Business Context > Business Rules

Business Rules

This section will highlight some key business considerations incorporated into the development of this implementation guide.

Client Identification

Client identifiers are required and used to uniquely identify client records. A Medical Record Number (MRN) is required to be included within MHA PDS Bundle submissions. Ontario Health (OH) will assign system identifiers during the implementation process. An Ontario health card number should be provided when made available. Other provincial/territorial health card numbers are also acceptable.

Organization Identification

Organization identifiers are required to uniquely identify the Health Information Custodian (HIC). The Ontario Healthcare Financial and Statistical (OHFS) Facility ID, and Connex Ontario Organization number SHALL be included in every data submission.

Location Identification

Location identifiers are required to uniquely identify a specific delivery site from where the client is receiving services. The Connex Ontario site number SHALL be included in every data submission.

Functional Centre Codes

Functional Centre Codes are used to identify program information and map to Ontario Healthcare Financial and Statistical (OHFS) information. These codes are to be submitted when a client has received services from a HIC site.

Client Journey and FHIR Bundles

Within the Community Mental Health and Addictions (MHA) sector, data collection occurs at various points throughout the client journey. It is expected that Point of Service (PoS) systems will submit data throughout the client journey. The frequency and timing of submissions are up to the discretion of the PoS system. Each MHA PDS Bundle submission should contain the full snapshot of data at the time of submission. For instance, if an MHA PDS Bundle has been previously submitted for a client, each subsequent submission should contain the new and/or updated data as well as any data that has not changed since the last submission, and not limited to delta changes. This section provides guidance to implementers on how to assemble MHA PDS Bundles for submission and when to include certain FHIR resources.

Minimum Requirements for Data Submission

The minimal requirements for an MHA PDS Bundle are the Patient and Organization resources. When a client has arrived for services, if the PoS system has the following information from the client: first name, last name, MRN and date of birth, they may choose to submit an MHA PDS Bundle.

MHA PDS Bundle (Basic)
  1. Bundle
  2. Patient
  3. Organization

Appointment Resource

The Appointment Resource is only to be included in an MHA PDS Bundle submission if the client has missed their first appointment with a HIC site. The appointment resource is used to capture information pertaining to the appointment reschedule reason. If the client made it to their first appointment, the Appointment Resource should not be included within an MHA PDS Bundle submission. If Appointment resource is part of the referral, the Appointment resource should be included in the reference in the ServiceRequest resource. Otherwise Appointment resource should be included as a reference in the Encounter resource. If neither ServiceRequest nor Encounter resource can be populated, client SHALL submit the Appointment resource and associated EpisodeOfCare resource in the same bundle.

If the client has missed their first appointment with the HIC site, the Appointment resource for the missed appointment should be included in every MHA PDS Bundle submission. Do not include an Appointment resource for any subsequent appointments beyond the initial.

Healthcare Resource

If a client has been matched to a service, then the Healthcare Service resource should be included in an MHA PDS Bundle submission. The Healthcare Service resource is used to capture information pertaining to the program such as functional centre code, Connex Ontario program number, and program name. When a client is receiving services from a HIC site, the Healthcare Service resource should be included in an MHA PDS Bundle. Please see the Episode of Care, and Encounter profiles for further details on how to include the Healthcare Service resource within an MHA PDS Bundle.

Service Request

In most scenarios, clients come to a HIC site for services by referral. The Service Request resource is used to capture referral information such as whether the referral came from the requesting HIC site, or externally, and who referred the client to the HIC site for services. In these scenarios, a Service Request resource should be included in an MHA PDS Bundle submission. Please see Episode of Care section for further details on how to include the Service Request resource within an MHA PDS Bundle.

Episode of Care

The Episode of Care resource is used to capture information pertaining to the client’s progress through a HIC site from the first contact date through to service termination. The PoS system should include the Episode of Care resource in the MHA PDS Bundle as the client’s Episode of Care progresses.

If the client is not matched to a program, and the services provided to the client have ceased, an Episode of Care resource should not be included in an MHA PDS Bundle submission.

MHA PDS Bundle (Episode of Care – in progress or complete)

  1. Bundle
  2. Patient
  3. Organization
  4. Location
  5. Episode of Care
  6. Healthcare Service
  7. Service Request

Encounter

The Encounter resource is used to capture information pertaining to a client’s interaction with a HIC site. It is understood that an encounter may occur regardless of whether a client is matched to a program, and with or without an Episode of Care. PoS systems should submit MHA PDS Bundles with Encounter resources after each client interaction. Below are suggested examples of how an MHA PDS Bundle can be assembled based on the scenario.

MHA PDS Bundle (Encounter Only, No Program)

  1. Bundle
  2. Patient
  3. Organization
  4. Location
  5. Encounter(s)
  6. Healthcare Service
MHA PDS Bundle (Encounter with Program)
  1. Bundle
  2. Patient
  3. Organization
  4. Location
  5. Episode of Care
  6. Service Request
  7. Healthcare Service
  8. Encounter(s)

Social Determinants of Health Data (SDOH) Elements

Client assessments may occur at various stages throughout the client’s journey. This implementation guide uses Observation Resources, Condition Resource, and some elements within the Patient Resource to capture social determinants of health. Resources containing SDOH elements should be included within the MHA PDS Bundle as displayed in the sections above if they are available at the time of submission.

Observation Resource Modelling

All SDOH Observation resources have been uniformly modelled. The Category (Obervation.category) data element will contain the same fixed values for all Observation resources. The value representing the client’s SDOH concept (e.g. Sexual Orientation, Housing Status, Employment Status) being captured is recorded under the Value (Observation.code) data element. The value set containing codes representing the permissible values for each SDOH category can be viewed under the Value (Observation.value) data element.

For Example:

Resource – Observation-SexualOrientation

For all Observation Resources:

Observation.category must contain a fixed value of “social-history”:

"system": "http://terminology.hl7.org/CodeSystem/observation-category"

"code": "social-history" 

"display": "Social History" 

Observation.code - this section is mandatory and is bound to the SDOH-ObservationCode value set. Each Observation resource will have a different fixed value code here depending on the SDOH category being captured. For Resource – Observation-SexualOrientation, the data element is modelled as such:

“system”: "http://loinc.org" 

“code”: "76690-7" 

“display”: “Sexual Orientation” 

Observation.valueCodeableConcept – this section is mandatory and bound to “SexualOrientation” value set. This value set contains codes from multiple code systems such as SNOMED CT. The example below uses “Bisexual” value from SNOMED.

“system”: "http://snomed.info/sct"  

“code”: "42035005" 

“display”: "Bisexual"