PS-CA:BC Library of Profiles
PS-CA:BC FHIR Implementation Guide has been developed in alignment with the Pan-Canadian Patient Summary Specification (PS-CA v2.0.0 DFT-Ballot) to address the specific needs of British Columbia (BC). This guide serves as a framework for standardizing the exchange of patient summary information across healthcare providers in BC, ensuring seamless integration with the broader Pan-Canadian efforts while incorporating unique provincial requirements.
This implementation guide focuses on providing structured and unstructured content for key sections of a patient summary, enabling healthcare providers to access and share essential patient information in a secure and standardized manner. The BC Clinical Advisory Group (i.e. Doctors of BC group) has determined the sections that are most relevant for patient care in the BC context. These sections reflect the province’s healthcare priorities and practices, and they align with the broader PS-CA framework to ensure consistency across jurisdictions. This release primarily relies on national artifacts, with additional BC-specific notes documented in the IG.
BC Patient Summary Sections (Structured)
The following table lists the sections that are part of the BC Patient Summary, as concluded during the BC Clinical Advisory Group sessions:
| PS-CA:BC Section | FHIR Profiles |
|---|---|
| Subject | Patient (PS-CA) |
| Author | Practitioner-Lab (PS-CA) |
| PractitionerRole-Lab (PS-CA) | |
| Organization-Lab (PS-CA) | |
| Health Record Custodian | Organization-Lab (PS-CA) |
| Allergies & Intolerances | AllergyIntolerance (PS-CA) |
| Conditions | Condition (PS-CA) |
| Immunizations | Immunization (PS-CA) |
| Procedures | Procedure (PS-CA) |
| Medications | Medication (PS-CA) |
| MedicationStatement (PS-CA) | |
| Social History | SHx Observation:Social History (PS-CA) |
Additional Notes:
- The above sections are included as structured content.
- Sections like Advance Directives and Family Member History will be represented as unstructured, free-text entries for Release 1. BC will not be using structured entries for these sections.
Additionally, the BC Clinical Advisory Group requested a free-text section for Current Clinical Concerns in the Patient Summary. This information is not confined to a particular section but is critical for providing a comprehensive view of the patient's clinical status.
As per Infoway's guidance, the Composition.text element in the Composition PS-CA profile allows for capturing human-readable narratives that summarize recent key clinical information. This narrative can include both structured content (e.g., medications, encounters, procedures) and additional general notes, providing relevant context for the receiving provider. This approach ensures a cohesive overview of recent priority concerns, changes in status, treatments and other actions, enhancing clarity for other healthcare providers.
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Bundle
The Bundle (PS-CA) profile represents the constraints the PS-CA project applies to the Bundle resource.
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Composition
The Composition (PS-CA) profile represents the constraints the PS-CA project applies to the Composition resource. A Canadian Patient Summary (PS-CA) document is an electronic health record extract containing essential healthcare information about a subject of care. The IPS-UV Composition profile informs it. Still, it differs primarily in its application of Must Support flags on some sections to allow jurisdictional implementers to have flexibility in which sections systems must support to show conformance to their respective patient summaries.
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Header Section
The Patient (PS-CA) profile represents the constraints applied to the Patient resource by the PS-CA project to represent the minimum expectations for the Patient resource when used in the PS-CA composition profile or in one of the referred resources. The constraints inform it of the Patient (IPS) profile and the Canadian Baseline Patient Profile.Determining which profiles (e.g., practitioner, practitionerRole, organization, device) are used to convey header details (e.g., author, attester, custodian, etc.) is determined by the workflow of the implementing jurisdiction. Readers are encouraged to review the Jurisdictional Context to review the approaches jurisdictions are implementing.
Note: Some elements in the Header section (author, attester, custodian) reference resources that do not currently have appropriate equivalent profiles in the current PS-CA specification; implementers are encouraged to utilize the minimal profiling expectations outlined in the Canadian Baseline profiles in these cases:
Practitioner Lab (PS-CA) Profile
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Immunizations Section
The Immunization (PS-CA) profile represents the constraints applied to the Immunization resource by the PS-CA project to represent an immunization record in the patient summary. It is informed by the constraints of the Immunization (IPS) profile and the Canadian Baseline Immunization Profile to allow for cross-border and cross-jurisdiction sharing of Medication Summary information. It describes the event of a patient being administered a vaccination or a record of vaccination as reported by a patient, a clinician, or another party.
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Medications Section
The Medication (PS-CA) profile represents the constraints applied to the Medication resource by the PS-CA project to represent a medication in the patient summary. It is informed by the constraints of the Medication (IPS) profile and the Canadian Baseline Medication Profile to allow for cross-border and cross-jurisdiction sharing of Medication Summary information.
The MedicationStatement (PS-CA) profile represents the constraints applied to the MedicationStatement resource by the PS-CA project to represent a record of a medication statement in the patient summary. It is informed by the constraints of the Medication Statement (IPS) profile and the Canadian Baseline MedicationStatement Profile to allow for cross-border and cross-jurisdiction sharing of Medication Summary information.
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Problems Section
The Condition (PS-CA) profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the Condition (IPS) profile and the Canadian Baseline Condition Profile to allow for cross-border and cross-jurisdiction sharing of patient conditions. A record of a problem is represented in the patient summary as an instance of the Condition resource constrained by this profile.
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Allergies & Intolerances Section
The AllergyIntolerance (PS-CA) profile represents the constraints applied to the AllergyIntolerance resource by the PS-CA project, which is informed by the constraints of the Allergy Intolerance (IPS) profile and the Canadian Baseline AllergyIntolerance Profile to allow for cross-border and cross-jurisdiction sharing of Allergies and Intolerances. It documents the relevant allergies or intolerances (conditions) for a patient, describing the kind of reaction (e.g., rash, anaphylaxis); preferably the agents that cause it; and optionally the criticality and the certainty of the allergy.
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Procedures Section
The Procedure (PS-CA) profile represents the constraints applied to the Procedure resource by the PS-CA project, which is informed by the constraints of the Procedure (IPS) profile and the Canadian Baseline Procedure Profile to allow for cross-border and cross-jurisdiction sharing of the History of Procedure information.
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Social History Section
The SHx Observation: Social History (PS-CA) profile represents the constraints applied to the Observation resource by the PS-CA project to represent a more generic social history profile used to represent health related lifestyle factors or lifestyle observations in a patient summary. Currently, there is no equivalent IPS UV profile, however there are ISO CEN IPS 17269 requirements for a more generic social history section that were used to inform this profile. This profile is considered a draft version and is informed and created as per the requirements of the first jurisdiction (i.e. Alberta) to pilot its use in patient summary within jurisdictional context. The constraints have been compared against other Social History FHIR profiles in Canada and internationally (US Core, Cyprus Core, Malaysia Core) and share many constraints in common with those profiles but represent the minimum requirements as they are known in Canada today. This profile is expected to be refined further as more jurisdictional requirements are defined and as more is known about use in the international patient summary space.
Research Notes
Potential Data Sources: