HL7+CPHA | Low | http://terminology.hl7.org/CodeSystem/subscriber-relationship | ||
| Response Codes | ClaimResponse.error and ClaimResponse.item.adjudication: ResponseCodes |
Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/response-codes | ||
| Response Sub-Type | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/claim-response-subType | |||
| Special Service Codes | ? | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/special-service-codes | ||
| Supporting Information Codes | Claim.supportingInformationCategory | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/supporting-info-category-codes | ||
| Claim Response Status | ClaimResponse.decision | Required | CPHA | None | http://pharmacyeclaims.ca/FHIR/CodeSystem/claim-response-status | ||
| Reversal Response Codes | ClaimResponse.? | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/reversal-response-codes | ||
| Unlisted Compound | Claim.item.code | Extensible | CPHA | Medium | http:// pharmacyeclaims.ca/FHIR/CodeSystem/unlisted-compound-codes | ||
| Code System for Response Codes | ClaimResponse.item.adjudication: ResponseCodes.reason.coding.system |
Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/code-system-values-for-response-codes | ||
| Code systems for Intervention Codes | Claim.item.modifier. coding:InterventionCode.system |
Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/Codesystem/code-system-for-intervention-codes | ||
| Claim Response Sub-Type | ClaimResponse.subType | Extensible | CPHA | low | http://pharmacyeclaims.ca/FHIR/CodeSystem/claim-response-subType | ||
| Province Codes | MH.Source.ext.SourceProvinceCode | Required | Infoway | none | http://canadapost.ca/CodeSystem/ProvinceCodes | ||
| Claim Response Outcome Code | ClaimResponse.outcome | Extensible | CPHA | low | TBD | ||
| Software Vendors PCS FHIR | Extensible | CPHA | medium |
Identifier System and Code System Identifiers - Fixed Values
The following identifiers have been created for use within the message specification in order to specify a code system or identifier system. These are "fixed values" that fall within the Pharmacy Claim Standard (pharmacyeclaims.ca) domain. The identifiers must be specified in the message.
No maintenance/changes will be required, though new ones may be added over time as necessary.
| CodeSystem | Usage | Notes |
|---|---|---|
| http://pharmacyeclaims.ca/FHIR/CPHA-identifier/trace-number | Claim.identifier | Required for backward compatibility |
| http://pharmacyeclaims.ca/FHIR/CPHA-identifier/reference-number | ClaimResponse.identifier | backward compatibility |
| http://pharmacyeclaims.ca/FHIR/CPHA-identifier/IIN | MessageHeader.receiver | Required for backward compatibility |
| http://pharmacyeclaims.ca/FHIR/CPHA-diagnosis-ODB-reason-code | Claim.diagnosis.code | Required for consistency and good practice |
| http://pharmacyeclaims.ca/FHIR/CPHA-diagnosis-DND-eligible-medical-conditions | Claim.diagnosis.code | Required for consistency/good practice |
| http://pharmacyeclaims.ca/FHIR/CodeSystem/special-service-codes | Claim.item.modifier | fixed value |
| http://pharmacyeclaims.ca/FHIR/CodeSystem/intervention-codes | Claim.item.modifier | fixed value |
| http://pharmacyeclaims.ca/FHIR/CodeSystem/pharma-service | Claim.item.detail.productOrService.coding.system | fixed value |
| http://pharmacyeclaims.ca/FHIR/CodeSystem/note-language | ClaimResponse.processNote.language.coding.system | Needed this as we need a third value to represent unknown; not available in preferred |
| http://pharmacyeclaims.ca/FHIR/CodeSystem/error-code | ClaimResponse.error.code.coding.system | fixed value |
| http://terminology.hl7.org/CodeSystem/v3-ActCode | MedicationDispense.type | fixed value in the Medication Dispense profile |
Notes
- CPHA Software vendor listing is not included. There is a placeholder for FHIR PCS certified software vendors that will be added and maintained.