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Revision History
| VERSION NO. | DATE | SUMMARY OF CHANGE |
|---|---|---|
| v0.9.0 | 10th April 2019 | Original Draft |
| v0.9.1 | 13th June 2019 | Updated the implementation guide to include the Open Review comments and make it suitable for the provincial rollout |
| v0.10.0 | 1st Dec 2019 | Updated the provincial spec to incorporate Home and Community Care Pathway Leveraged tooling support (Forge & Simplifier) to profile resources Updated Terminology page with provincial value sets. |
| v0.10.1 | 20 July 2021 | Updates and clarifications to expected use of messaging, including updates to the MessageEventCode value set (agreed to by eReferral WG on June 22, 2021); Technical corrections to existing FHIR artifacts to enable resource validation, including: - slicing in AllergyIntolerance & all extensions, - fix URIs for references in profiles to match canonicals (vs Simplifier url); Rework implementation guidance, replacing "Method 1", "Method 2" language with separate specification pages for: - Direct Messaging integrations, and - SMART integrations; Added pages with implementation notes for Profiles and messages in the FHIR Artifacts menu; Added CapabilityStatements for key system roles specified in the specification pages to clarify requirements Added MessageDefinition artifacts to show expected use of message events / for reference in CapabilityStatements; Updated examples for resources and added examples |
| v0.11.0 | 29 July 2022 | Updated the implementation guide to incorporate eConsult workflow. The following sections were added/updated: - StructureDefinition: Questionnaire - Specification: RESTful FHIR API Updates to: - Scope - Renamed Acronyms to Glossary and added new terms - Business Context - Use Cases: Added eConsult Use Cases - Business Rules: added eConsult related business rules - Renamed Consumer Responsibility to Data Consumer Responsibility - Technical Backgroud: moved Conventions and FHIR Artifacts to this page - Integration Patterns: added REST related interactions - Direct Messaging: updated flow and state diagrams, added implementer notes for consult integrations - Supporting Workflow: added Use Case #4 - FHIR Artifacts: added links to RESTful Client/Server capability statements, updated message event codes, combined resource profile tables into one single table, added links to new extensions |
| v0.11.1 | February 28 2023 | Updated the IG following the Provincial Open Review, OH Privacy recommendations as well as IPC consultation: - Updated the Copyright section to address that FHIR is licensed under creative commons. - Fixed minor typographical errors - Updated the narrative in the use cases to address patient's consent prior to transmit any PHI data across the referral systems - eReferral Analytics repository use case has been added to the IG - Added hyperlinks for all of the extensions to the page where they are defined - Fixed the broken link on Downloads page - Updated meta.profile of the profiles to reflect the correct version - Added eConsult specific examples to the IG. |
| v0.12.0 | 31 October 2024 | - Changed FHIR resource baseline from base HL7 FHIR R4 to pan-Canadian eReferral/eConsult where possible- Added use cases, FHIR extensions and guidance to support central intake scenarios- Added clarifications, usage notes, etc. relating to retrieving information from the Ontario Provincial Health Services Directory (PHSD)- Added clarifications, usage notes, etc. for file/attachment handling- new discrete FHIR Resources (FamilyMemberHistory, Procedure, and MedicationStatement) as ServiceRequest supportingInfo- Apply ON FHIR profile harmonization decisions- Updated Conceptual Information Architecture Model- specification corrections- changes to improvide clarity and readability |
| v0.12.0-Projectathon | 28 January 2025 | -publication to support pan-Canadian Projectathon with the focus being pan-Canadian alignment |
| v0.12.1 | 25 March 2025 | Post-ON:eReC open review publication- fix typos, broken links, etc.- reduce ON Must Support requirements- updated business rules and usage notes for clarity- use case updates -add support for notify-add-service-record and notify-update-service-record |
| v0.12.2 | 1 May 2025 | - Added extensions to the MessageHeader.source and MessageHeader.destination to support HTTP Header information. |
| v0.12.3 | 23 May 2025 | - Updated consent example; added display to TaskCode and MessageEventCode; updated guidance for inclusion of Condition; add context to use case #3 |
