Home > Introduction


This Ontario eReferral FHIR Implementation Guide (IG) was written to support implementers of systems that will use HL7 FHIR to support the electronic transfer of information when patients are referred from one healthare service provider to another in the province of Ontario.


Clinicians in Ontario need to be able to refer patients to the care they need, anywhere in the province in a fair and consistent manner. Current paper based referrals and disconnected electronic systems are a significant barrier to this.

Electronic Referral (eReferral) simplifies the referral process by enhancing communication between primary care providers, specialists and other healthcare service providers enabling quick and secure referrals to be sent, received and managed through an electronic platform.

Content and Organization

The implementation guide is organized into the following sections:


This FHIR eReferral implementation guide is a work product of the Canadian eReferral FHIR workstream. This workstream is composed of a dedicated group of Canadian stakeholders and technology vendors who have met regularly since 2016 with the objective of establishing a vendor independent, standards-based system integration to support seamless electronic referrals and consultations between care providers that improves patient care - both experience and outcomes - and reduces administrative burden for providers.

Implementation Guide Contributors include:

  • Co-Chair: Tim Berezny (Caredove)
  • Co-Chair: Caryn Harris (Orion Health)
  • Alfred Wong (Think Research)
  • Amadou Tall (Strata Health Solutions)
  • Cindy Jiang (Ontario Health)
  • Dustin Doan (CognisantMD)
  • Fariba Behzadi (Ontario Health)
  • Ion Moraru (Ontario Health)
  • Janice Spence (Ontario Health)
  • Jeff Kavanagh (CognisantMD)
  • John Wills (eServices Program, eHealth Centre of Excellence)
  • Jon Fishbein (CognisantMD)
  • Leke Akinyele (Think Research)
  • Matt Atwood (Novari Health)
  • Radhika Verma (Ontario Health)
  • Russ Buchanan (Gevity Consulting)
  • Ted Jin (Ontario Health)
  • Yaron Derman (CognisantMD)

This specification is fully copyright protected by the owner. The owner has the exclusive right to make copies of this specification. No alterations, deletions or substitutions may be made without the prior written consent of the owner. No part of it may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, email or any information storage and retrieval system, without the prior written consent of the owner.

This specification contains information for which copyright is held by Health Level Seven, Inc. Implementors of the standards (those developing software or otherwise making use of the specification) are required to be members of either Health Level Seven Inc., HL7 Canada or one of the other HL7 affiliates. There is no such membership requirement for individuals and organizations which merely install or use software with built-in HL7 interfaces.

HL7® and FHIR® are registered trademarks of Health Level Seven, Inc. (https://www.hl7.org).

LOINC® is a registered trademark of the Regenstrief Institute, Inc. (http://regenstrief.org)

This material includes SNOMED Clinical Terms® (SNOMED CT®) (https://www.snomed.org/snomed-ct/) which is used by permission SNOMED International. All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists.

“SNOMED” and “SNOMED CT” are registered trademarks of SNOMED International (https://www.snomed.org/).


This specification contains proprietary and confidential information . This specification is offered to you on the condition that you accept these terms and conditions without modification. Any dissemination or distribution of this specification or any copies thereof to any third party without Ontario Health's prior written consent is strictly prohibited.

We have prepared this specification for its own use and provides it to you for information purposes only. You understand that the information in this specification may be subject to change at any time and that Ontario Health cannot be responsible for the completeness, currency, accuracy or applicability of this specification, or any information contained in it, to your needs or the needs of any other party. You understand and agree that:

(i) you are solely responsible for determining whether any information in this specification is applicable to your needs;

(ii) any access, use or reliance on any information in this specification is at your sole and exclusive risk;

(iii) this specification is provided “AS IS” without any warranties or representations of any kind, express or implied, in fact or in law;

(iv) Ontario Health is not responsible for your use or reliance on the information in this specification or any costs associated with such use or reliance; and

(v) Ontario Health has no liability to any party for that party’s access, use or reliance on this specification or any of the information contained in it.