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Revision History

VERSION NO. DATE SUMMARY OF CHANGE CHANGED BY
v0.1 2016-08-18 Initial Draft, based on DHDR v0.3.3 Specification Ontario Health Digital Services
MOHLTC
v0.2 2016-08-23 Updated content for Use Cases, Ontario Health Digital Services Ontario Health Digital Services
v0.3 2016-08-24 Completed content for Use Cases
Formatting Consistency
Ontario Health Digital Services
v0.4 2016-08-29 Formatting Indentation
Table Labels
DHDR Spec Alignment
FHIR Version Alignment
BRD References
FHIR Definitions
Ontario Health Digital Services
MOHLTC
v1.0 2016-09-08 Finalized for Distribution Ontario Health Digital Services
v1.1 2016-10-31 Updated dispense identifier to support NMS data.
Updated examples and data elements’ comments.
Ontario Health Digital Services
MOHLTC
v1.2 2016-11-28 Version change to align w/ terminology worksheet
Change to Consent SDM value to, to reflect DHDR initial release
Ontario Health Digital Services
v1.2.1 2017-04-12 Corrected cardinalities to align with DHDR v0.4 specification:
MedicationDispense.whenHandedOver (1..1)
Medication.code.coding.drugSubclass.display(0..1)
Corrected description for:
MedicationOrder.prescriber: “…individual responsible for prescribing ...”
Corrected comment for:
Practitioner.telecom.system: “ValueSet: “phone” or “fax” only (ValueSet previously defined in wrong row “telecom.value”)
Updated Appendix B to reflect latest revisions; removed Change Log from Appendix B due to outdated content
Ontario Health Digital Services
v2.0.0 2017-06-22 Updated to align with FHIR STU3 (v3.0.1)
Renamed MedicationOrder resource to MedicationRequest
Replaced Contract resource (ConsentDirective profile) with Consent resource
Replaced DUR related extensions with DetectedIssue profiles
Added fax numbers to practitioner and organization
Updated and validated examples
Separated dispense Practitioner profile into separate Prescriber and Dispenser profiles
Additional Details available in Appendix B: DHDR R2 Change Log
Ontario Health Digital Services
MOHLTC
v2.0.1 2017-08-09 Updates in accordance with the dispositions of the comments received during the open review. Ontario Health Digital Services
MOHLTC
v2.0.2 2017-09-28 Changed cardinality of patient & practitioner names for consent unblock from optional to required.
Added a text RelatedPerson relationship element when consent unblock is provided by an extended family member
MOHLTC
v2.0.3 2018-03-16 Updated value set and examples of MedicationDispense.category to distinguish between dispenses of drugs/devices and pharmacy services.
Updated mime format from “json+fhir” & “xml+fhir” to “fhir+json” & “fhir+xml” (FHIR DSTU2 to STU3 change).
Updated sorting syntax from “:desc” qualifier to “-“ prefix (STU3 change).
Updated Patient Id search parameter from patient:patient.identifier to patient.identifier.
Changed whenandedover search parameter to lowercase (the element is still whenHandedOver in the resource).
Added a note that DetectedIssue.implicated is not used in the current release.
Added a note that DetectedIssue.severity (for DetectedIssue-dur-message-nms profile) is not used in the current release.
Relaxed cardinality of MedicationDispense.performer from 1..2 to 0..2 to accommodate dispense records where pharmacy is unknown, e.g. HNS Receipt.
Updated RelatedPerson.relationship.text element to be used for Extended Family or Sibling (previously only Extended Family)
Updated section title for 4.4.3.2 to Patient Demographics Profile, to match the profile name
MOHLTC
v2.0.4 2018-08-10 For Consent, relaxed cardinality of Practitioner.identifier and Organization.name from 1..1 to 0..1 with a note describing when these elements are supposed to be populated.
Added an example of OperationOutcome indicating that some information is presented due to a temporary consent unblock.
MOHLTC
v2.0.5 2018-10-30 Removed Patient Demographics profile: only patient information from the dispense record would be returned (DHDR consumers would get patient demographics information from PCR or from their own database).
Changed the way 3-point validation is performed: gender & date of birth parameters are matched against PCR rather than against historical dispense records.
MOHLTC
v3.0.0 2019-03-29 Updated to FHIR R4.
Updated to address requirements for new data elements.
Added search by POST in addition to GET.
Added “whenprepared” search parameter (and removed “whenhandedover” search parameter).
Replaced references to the Terminology Worksheet with links to Infoway’s Terminology Gateway Value Sets for codes and to the Canadian URI Registry for URIs.
Added “source” extension to meta data to indicate a source of MedicationDispsense.