| v0.12.4 | 15 August 2025 | - fix appointment ids in bundles - add .contentReference to Communication profile - add guidance to task.focus indicating how it should point to the consent resource for RMS-T to RMS-S consent updates; update consent bundle diagram; add sample messages to illustrate consent updates from RMS-S and RMS-T - add guidance to AllergyIntolerance when Vendor RMS system doesn’t have codes to support the AllergyIntolerance -add guidance to FamilyMemberHistory when Vendor RMS system doesn’t have codes to support the FamilyMemberHistory - add guidance to MedicationStatement when Vendor RMS system doesn’t have codes to support the MedicationStatement - update ServiceRequest, Appointment, and Task bundle message definition tables to include service-record events - update interaction diagrams to better illustrate implementation-view message flow between RMS-S, PCCG, and RMS-T in routing and splitting scenarios. - add more clarity and guidance with respect to referral routing, chaining, and splitting - add guidance to the QuestionnnaireResponse profile with respect to populating .questionnaire - add guidance to illustrate how to handle messages accepted by a central system but not able to be delivered to downstream systems - corrections to the “use of FHIR Messaging” trigger event table - add business rules regarding Referral Form Retrieval, Customization and Rendering - updated Glossary |
| v0.12.5 TU | 12 Dec 2025 | - add support for Central Waitlist Management integration - fix errors in PCCG sequence diagram - general cleanup |
| v0.12.6 TU | 31 Mar 2026 | - add Binary, BundleDocument, and Composition profiles for supporting the write back of clinical documents in a workflow. These profiles are aligned with other Ontario initiatives (such as Ontario Clinical Report Exchange) for consistency - add "Get File Status" to FHIR Operations - add guidance related to eFax - changes to Questionnaire and QuestionnaireResponse profiles to strengthen the relationship between the two- updated Conceptual Information Architecture diagram - split out Central Intake and PCCG example workflows into their own pages in Technical Specifications - update diagram for UC #6 - Glossary updates - general cleanup |
| v1.0.0 TU-snapshot1 | 30 Jun 2026 | POST DHISC Approval Release - add usage context for Composition and BundleDocument profiles - corrections to Central Intake message flow diagram and event tables - update v0.12.6 TU revision history for clarity |
Differences between v0.10.1 and v0.11.0
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Home | Introduction | - added DHIEX section - eConsult sentence added to background |
| Scope | -Scope – added RESTful API - Out of Scope – removed “Communication with a health services directory to expand the list of services/providers that can be searched” | |
| Glossary | - Renamed to Glossary from Acronyms - Added additional terms | |
| Business Context | Business Model | - Context – added sentence on Electronic Consult - Conceptual Architecture – diagram updated, added provincial digital health assets - Systems – added section on “Provincial Digital Health Assets” - Supporting eReferral Processes – added RESTful FHIR API sentence |
| Use Cases | - Added use cases 4 and 5 for eConsult | |
| Business Rules | - Added section on eConsult Business Events and HealthcareService Directories | |
| Technical Specifications | Technical Background | - Conventions and FHIR Artifacts moved to here |
| Integration Patterns | - Building Blocks: added RESTful Interactions - Workflow Support: added RMS GETs information using RESTful interactions and exchanges event-related information using Direct Messaging | |
| Direct Messaging | - Flow of Information – updated diagram with eConsult flow - Use of FHIR Messaging – updated table to align with flow diagram - Contributions to Repositories for Analytics and Performance Monitoring – added entire section - Diagram: ServiceRequest Message Bundle – diagram updated to include Questionnaire and HealthcareService - State Machines – Requester and Performer diagrams updated with new event codes - Performer State Machine – added workflow event table - Request completed by Requester – entire section added | |
| Specification: RESTful FHIR API | - Entire page added | |
| Supporting Workflow | - Use Case #4: Consultation Request added | |
| FHIR Artifacts | FHIR Artifacts | - Behaviour: Capability Statements – added RESTful Client and RESTful Server - Structures: Resource Profiles - Merged tables into one, added Questionnaire and HealthcareService profile - Structures: Extensions – New extensions added: o AccessInstructions o DART o DARC o CopiedParticipants o DeliveryMethod o Facet o PrimaryType o RoutingOptions o Media o UsageLicense |
