CA Core+ 1.0.0 DFT-preBallot

Draft preBallot - This specification is under preBallot review and subject to change. It should not be used for implementation purposes. . . . . For a full list of available versions, see the Directory of published versions

Business Context

The CA Core+ Implementation Guide (IG) is a foundational specification aimed at advancing interoperability and standardizing data exchange across Canada’s healthcare ecosystem. This IG is informed by the ongoing development of the pan-Canadian Health Data Content Framework (pCHDCF), a collaborative initiative defining person-centric health data expectations for use, capture, and exchange at a pan-Canadian scale.

CA Core+ is a harmonization effort that integrates existing production pan-Canadian and jurisdictional product-specific specifications, ensuring a consistent and scalable interoperability framework. It is designed to provide reusable, high-quality, and standardized data structures that facilitate interoperability across healthcare systems and jurisdictions in Canada.

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In this section:

Key Drivers and Rationale

Alignment with the Pan-Canadian Health Data Content Framework (pCHDCF)

The pCHDCF provides a structured, comprehensive, and inclusive set of data elements to enable standardized health data exchange across diverse care settings.
CA Core+ translates pCHDCF elements into FHIR artifacts, ensuring they are machine-readable and actionable.
The guide enables iterative refinement in response to evolving jurisdictional needs and FHIR interoperability advancements.

The Relationship to PCHDCF section details how pCHDCF and CA Core+ interact.

Incorporation of the pCHDCF Logical Data Model (LDM) and Canadian Core Data for Interoperability (CACDI)

CA Core+ integrates content from the pCHDCF Logical Data Model (LDM) and the Canadian Core Data for Interoperability (CACDI), which together define core data elements critical for cross-jurisdictional exchange.
The pCHDCF LDM provides a logical structure for organizing health data, ensuring consistency across multiple implementations.
CACDI is a structured subset of the pCHDCF that focuses on core data elements necessary for interoperability.
These elements are translated into FHIR profiles, ensuring consistency, reuse, and conformance with FHIR best practices.
The full list of profiles and their descriptions can be found on the Artifact Status Summary page. For a detailed view of the resources in this implementation guide visit the FHIR Artifacts page.

Harmonization with Existing and Emerging Standards

Many existing jurisdictional FHIR implementation guides and specifications were developed before the formalization of pCHDCF and CACDI.
To bridge this gap, CA Core+ employs a collaborative engagement model that:
- Ensures alignment with both pan-Canadian standards and real-world implementations.
- Supports an iterative development approach, allowing technical input from implementers to refine CA Core+ and influence upstream pCHDCF LDM and CACDI content.

Collaboration and Harmonization Strategy

Gap Analysis

To accelerate the development of this version of CA Core+ and its adoption, existing Canadian production specifications were referenced. A structured approach involving gap analysis and iterative profile development with jurisdictions was undertaken to establish an initial draft that can be leveraged and improved upon.

To ensure alignment between existing implementations and pan-Canadian priorities, a Gap Analysis was conducted to assess:

Existing pan-Canadian FHIR specifications and profiles (e.g., PS-CA, CA:eReC)
The mapping of pCHDCF LDM and CACDI elements to FHIR and identification of constraints
Real-world implementations across jurisdictions, ensuring compatibility with jurisdictional FHIR IGs

This analysis surfaced key areas for harmonization, including:

Priority data elements for interoperability
Terminology binding inconsistencies
Cardinality mismatches and constraints (e.g., Must Support, required vs. optional elements)

Iterative Profile Development and Bi-Directional Alignment

Rather than waiting for the finalization of pan-Canadian information models, CA Core+ is developed concurrently with pCHDCF LDM and CACDI to:

Allow early implementer engagement with emerging pan-Canadian standards
Ensure that feedback from real-world implementations informs both CA Core+ and pCHDCF LDM and CACDI refinements

This approach fosters a bi-directional synchronization process, where:

Feedback on CA Core+ informs pCHDCF LDM and CACDI refinements
pCHDCF LDM and CACDI updates guide ongoing profile enhancements in CA Core+

Scope and Target Use Cases

Scope of This Version

This early draft release of CA Core+ (v1.0.0 DFT-preBallot) delivers a focused subset of reusable FHIR profiles and workflow modules grounded in the pan-Canadian Health Data Content Framework (pCHDCF) and aligned with the Logical Data Model (LDM) and the Canadian Core for Data Interoperability (CACDI) dataset.

The initial scope prioritizes foundational, person-centric health data and common patterns of data exchange that support broad reuse across jurisdictional and domain-specific implementation guides. Profiles included in this release were selected based on:

Preliminary jurisdictional and stakeholder feedback
Gaps identified through implementation alignment reviews
High-priority use cases such as referrals, summaries, and provider directories

Note: While pCHDCF LDM and CACDI refer broadly to "person"-level concepts, this version of CA Core+ focuses on the FHIR Patient resource. A dedicated Person resource profile will be considered in future iterations for registry, EMR, and billing system applications. An immature Person (CA-Core) Profile has been included as a placeholder.

More on versioning this guide can be found in Specification Guidance section, and the differences between versions can be reviewed in the Change Log.