MedicationDispense profile changes: added mandatory “whenPrepared” (a dispense date), changed cardinality of “whenHandedOver” to optional and changed definition of whenHandedOver to indicate that this is a pickup date rather than a dispense date;
Added “refillsRemaining” & “quantityRemaining” extensions;
Updated “identifier” to contain the Current Rx number;
Added optional “unit”, “system” & “code” sub-elements to “quantity” for records that have this information;
Added “dosageInstruction” element with sub-elements for: Dosage Specification, Patient Dosage Instruction, Frequency, PRN (asNeeded) Indicator, Administrable Route, Administrable Dose.

Medication profile changes:
Added an option of using CCDD terminology in addition to DIN/PIN codes;
Added an optional coded drug dosage form in addition to the textual one for records that have coded information,
Added compound-indicator extension.

MedicationRequest profile changes:
Added original Rx “identifier” to replace the “identifier” definition from the previous version;
Added an option of having SNOMED CT “reasonCode” codes from the Canadian “indication for use” value set in addition to ODB reason codes for limited use drugs.

OperationOutcome profile changes: Added “expression” element, deprecated “location” element.

Removed DUR information (DetectedIssue).
Added Bundle.timestamp.
Updated Consent purpose code.
Updated examples.
MOHLTC
v3.0.1 2019-06-11 Corrected previous wording of MedicationRequest profile changes in the change log – “identifier” is not sliced. MOHLTC
v3.0.2 2019-08-26 Updated Ontario logo.
Corrected OperationOutcome search example.
Added Appendix E Integration Traceability.
MOHLTC
v3.0.3 2019-09-12 Corrected severity in OperationOutcome consent block example MOHLTC
v3.0.4 2020-01-08 Replaced Instances of “eHealth Ontario” with “Ontario Health Digital Services”, and “eHO” with “OHDS”
Changed “HL7 FHIR R4 (Dec 2018 Build, v4.0.0)” “HL7 FHIR R4 (First Normative Content, v4.0.1)”
Added “EMPI” to Acronyms table
Replace instances of “eHealth Ontario Gateway” with “Ontario Health Provider Gateway”, and “eHO Gateway” with “OH Provider Gateway”
Changed refills remaining and quantity remaining extensions to the [base-structure] namespace, as all other extensions are defined, i.e. http://ehealthontario.ca/fhir/StructureDefinition
Add Example with Contained Resources in appendix
Change value set for route of administration
MOHLTC
v3.0.5 2020-02-11 Changed DHDR extensions namespace for quantity and refill remaining to “[base-structure]/ca-on-medications-ext-quantity-remaining and “[base-structure]/ca-on-medications-ext-refills-remaining”for consistency
Minor Edits to the fill contained resource example
POST search – removed query string parameters from URL definition to help ensure personal health information is not captured in logs
MOH
v3.0.6 2020-02-12 The following changes have been made to support the implementation of the Provincial Consent Override Interface (PCOI) by Ontario Health Digital Services (OHDS). PCOI documentation will be available by contacting OHDS (architecture@ehealthontario.on.ca):
Updated Use Care Diagram to include PCOI Viewlet
Updated Temporary Consent Unblock Use Case to reference the Ontario Health Provincial Consent Override User Interface
Updated acronyms to add “PCOI”
Updated Figure 4 to include PCOI Viewlet
Updated Use Case Category: Temporary Consent Unblock to include PCOI Viewlet flow
Updated resource list to reflect use of PCOI Viewlet
Removed Consent interaction from Summary of Supported Operations
Updated "Create Temporary Consent Unblock" to reference PCOI Viewlet documentation.
Updated list of resources and profiles: FHIR Resources to reflect use of PCOI Viewlet
Removed Consent Profiles
Removed Consent Operation Examples
Removed Response Codes related to Consent operation
Updated extension titles to match extension names
Replaced instances of “MOHLTC” with “MOH”
Changed [id-system-local-base] to http://ehealthontario.ca/fhir/NamingSystem
Changed [id-system-global-base] to https://fhir.infoway-inforoute.ca/NamingSystem
OHDS
v3.0.7 2020-05-11 Fix documentation error extension URIs (Refills Remaining, Quantity Remaining) OHDS
v3.0.8 2020-11-04 Added a table that contains a mapping of the DHDR data elements to the FHIR resources MOHLTC
v4.0.0 2023-03-31 Added MedicationDispense Submit and Update operation
Added MedicationAdministration Search, Read, Submit and Update operations
Added PractitionerRole resource to MedicationDispense Search and Read Operations
Changed [code-system-local-base] to http://ehealthontario.ca/fhir/CodeSystem

