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) and Ontario Health Care are required to be included within MHA PDS Bundle submissions. Ontario Health (OH) will assign system identifiers during the data process. 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 organization SHALL be included in every data submission. Connex Ontario Organization numbers should be provided when made available.
Location Identification
Location identifiers are required to uniquely identify a specific delivery site from where the client is receiving services. The site name and postal code SHALL be included in every data submission.
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)
- Patient
- Organization
- Health Service
- Health Service Encounter
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, HSP health program ID, 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 Health Service (Episode of Care) section for further details on how to include the Service Request resource within an MHA PDS Bundle.
Health Service (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"
Submission Groups
There are two submission groups for this project – Health Service (former EOC) and Health Service Encounter (HSE).
Key Considerations:
- Health Service (EOC) is collected when client enrolls into a program.
- HSE is collected when client is going through the program.
Submission Groups and Triggers These submission groups and their triggers are outlined in detail below. The conformance column details whether data elements are mandatory, conditional or optional. If a data element does not appear in the Submission Group table, it should not be included. - Mandatory (M): This data element is mandatory for submission and must be included in the submission group. - Optional (O): This data element should be submitted if the data is available. If not available in the CMS, it can be omitted. - Conditional (C): This data element must be submitted based on the conditions indicated. Conditions are outlined in the Submission Guideline column.
- Health Service Submission Group The purpose of this submission is to enable HSP to submit Health Service or Program related information accompanying the client, organization and referral information. Once the client finishes or terminates the program, all applicable information and/or changes should be submitted using the 'Health Service' submission group.
- Health Service Encounter Submission Group The purpose of this submission is to enable the HSP to submit encounter information accompanying the client, organization, referral and key program information.
| ID | Data Elements | Health Service (Former EOC) | Submission Guideline | Health Service Encounter | Submission Guideline |
|---|---|---|---|---|---|
| 1.1 | Client Information | ||||
| 1.1.1 | Client First Name | M | M | ||
| 1.1.2 | Client Middle Name | O | O | ||
| 1.1.3 | Client Last Name or Single Name | M | M | ||
| 1.1.4 | Date of Birth | M | M | ||
| 1.1.5 | Date of Birth Estimated Flag | M | M | ||
| 1.1.6 | Client Identifier - MRN | M | M | ||
| 1.1.7 | Client ID Issuing Vendor | M | M | ||
| 1.1.8 | Health Card Number | M | If no HCN, a No Health Card Number Reason must be submitted. | M | If no HCN, a No Health Card Number Reason must be submitted. |
| 1.1.9 | No Health Card Number Reason | C | Condition: must be sent if no Health Card Number is provided. | C | Condition: must be sent if no Health Card Number is provided. |
| 1.1.10 | HCN Issuing Authority | C | Condition: Must be included if a Health Card Number is provided. | C | Condition: Must be included if a Health Card Number is provided. |
| 1.1.11 | City | O | O | ||
| 1.1.12 | Province | C | Condition: Postal Code has a value and being submitted. | C | Condition: Postal Code has a value and being submitted. |
| 1.1.13 | Postal Code | M | If no Postal Code, a No Postal Code Reason must be submitted. | M | If no Postal Code, a No Postal Code Reason must be submitted. |
| 1.1.14 | No Postal Code Reason | C | Condition: Must be sent if no Postal Code is provided. If the selection is blank, default "Did not ask" value for submission. If an Out of Country address is captured, default “Does not have address” value for submission. | C | Condition: Must be sent if no Postal Code is provided. If the selection is blank, default "Did not ask" value for submission. |
| 1.1.15 | Confirmed Diagnosis | O | O | ||
| 1.1.16 | Client Active Flag | M | M | ||
| 1.2 | Client SDOH | All available SDOH elements should be submitted for all submission groups. | All available SDOH elements should be submitted for all submission groups. | ||
| 1.2.1 | Racial Group | O | O | ||
| 1.2.2 | Disability Status | O | O | ||
| 1.2.3 | Disability Type | C | Condition: Disability Status being answered and has a value. | C | Condition: Disability Status being answered and has a value. |
| 1.2.4 | Language of Comfort | O | O | ||
| 1.2.5 | Official Language | C | Condition: Language of Comfort has a value other than English or French. | CO | Condition: Language of Comfort has a value other than English or French. |
| 1.2.6 | Gender Identity | O | O | ||
| 1.2.7 | Transgender Identity | O | O | ||
| 1.2.8 | Sexual Orientation | O | O | ||
| 1.2.9 | Born in Canada | O | O | ||
| 1.2.10 | Arrive in Canada | C | Condition: Born in Canada = No. | C | Condition: Born in Canada = No. |
| 1.2.11 | Educational Attainment | O | O | ||
| 1.2.12 | Employment Status | O | O | ||
| 1.2.13 | Housing Status | O | O | ||
| 1.2.14 | Income Amount | O | O | ||
| 1.2.15 | Income Supporting | O | O | ||
| 1.2.16 | Indigenous Identity | O | O | ||