Initial Priority Use Cases

Primary Care, Clinical, and Administrative Data Interoperability
Pan-Canadian Health Application Lightweight Protocol (HALO), which describes use of SMART on FHIR
Digital Health Innovation

Governance and Continuous Improvement of CA Core+

The development and evolution of CA Core+ follows an integrated business process designed to align priorities, accelerate adoption, and ensure consistency across jurisdictions and stakeholders. This structured approach enables collaborative problem-solving and continuous improvement while ensuring that solutions meet both jurisdictional and pan-Canadian needs.

Key Phases of the Business Process

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Intake Request

Collect requests from jurisdictions, vendors, and the community for new initiatives or enhancements to existing projects
Prioritize interoperability challenges that require pan-Canadian standardization

Evaluation and Prioritization

Assess requests based on alignment with pan-Canadian priorities, feasibility, and impact
Shorten time-to-market for high-value initiatives
Accelerate adoption by aligning provincial/territorial (PT) priorities and leveraging existing investments

Pan-Canadian Collaborative Solution & Design

Engage jurisdictions, vendors, and stakeholders to co-develop solutions
Ensure that designs harmonize existing FHIR specifications and meet real-world implementation needs

Collaborative Build

Develop FHIR artifacts, implementation guides, and conformance materials in iterative cycles
Incorporate stakeholder feedback through structured validation and testing

Integrated Go-to-Market Strategy

Support implementation by providing guidance, conformance tools, and training
Facilitate vendor and jurisdictional adoption through targeted engagement and interoperability testing

Objectives of the Integrated Business Process

This approach ensures that CA Core+ remains a practical, scalable, and widely adopted standard. Key objectives include:

Collaboratively Align Federal-Provincial-Territorial (FPT) Priorities
Ensure interoperability efforts support pan-Canadian and jurisdictional health initiatives
Create Awareness and Foster Participation
Engage health IT vendors, jurisdictions, and the community to drive adoption
Promote a shared understanding of FHIR best practices in Canada
Deliver Consistent, High-Quality Solutions
Ensure that FHIR profiles and implementation guidance are consistent, reusable, and well-documented
Accelerate Adoption & Time-to-Market
Streamline the development lifecycle to enable faster deployment of CA Core+ solutions
Leverage existing production implementations to minimize rework and enhance scalability
Enhance Pan-Canadian Interoperability & Conformance
Establish a structured validation process to support adoption across jurisdictions and vendors
Provide guidance on implementation best practices and harmonization strategies

Intent of This Guide

This guide provides an initial structure for surfacing and reviewing early versions of CA Core+ profiles in a way that supports community feedback and technical validation.

Specifically, the guide:

Serves as a collaborative space for gathering jurisdictional and pan-Canadian feedback on constraint patterns, element usage, and terminology alignment
Supports analysis of gap areas between pCHDCF LDM and CACDI expectations and current production profiles used across Canada
Lays the foundation for a broader pan-Canadian conformance strategy, where pan-Canadian and jurisdictional profiles can align on shared artifacts

The profiles presented in this guide are early drafts and not yet finalized. Constraints may evolve in response to:

Stakeholder feedback (see Specification Feedback)
Refinements to the pCHDCF LDM and CACDI datasets
Updates to pan-Canadian priorities and production implementation guides

The guide will continue to expand and stabilize as the CA Core+ specification matures and prepares for future releases.

Versioning Strategy

Current Release

CA Core+ v1.0.0 DFT-preBallot is a draft version intended for:

Transparency on early content alignment with pCHDCF LDM, CACDI, and existing production specifications
Structured stakeholder feedback solicitation
Foundation for conformance testing, review, and harmonization

Future Roadmap

Refinements will be driven by:

Updates to pCHDCF LDM and CACDI
Jurisdictional and vendor feedback
Lessons learned from pilot implementations
Alignment with US Core with pan-Canadian context

CA Core+ is based on HL7® FHIR® Release 4 (R4)

FHIR R4 is the first normative version of the FHIR standard and is widely adopted across health systems in Canada and internationally. By building on FHIR R4, CA Core+ ensures compatibility with existing production implementations while supporting alignment with pan-Canadian and international interoperability initiatives. The use of R4 also facilitates reuse of well-established patterns for resource profiling, terminology binding, and API design.

CA Core+ artifacts—including profiles, value sets, extensions, and capability statements—are all constructed using FHIR R4 as the foundational specification. Implementers are expected to use R4-conformant tooling and servers when working with this guide.

Feedback Loops and Alignment Goals

This engagement model is intended to support a bi-directional synchronization process: as feedback is collected on CA Core+ profiles, corresponding updates may be proposed for CACDI content—and vice versa. This approach supports long-term convergence between FHIR profiles and the broader pCHDCF while enabling flexible, incremental adoption in local contexts.

Ultimately, CA Core+ is not just a translation of CACDI into FHIR—it is a working draft of a shared foundation. Its development is guided by a principle of mutual adaptation where pan-Canadian guidance should reflect implementation realities, and implementations are able to reuse shared structures where feasible. If you have feedback about the specification visit the Specification Feedback page to learn about how you can contribute.