| MessageDefinition: ServiceRequest Bundle | - Diagram updated to include Questionnaire and HealthcareService resources | |
| MessageDefinitions: Task Bundle | - Diagram updated to include Communication resource | |
| StructureDefinition: MessageHeader Profile | - Added extension – ContentType, updated usage notes | |
| StructureDefinition: ServiceRequest Profile | - Added extensions: DART, DARC, CopiedParticipants - Added Search Parameters - .reasonCode - updated usage notes | |
| Structure Definition: Task Profile | - Added extension - patientNeedsToBeSeen - Added Task Code - "process-request-consult" | |
| Structure Definition: Communication Profile | - Updated usage notes under .payload.content | |
| Structure Definition: HealthcareService Profile | - New profile added | |
| Structure Definition: Location Profile | - Added extension GeoJSON | |
| Structure Definition: Questionnaire Profile | - New profile added |
Differences between v0.11.0 and v0.11.1
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Business Context | Business Model | - Narratives updated to add clarifications such as indicating that a referral recipient could be either performer or its delegate rather than only performer |
| Use Cases | - The IG has been updated to clarify that if the recipient is not a health information custodian then the family doctor is required to obtain the individual's express consent prior to disclosing any PHI to the other provider - The section headings on the page have been reworded to add eConsult to it |
|
| Business Rules | - Clarification added to the Patient Self Referral section - Updated the link to the US Core Birthsex extension - Reworded the Referral Status & Messaging Paradigm section |
|
| FHIR Artifacts | Usage Notes | Updated meta.profile to reflect the correct version of the profiles |
| FHIR Artifacts | - Added link on this page to navigate to the repository events - Fixed broken links for the sample messages - The FHIRArtifacts, Behaviour: Message Definitions section has been updated with eConsult specific sample bundles |
|
| Message Bundle: ServiceRequest | - Missing label on line from HealthcareService to Location has been added to the diagram - Bundle has been updated with the description of HealthcareService |
|
| Message Bundle: Task | - Diagram has been updated and the linkage between MessageHeader and ServiceRequest has been removed - Fixed broken link for Task & Communication bundle |
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| Structure Definition: ServiceRequest Profile: Search Parameters | - ServiceRequest Search Parameters has been updated with _include & _revinclude examples | |
| Structure Definition: HealthcareService Profile: Notes | - Updated missing URLs and valuesets in the profile | |
| FHIR Artifacts: Structures: Extensions | - Primary type extension has been renamed to 'isPrimary' to avoid data that duplicate with 'type' |
Differences between v0.11.1 and v0.12.0
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Business Context | Business Model | - Conceptual Architecture – diagram updated |
| Use Cases | - Added use cases 6,7 and 8- Added use case specific sequence diagrams | |
| Business Rules | - Added wording around the use of discrete FHIR resources | |
| Technical Specifications | Specification: SMART Integration | - Added note about HALO alignment |
| Specification: RESTful FHIR API | - Added section on file handling | |
| FHIR Artifacts | FHIR Artifacts | - general corrections |
| FHIR Artifacts | - new extension: ServiceProviderPreference- new extension: ServiceRequestDelegate | |
| MessageDefinition: Appointment Bundle | - correction to diagram | |
| MessageDefinition: ServiceRequest Bundle | - correction to event table | |
| MessageDefinition: AllergyIntolerance Profile | - add guidance for recording "no known allergy" | |
| MessageDefinition: Appointment Profile | - set baseline to CA:eReC | |
| MessageDefinition: Bundle Profile | - set baseline to CA:eReC- update .entry cardinality to align with CA:eReC | |
| MessageDefinition: Communication Profile | - set baseline to CA:eReC | |
| MessageDefinition: DocumentReference Profile | - set baseline to CA:eReC- Add attachment/file handling guidance | |
| MessageDefinition: FamilyMemberHistory Profile | - NEW | |
| MessageDefinition: Location Profile | - set baseline to CA:eReC | |
| MessageDefinition: MedicationStatement Profile | - NEW | |
| MessageDefinition: MessageHeader Profile | - set baseline to CA:eReC | |
| MessageDefinition: Organization Profile | - set baseline to CA:eReC- add eConsult usage guidance | |