| 1.2.17 | SDOH Effective Date | C | Condition: Provided for relevant SDOH elements that have a value. | C | Condition: Must provide if one or more SDOH elements has a value for submission. |
| 2.1 | Organization Information | ||||
| 2.1.1 | MOH Organization ID | M | M | ||
| 2.1.2 | Connex HSP Organization Number | O | O | ||
| 2.1.3 | HSP Organization Name | M | M | ||
| 2.1.4 | HSP Organization Active Flag | O | O | ||
| 2.2 | Organization Referral and Discharge | Must be included when available. | Optional elements should be included as a reference where available. | ||
| 2.2.1 | Organization Referral ID | O | O | ||
| 2.2.2 | Organization Referral Received Date | O | O | ||
| 2.2.3 | Organization Referral Source | O | O | ||
| 2.2.4 | Organization Discharge Date | O | O | ||
| 2.2.5 | Reason for Discharge | C | Condition: Must provide if Organization Discharge Date has a value. | C | Condition: Must provide if Organization Discharge Data has a value. |
| 3.1 | Program Information | Optional elements should be included as a reference where available. | |||
| 3.1.1 | Connex Health Program Number | O | O | ||
| 3.1.2 | Health Program Name | M | M | ||
| 3.1.3 | HSP Health Program ID | M | M | ||
| 3.1.4 | Functional Centre Code | M | M | ||
| 3.1.5 | Connex HSP Site Number | O | |||
| 3.1.6 | HSP Site Name | M | M | ||
| 3.1.7 | HSP Site Postal Code | M | M | ||
| 3.1.8 | Health Service ID | M | M | ||
| 3.1.9 | Health Service Status | M | M | ||
| 3.1.10 | Service Referral Date | O | |||
| 3.1.11 | Service Referral Type | O | |||
| 3.1.12 | Service First Contact Date | O | |||
| 3.1.13 | Service Eligibility Screening Date | O | |||
| 3.1.14 | Service Initial Assessment Date | O | |||
| 3.1.15 | Service Enrollment Date | C | Conditional on Health Service Status = Active | ||
| 3.1.16 | First original appointment date | C | Condition: Must provide if 'First Original Appointment Rescheduled Reason' has a value. | ||
| 3.1.17 | First original Appointment Rescheduled Reason | O | |||
| 3.1.18 | Service Initiation Date | O | |||
| 3.1.19 | Service Termination Date | C | Conditional on Health Service Status = Finished | C | Conditional on Health Service Status = Finished |
| 3.1.20 | Service Termination Reason | C | Conditional on Service Termination Date | C | Conditional on Service Termination Date |
| 3.1.21 | Service Termination Continuity | C | Conditional on Health Service Status = Finished or Cancelled | ||
| 3.1.22 | Outbound Referral | C | Condition: Must provide based on specific response to Service Termination Continuity. | ||
| 3.2 | Clinical Summary | ||||
| 3.2.1 | Symptoms of Clinical Concern | O | Must provide if collected during program enrollment | ||
| 3.2.2 | Substance and Behavioural Addictions | O | |||
| 3.2.3 | Other Reasons for Seeking Service | O | |||
| 3.2.4 | Gambling Problem Identified | O | Must provide for Problem Gambling Designated Agencies | ||
| 3.2.5 | Reason for Non-completion of Gambling Data Form | O | |||
| 3.2.6 | Gambling Treatment Plan Status | O | |||
| 3.3 | Substance Addiction | ||||
| 3.3.1 | Prescribed pharmacotherapy or anti-craving medication for alcohol use disorder | C | Conditional on Functional Centre | ||
| 3.3.2 | Anti-craving medication prescribed | C | Condition: Must provide if above element has a value | ||
| 3.3.3 | Prescribed pharmacotherapy or Opioid agonist therapy for Opioid Use Disorder | C | Conditional on Functional Centre | ||
| 3.3.4 | Opioid Agonist Therapy Prescribed | C | Condition: Must provide if above element has a value | ||
| 3.4 | Problem Gambling | Data elements in this category should be submitted together, i.e. the Problem Gambling Questionnaire in its entirety. | |||
| 3.4.1 | Reason for Seeking Help With Gambling Behaviour | O | All Problem Gambling elements under section 3.4 must be submitted collectively if client has a problem gambling identified. | ||
| 3.4.2 | Number of Years Life Negatively Affected by Gambling Behaviour | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.3 | Length of Time Since Last Gambling Activity (Days) | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.4 | Sequence of Gambling Problem Identification | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.5 | Primary Gambling Activity in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.6 | Primary Gambling Activity Frequency in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.7 | Additional Gambling Activities in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.8 | Additional Gambling Activities Frequency in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.9 | Primary Gambling Location in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.10 | Primary Gambling Location Frequency in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.11 | Additional Gambling Locations in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.12 | Additional Gambling Locations Frequency in last 12 months | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.13 | Percentage of Time Spent Gambling by Jurisdiction - In Ontario | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.14 | Percentage of Time Spent Gambling by Jurisdiction - In another province | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 3.4.15 | Percentage of Time Spent Gambling by Jurisdiction - Outside of Canada | C | Condition: Must submit if 3.4.1 has a value = 2 or 3 | ||
| 4.0 | Health Service Encounter | ||||
| 4.0.1 | Health Service Encounter ID | M | |||
| 4.0.2 | Encounter Status | M | |||
| 4.0.3 | Service Modality Class | M | |||
| 4.0.4 | Service Modality Type | M | |||
| 4.0.5 | Encounter Date | M | |||
| 4.0.6 | Direct Minutes | O | |||
| 4.0.7 | Indirect Minutes | O |