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Introduction

This FHIR implementation guide is developed to support retrieving patient's lab report for health care practitioners from OLIS.

This guide is based on FHIR R4.0.1.

Digital Health Information Exchange (DHIEX)

On January 1, 2021, Ontario Regulation 329/04 ("O. Reg. 329/04") under the Personal Health Information Protection Act, 2004 (PHIPA), was amended to provide a regulatory framework for Ontario Health, as directed by the Minister of Health (“the minister”), to establish, maintain and amend interoperability specifications. This regulatory framework, as set out in sections 26 to 34 of O. Reg. 329/04, is referred to by Ontario Health as the Digital Health Information Exchange (DHIEX) framework.

Ontario Health guides and supports the adoption of modern interoperability specifications applicable to digital health assets as defined in s. 26 of O. Reg. 329/04. A health information custodian (HIC) 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 the requirements of the DHIEX framework does not relieve a HIC of its obligation to comply with the other provisions of PHIPA and its regulations.

Ontario Health is required to consult with and consider the recommendations of the Information and Privacy Commissioner of Ontario (where a specification relates to the confidentiality of personal health information, the privacy of individuals or the rights of individuals to access or correct records of their personal health information) prior to providing the specification to the Minister of Health for review and approval.

Ontario Health is also required to consult with any health care provider organizations, individuals, stakeholders and other parties as appropriate, in order to inform its decisions concerning the establishment, maintenance or amendment of interoperability specifications.

Background

Ontario Laboratories Information System (OLIS) is the single provincial system that allows all laboratory information on patients in Ontario to exchange electronically between practitioners and laboratory service providers and provides the Ministry of Health and Long-Term Care (MOHLTC) with program management information. OLIS facilitates the exchange of laboratory information on human beings in Ontario amongst Laboratory Information System (LIS), Hospital Information System (HIS), Electronic Medical Record (EMR) and other point of service systems (POS), but it is not a LIS system in its own right, and is not intended to replace existing LIS systems.

OLIS has an existing HL7 v2 interface that is used by labs to submit laboratory results as well as an inquiry interface that allows authorized clinicians to access lab results via EMR’s, regional and standalone clinical viewers. OLIS also supports RESTful FHIR® STU3 interface that enables health care provider oriented portals and apps to access lab results from OLIS for their patients. This interface can be consumed by leveraging the OLIS FHIR Patient Query for Providers by a variety of clients from traditional portals and EMR’s to mobile apps and devices.

This implementation guide is to uplift the existing FHIR STU3 interface to FHIR R4. FHIR R4 is the latest official release of FHIR that contains normative content. As more and more FHIR implementations are using FHIR R4, this upgrade will align OLIS FHIR interface with the latest version of FHIR, and bring consistency to FHIR based EHR implementations in Ontario.

While the information retrieved by the health care provider access interface using the RESTful FHIR® interface is identical to what would be retrieved using the current HL7 based patient query in many cases, the business rules related to processing these two requests are different in terms of, consent application, audit generation, consent overrides and notification.

Table: Service Endpoints and Standards

Function Messaging Transport Security
Patient Query For Providers HL7 FHIR R4 REST over HTTPS PKI / JWT

Note:

Public Key Infrastructure (PKI) certificate (i.e. HTTPS) and Jason Web Token (JWT) token.

PKI: PKI certificate required

JWT: JWT token required

Content and Organization

The implementation guide is organized into the following sections:

  • Home includes general background information about OLIS solution, Ontario Health's Digital Health Information Exchange (DHIEX) program, and this implementation guide.
  • Business Context includes pages that provide an overview of the business model, business data, use cases and business rules that this implementation guide supports.
  • Implementation Guidance includes pages that provide high level guidance to implementers related to the responsibility of participating systems, conformance rules, and connectivity summary.
  • Profiles & Operations provides details on the FHIR profiles included in the scope of this guide, including profile-specific implementation guidance and message definitions.
  • Capability Statement provides a description of the expected response codes as well as links to download the Capability Statement that defines the behaviour of systems associated with this guide.
  • Terminology Terminology provides a full list of terminology artifacts used in this implementation guide with a terminology updates subsection.
  • Downloads allows download of this and other specifications as well as other useful tools.

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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 the interoperability specification most recently approved by the Minister available to the public by posting it on Ontario Health’s website or by such other means as Ontario Health considers advisable.

As the Minister may direct Ontario Health to amend the interoperability specifications from time-to-time, Ontario Health advises the public and any other users of information concerning interoperability specifications to regularly review Ontario Health’s website where the interoperability specifications are posted, or such other means Ontario Health considers advisable, in order to confirm that they are accessing the interoperability specifications most recently approved by the Minister.

You understand and agree that:

(i) This specification is provided “AS IS” without any warranties or representations of any kind, express or implied, in fact or in law;

(ii) 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

(iii) 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.

Document Control

The electronic version of this specification is recognized as the only valid version.

Approval History

APPROVER(S) APPROVED DATE
Business and Technical Committee 2019-06-19