| MessageDefinition: Patient Profile | - set baseline to CA:eReC- add eConsult usage guidance | |
| MessageDefinition: Practitioner Profile | - set baseline to CA:eReC- bind .qualification to QualifiedCredentialRoleType | |
| MessageDefinition: PractitionerRole Profile | - set baseline to CA:eReC- bind .specialty.coding to QualifiedExpertiseRoleType | |
| MessageDefinition: Procedure Profile | - NEW | |
| MessageDefinition: Questionnaire Profile | - add statement regarding the use of Questionnaire/QuestionnaireResponse | |
| MessageDefinition: QuestionnaireResponse Profile | - set baseline to CA:eReC- add statement regarding the use of Questionnaire/QuestionnaireResponse | |
| MessageDefinition: ServiceRequest Profile | - set baseline to CA:eReC- additional usage notes- new extensions: ServiceProviderPreference, and ServiceRequestDelegate | |
| MessageDefinition: Task Profile | - set baseline to CA:eReC |
Differences between v0.12.0 and v0.12.0-Projectathon
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Business Context | Use Cases | - UC#6 add interaction diagram to show how a RMS Source is notified that their referral was routed, split or chained |
| Technical Specification | Direct Messaging | -Updated trigger event table to include notify-add-service-record and notify-update-service record |
| -correct Focus for updating an appointment | ||
| -add interaction diagram for Branching and/or Chaining Events section | ||
| -update Branching and/or Chaining Events business event table to include notify-add-service-record and notify-update-service-record |
Differences between v0.12.0-Projectathon and v0.12.1
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Home | Scope | - remove "the ability to forward referrals" from the Out of Scope section |
| Business Context | Business Model | - change POS references to PoC |
| Use Cases | - Use Case #1 interaction diagram updates- Use Case #5 update steps- Use Case #6 update interaction diagram- Use Case #6 update steps- Use Case #8 update steps | |
| Business Context | Business Rules | - updated Handling Clinical Resources & Un-profiled Data Elements section- updated HealthcareService Directories section |
| Technical Specification | Direct Messaging | - corrections to trigger event table- updated Referral Forms and Supporting Information section- renamed "Branching and/or Chaining Requests" section to "Routing, Splitting and Chaining Requests" and updated section |
| FHIR Artifacts | FHIR Artifacts | - ALL PROFILES: reduce must support requirements - ALL PROFILES: updated cardinality requirements for .coding and .identifier- corrections to event table- updated bundle and profile examples- removed ReferralIdentifier extension |
| Appointment Bundle | - updated event table - updated ERD | |
| ServiceRequest Bundle | - updated ERD | |
| MessageDefinition: Communication Profile | - add Endpoint to .sender- updated usage notes | |
| MessageDefinition: Appointment Profile | - updated usage notes | |
| MessageDefinition: DcoumentReference Profile | - .content is now 1..1 | |
| MessageDefinition: MessageHeader Profile | - removed ReferralIdentifier extension | |
| MessageDefinition: Practitioner Profile | - updated usage notes | |
| MessageDefinition: Procedure Profile | - removed holdover text in usage section | |
| MessageDefinition: ServiceRequest Profile | - updated usage notes- updated FHIR profile references in .baseOn and .replaces to use ON profile references | |
| MessageDefinition: Task Profile | - updated usage notes | |
| Terminology | Identifiers | - add URI for OHIP Billing Number |
| Terminology | Terminology | - Language: updated code system |
Differences between v0.12.3 and v0.12.4
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Home | Glossary | - add eReC- add PCCG |
| Business Context | Business Rules | - add section for "Referral Form Retrieval, Customization and Rendering" |
| Technical Specifications | Direct Messaging | - corrections to the “use of FHIR Messaging” trigger event table- addition of the "PCCG Message Workflows" section in "Routing, Splitting, and Chaining Request" |
| FHIR Artifacts | FHIR Artifacts | - new Communication payload example "A(n) Connectivity Issue message" - new consent update examples using notify-update-service-request (Consent update from RMS-S using notify-update-service-request), and notify-update-process-request (Consent change from RMS-T using notify-update-process-request) |
| Message Definition:Appointment Bundle | - update bundle diagram | |
| Message Definition:Consent Bundle | - add service-record events to bundle message definition table | |
