Ontario eReferral - eConsult HL7® FHIR® Implementation Guide

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Scope

This Ontario eReferral - eConsult FHIR Implementation Guide supports referral patterns for various pathways such as an EMR integration with a Regional Home to Community Care Solution, Primary Care to Home and Community Care, Acute Care, Consultation Requests (eConsult) etc. It describes the business considerations and implementation details for enabling interoperability with referral management systems to initiate and manage an electronic referral request.

Three integration methods are defined in this release of the implementation guide that should facilitate a range of different referral processes and software applications with different capabilities:

(1) A SMART integration that allows a Referral Management System (RMS) to be directly launched from clinician’s Point of Service (POS) system to enable users to create an eReferral and eConsult request;

(2) A Direct Messaging integration that allows two RMS to exchange referral/consult messages (e.g., initial eReferral request, appointment updates, communications and notifications), and/or a single RMS to contribute information to an analytics repository, all via FHIR-based API interfaces; and

(3) A RESTful API integration that enables RMS systems to conduct search and read interactions, export operations to support retrieval of information from other systems.

Out of scope

At this time, the implementation guide does not cover:

Integration with Ontario digital health assets such as Provincial Client Registry
Semantically interoperable eReferral form templates and/or content
System and/or user authorization and authentication
Wait time calculations
The ability to forward referrals

Applying the Ontario eReferral - eConsult HL7 FHIR IG

Ontario Health will be establishing the Ontario eReferral - eConsult HL7 FHIR IG as an interoperability specification under Ontario’s Digital Health Information Exchange (DHIEX) framework.

The following information is provided in accordance with section 28 of O. Reg. 329/04 made under the Personal Health Information Protection Act (PHIPA), 2004.

DHIEX Requirement	eReferral eConsult Interoperability Specification
Date on which the specification becomes effective:	N/A as proceeding as Balloted Draft status
Name, description, or class of Health Information Custodians that must select, develop, or use digital health assets that comply with the specification:	A health care practitioner or a person who operates a group practice of health care practitioners. A health service provider or person or entity that is part of an Ontario Health Team and that provides a home and community care service pursuant to funding under section 21 of the Connecting Care Act, 2019, including a person or entity from whom the provider or Team has purchased the home and community care service. A person who operates one of the following facilities, programs or services: A hospital within the meaning of the Public Hospitals Act, a private hospital within the meaning of the Private Hospitals Act, a psychiatric facility within the meaning of the Mental Health Act or an integrated community health services centre within the meaning of the Integrated Community Health Services Centres Act, 2023. A long-term care home within the meaning of the Fixing Long-Term Care Act, 2021, a placement co-ordinator described in subsection 47 (1) of that Act, or a care home within the meaning of the Residential Tenancies Act, 2006. A centre, program or service for community health or mental health whose primary purpose is the provision of health care.
Types of digital health assets to which the specification applies:	eReferrals: Any RMS product from vendors listed as an Ontario Health Vendor of Record, used by the above classes of Health Information Custodians, for the purposes of sending and receiving eReferrals. eConsults: OTNHub and any OntarioMD-certified EMR used by the above classes of Health Information Custodians for the purposes of sending eConsults.
Circumstances, if any, when a Health Information Custodian may be exempted from the requirement to select, develop or use digital health assets that comply with the specification:	Hospitals that choose to directly integrate with the PCCG will be exempt from this requirement, as their eReferral messaging will be processed by the PCCG through an integration engine. Hospitals that choose to employ a vendor RMS solution to send and receive eReferrals instead of direct integration will be subject to the eReC interoperability specification.