CA Core+

DFT-Ballot - The specification is a DFT-Ballot version of CA Core+ for collecting ballot feedback. 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 use, capture, and exchange across diverse care settings.
CA Core+ translates the Canadian Core Data for Interoperability (CACDI) and Logical Data Model (LDM) components of the PCHDCF 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 Logical Data Model (LDM) and the Canadian Core Data for Interoperability (CACDI) , which together define core data elements critical for cross-jurisdictional exchange.
The 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, LDM 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 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 CACDI elements and LDM constraints to FHIR elements and 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 draft release of CA Core+ (v1.2.0 DFT-Ballot) 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

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
Clinical decision support
Other workflows requiring identifiable information
Digital Health Innovation

Use of Identifiable Information in CA Core+

CA Core+ is designed for use cases that require identifiable information.
This implementation guide includes identifying elements such as Patient.name (which is required as 1..*) to support clinical, administrative, and operational workflows where identifiable patient information is necessary.

Other resources such as Condition, Observation, and ServiceRequest may also contain identifiable information.

Out-of-Scope Use Cases

Use cases involving anonymous reporting, de-identified datasets, or research workflows that do not require identity are considered out of scope for this guide.

Implementers supporting such use cases should refer to other profiles or guides designed for de-identified or pseudonymized data exchange, where Patient.name, Practitioner.name, and other identifying elements may be optional or excluded entirely.

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.