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The Ontario eReferral - eConsult FHIR Implementation Guide (IG) was written to support implementers of systems that will use HL7 FHIR to support communication between healthcare practitioners and service providers performing electronic patient referrals and/or electronic consultations in the province of Ontario.

Digital Health Information Exchange (DHIEX)

On January 1, 2021, an amendment to Ontario Regulation 329/04 (“O. Reg. 329/04” or the “regulation”) came into force to establish the DHIEX framework for interoperability specifications, as set out in sections 26 to 34 of the regulation. As a cornerstone of the Ministry of Health’s Digital First for Health Strategy, the DHIEX framework is intended to guide and support adoption of modern interoperability specifications for seamless access to integrated records of personal health information. In accordance with the regulation, Ontario Health is required to, subject to the review and approval of the Minister, establish, maintain and amend interoperability specifications for digital health assets selected, developed or used by health information custodians.

In accordance with O. Reg. 329/04, a health information custodian is required to ensure that every digital health asset that it selects, develops or uses complies with every applicable interoperability specification, as it may be amended from time to time, within the time period set out in the specification. Compliance with this requirement does not relieve a health information custodian of its obligation to comply with the other provisions of PHIPA and its regulations.


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.

Electronic Consult (eConsult) enables primary care providers to consult with specialists across the province in order to receive advice to enhance patient care.

Content and Organization

The implementation guide is organized into the following sections:


This FHIR eReferral - eConsult 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)
  • Alex Reidiboim (Ontario health)
  • Alfred Wong (Think Research)
  • Amadou Tall (Strata Health Solutions)
  • Cindy Jiang (Ontario Health)
  • Dustin Doan (CognisantMD)
  • Fariba Behzadi (Ontario Health)
  • Inderpal Singh (Accenture)
  • 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 (eHealth Centre of Excellence)
  • Sarabjit Singh (Ontario Health)
  • Sue Schneider (Ontario Health)
  • 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/).


Pursuant to O. Reg. 329/04, Ontario Health is required to, subject to the review and approval of the Minister, establish, maintain and amend interoperability specifications. The Minister may direct Ontario Health to establish or amend interoperability specifications, and Ontario Health is required to comply with such direction.

In accordance with O. Reg. 329/04, Ontario Health makes this interoperability specification available to the public by posting it on Ontario Health’s website or by such other means as Ontario Health considers advisable.

You understand and agree that:

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

(ii) 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

(iii) 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.