MedicationDispense profile changes:
Added Paid By extension
Added identifier "Original RX Number"
Changed MedicationDispense.performer:performerOrganization.actor.reference and MedicationDispense.performer:performerPractitioner.actor.reference to MedicationDispense.performer.actor.reference "practitionerRole" resource
Relaxed cardinality of MedicationDispense.quantity from 1..1 to 0..1
Constrained cardinality of MedicationDispense.dosageInstruction.doseAndRate.dose[x] from 0..1 to 1..1

Medication profile changes:
Removed Medication Strength extension
Added Monitored Drug extension
Added CCDD and HC-NPN terminology for medication code
Removed PINs local/global, drug class and drug subclass terminology
Added medication.ingredient for compound medication
Added medication.code.text element
Removed medication.form element

MedicationRequest profile changes:
Removed ODB reason codes terminology
Relaxed cardinality of reasonCode from 0..1 to 0..5
Added medicationRequest.reasonCode.text element

Patient profile changes:
Added patient.address and patient.telecom elements
Added patient.identifier.type element
Removed slice from patient.identifier
Constrained patient.name cardinality from 0..1 to 1..1

Organization profile changes:
Added organization.address element

PractitionerDispenser/Administrator profile changes:
Constrained practitioner.name cardinality from 0..1 to 1..1
Ontario Health
v4.0.1 2024-01-24 Replaced contained model with discrete model
Added Composition and Bundle (Document) resouces
Replaced MedicationDispense Submit and MedicationAdministration Submit operations with Submit Medication Document Bundle operation
Replaced MedicationDispense Read/Search and MedicationAdministration Read/Search operations with Search Medication Document Bundle operation
Added "composition.type" search parameter
Removed phone number from Practitioner profile and added to the PractitionerRole profile
Renamed PaidBy extension to DrugServiceCoverage
Updated Expected Behavior table
Added new error codes
Relaxed cardinality of medicationRequest.dosageInstruction.text from 1..1 to 0..1
Relaxed cardinality of MedicationRequest.repeat.timing from 1..1 to 0..1
Changed OCP college URL from https://simplifier.net/canadianuriregistry/ca-on-pharmacy-id-ocp tohttps://fhir.infoway-inforoute.ca/NamingSystem/ca-on-license-pharmacist-org
Added references to practitioner and organization profiles in addition to practitionerRole in MedicationAdministration and MedicationRequest profiles
Added doseRange element to MedicationRequest and MedicationRequest (Submission) profiles
Updated composition.patient.birthDate search parameter to composition.patient.birthdate
Updated [base] URI to [base-submit] and [base-search]
Ontario Health