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Introduction

Overview

This FHIR implementation guide is developed to support data contribution and retrieval of patient's medical imaging reports, orders and imaging studies from medical imaging Clinical Data Repository (MiCDR).

This guide is based on FHIR R4.0.1.

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.

MiCDR Background

Ontario Health has historically funded three (3) regional DIRs (Diagnostic Imaging Repository) at the core of diagnostic imaging services in Ontario, namely:

  • Hospital Diagnostic Imaging Repository Services (HDIRS) in central Ontario
  • Northeastern Ontario Diagnostic Imaging Network (NEODIN), and
  • Southwestern Ontario Diagnostic Imaging Network (SWODIN).

These DIRs are based on technology platforms that were deployed over a decade ago and are ill-suited to support many of the emerging technologies being leveraged in imaging facilities today, such as new image file formats and modernized image acquisition equipment (“modalities”) being demanded by a broader range of medical specialists beyond traditional radiology. Additionally, each DIR is an island unto itself with its own repositories, archives, registries and viewers and lacks proper integration into Ontario’s EHR solution. The underlying DIR infrastructure also requires very costly and recurring refreshes and are currently nearing end of life.

Ontario Health also operates the Diagnostic Imaging Common Services (“DI CS”) solution which maintains a centralized copy of imaging reports and image manifests that are stored in the three regional DIRs and enables access to full longitudinal patient DI records from a variety of clinical viewers today, including Clinical Connect, ConnectingOntario, and eChin viewers. While serving its intended purpose, DI CS represents additional duplication in systems and data with its associated operational and cost overhead.

To address these and other challenges, a Medical Imaging Digital Health Strategy: 2022-2032 was developed by DxH and submitted as a discussion draft to MOH Digital Branch, within which the consolidation and technological refresh of the DIRs was recognized as a key technology enabler in the modernization of imaging services in the province. The formation of the Ontario Clinical Imaging Network (OCI Net) Corporation effective April 1, 2022, as directed by Ontario Health, represents consolidated governance of the three (3) legacy DIRs into a single not-for-profit entity and sole operator of the province’s imaging repositories. The new direction also progresses technology streamlining and modernization at a provincial scale, to capitalize upon new and innovative image exchange technologies and creates a foundation for an expanded array of digital images.

Content and Organization

The implementation guide is organized into the following sections:

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Disclaimer

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:

  1. This specification is provided “AS IS” without any warranties or representations of any kind, express or implied, in fact or in law;
  2. 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
  3. 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.