| Message Definition:ServiceRequest Bundle | - add service-record events to bundle message definition table | |
| Message Definition:Task Bundle | - add service-record events to bundle message definition table | |
| Message Definition: AllergyIntolerance Profile | - add guidance for situations where a vendor RMS system does not have codes to support the AllergyIntolerance | |
| Message Definition: Communication Profile | - add .contentReference - add guidance to illustrate how to handle messages accepted by a central system but not able to be delivered to downstream systems using Communication |
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| Message Definition: FamilyMemberHistory Profile | - add guidance for situations where a vendor RMS system does not have codes to support the FamilyMemberHistory | |
| Message Definition: MedicationStatement Profile | - add guidance for situations where a vendor RMS system does not have codes to support the MedicationStatement | |
| Message Definition: QuestionnaireResponse Profile | - add guidance with respect to populating .questionnaire | |
| Message Definition: Task Profile | - add usage note for .focus to point to Consent in situations where consent updates occur at the RMS-T |
Differences between v0.12.4 and v0.12.5 TU
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Technical Specifications | Specification: Direct Messaging | - add trigger event 'notify-internal-process' - corrections to PCCG Message Workflows diagram |
| FHIR Artifacts | FHIR Artifacts | - add 'notify-internal-process' as an external event in the State Machine diagram |
| Message Definition: Patient Profile | - fix canonical URL for HealthCardNumberVersionCode extension | |
| Message Definition: ServiceRequest Profile | - Add ugage note to ServiceRequest.performer to describe how the base HL7 R4 extension request-performer-order is to be used to indicate a provider has been recommended by Central Waitlist Management | |
| Message Definition: Task Profile | - add MS to Task.focus | |
| Terminology | Terminology | - add concepts related to Central Waitlist Management reouting to ereferral-source-types for use with the RoutingOptions extension - add 'notify-internal-process' to message-event-code |
Differences between v0.12.5 TU and v0.12.6 TU
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Glossary | - updated glossary | |
| Business Context | Business Model | - updated Conceptual Information Architecture diagram |
| Use Cases | - updated diagram for UC #6 | |
| Technical Specifications | Integration Patterns | - add "POS launches RMS Source and receives information via SMART Backend Service" |
| Specification: SMART Integration | - update NOTE TO READER to point to Pan-Canadian HALO Specification | |
| Specification: RESTful FHIR API | - add "Get File Status" | |
| Supporting Workflow | - update Use Case #4: Consultation Request to include pattern related to a RMS receiving information via SMART Backend Service | |
| Example PCCG Message Workflows | - split out content from Direct Messaging into new page | |
| Example Central Intake Message Workflows | - split out content from Direct Messaging into new page- add CI-specific examples flows and event tables | |
| FHIR Artifacts | FHIR Artifacts | New profiles for HALO alignment:- add Binary profile- add BundleDocument profile- add Composition profile |
| StructureDefinition: Binary Profile | - new profile | |
| StructureDefinition: BundleDocument Profile | - new profile | |
| StructureDefinition: Composition Profile | - new profile | |
| StructureDefinition: Questionnaire Profile | - Questionnaire.version is now MS | |
| StructureDefinition: QuestionnaireResponse Profile | - QuestionnaireResponse.questionnaire is now MS | |
| StructureDefinition: Task Profile | - add usage notes for task.meta.tag to show usage for eFax |
Differences between v0.12.6 TU and v1.0.0 TU-snapshot1
| Menu Title | Page Name | Summary of change |
|---|---|---|
| Home | Revision History | - Add additional context to the v0.12.6 revision history. |
| Technical Specifications | Example Central Intake Message Workflows | - Update the Central Intake FHIR Event Workflow for Referral Split Scenario diagram and the associated Business Event table to align with the correct message flows related to appointment creation from RMS-T2. |
| FHIR Artifacts | StructureDefinition: Composition Profile | - Update the general usage notes, as well as the usage notes for .encounter and .custodian. |
| StructureDefinition: BundleDocument Profile | - Update the general usage notes. |