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Introduction

Background

The Provincial Client Registry (PCR) is a repository that stores demographics and identifiers pertaining to patients who have received health care in Ontario. It enables organizations to uniquely identify patients based on their local or global identifiers (e.g. MRN or HCN) and demographic information. The repository also enables the merging and unmerging of duplicate records from a variety of contributing sources, leading to improved quality of client information across different health care organizations.

The PCR supports eHealth Ontario programs such as identity, access and privacy, the Ontario Laboratory Information System (OLIS), Diagnostic Imaging Common Services, the cardiac care network, Connecting Ontario patient results online, and the Ministry of Health and Long-Term Care's Registered Person Database (Ontario Health Insurance Plan).

Ontario has published the following standards for querying or contributing to the PCR:

• Pan-Canadian HL7 V3 based PCR standard (used for both contribution and querying)

• HL7 V2 based standard (used exclusively for contribution)

• IHE PIX/PDQ based standard (used exclusively for querying)

This specification provides an additional FHIR-based interface for the PCR. It exposes 4 operations:

1. EMPI Patient Match

2. Patient Search

3. Patient Read

4. Patient Identifier Cross-reference - PIXm

Additional sections provides documentation on eHealth Ontario's use of the FHIR standard as well as on how errors are handled across the various types of interactions.

The table below shows what is supported by each of the specifications:

*Active interfaces require the registration system to communicate directly to PCR to check for matching patients, before additional data is collected and written to file. Passive interfaces require downstream systems to perform a merge after data is collected.

Patient read is implemented exactly as described by the HL7 specification (http://hl7.org/fhir/stu3/http.html#read), so no further description is provided here. This specification focuses on the two operations more complex operations:

• The IHE Patient Identifier Cross Referencing for Mobile (PIXm) Integration Profile, enables organizations to find alternate unique identifiers for patients using both local (such as hospital specific MRNs) or global identifications (such as Ontario Health Card Number) using a RESTful paradigm. The eHealth Ontario PCR exposes a constrained version of that interface. Note that although the profile is labeled as 'mobile', it can be implemented on both traditional as well as mobile platforms.

• The draft FHIR Patient EMPI Match operation allows searching for candidate patients by specifying a set of patient characteristics. The Enterprise Master Patient Index (EMPI) - in this case the eHealth Ontario Provincial Client Registry - then performs a probablistic match based on those criteria and returns a list of potential matches, with a score indicating the likelhihood of match.

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