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Difference between version 1.0.0 and 2.0.0
This page lists the differences for resource profile definitions between Version 1.0.0 and this Version 2.0.0 of the OLIS FHIR Provider Query implementation guide. The purpose is to help implementers who are supporting Version 1.0.0 understand the necessary changes required to migrate to Version 2.0.0. At this point, both versions will be supported by Ontario Health.
Patient Identifier Support in Patient Query
In Version 1.0.0, the patient query only supports Ontario HCN in the patient identifier search parameter. Version 2.0.0 of the implementation guide will also support patient MRN number as patient identifier query parameter.
Query By Test Request code in Patient Query Since FHIR R4 renamed ProcedureRequest to ServiceRequest, querying by test request code should use "ServiceRequest" instead of "ProcedureRequest".
Example:
result.based-on:ServiceRequest.code= [code-system-local-base] /lab/test-request-codes|TR11663-2
Support of fhirVersion in Accept header
In order for OLIS endpoint to support both FHIR STU3 and R4 content, fhirVersion must be used in the R4 request header. Refer to "FHIR Versioning" section in Implementation Consideration page on how to support this.
Profile canonical URL change in all resource profile definitions:
Version 2.0.0 of the implementation guide will use different canonical URIs for all the profiles by removing "provider" from it. Please refer to the table below for the new canonical URIs:
| Profile | Version 1.0.0 Canonical URI | Version 2.0.0 Canonical URI |
|---|---|---|
| DiagnosticReport | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-DiagnosticReport | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-DiagnosticReport |
| ServiceRequest (previously ProcedureRequest) | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-ProcedureRequest | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-ServiceRequest |
| Observation | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-Observation | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-Observation |
| Patient | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-Patient | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-Patient |
| Practitioner | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-Practitioner-[role] | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-Practitioner |
| Organization | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-Organization-[role] | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-Organization |
| Specimen | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-Specimen | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-Specimen |
| Encounter | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-provider-profile-Encounter | http://ehealthontario.ca/fhir/StructureDefinition/ca-on-lab-profile-Encounter |
STU3 profiles replaced in R4
The following profiles in version 1.0.0 have been replaced or renamed in version 2.0.0.
| Profile | Changes |
|---|---|
| ProcedureRequest | Renamed to ServiceRequest in R4 |
| Observation(MicrobiologyChild) | Replaced by Observation profile in version 2.0.0 |
| Practitioner(Ordering, Performing and Reporting) | Replaced by various elements in other resources and practitioner profile in 2.0.0 |
| Practitioner(Attending) | Replaced by Practitioner profile in version 2.0.0 |
| Practitioner(Admitting) | Replaced by Practitioner profile in version 2.0.0 |
| Organization(Ordering Facility) | Removed in version 2.0.0 |
| Organization(Specimen Collector) | Replaced by Specimen.collector and Organization profile in 2.0.0 |
| Organization(Destination Laboratory) | Replaced by ServiceRequest.performer in 2.0.0 |
| Organization(Identifier Assigner) | Replaced by identifier.assigner and organization profile in 2.0.0 |
| Organization(Requesting) | Replaced by ServiceRequest.requester and organization profile in 2.0.0 |
Profiling Changes
Version 2.0.0 of the implmentation guide introduces the following changes in the profiling design. The details are listed below.
All profiles
- All OLIS R4 profiles will have
.meta.profilefield set to its canonical URI with version number 2.0.0. All resource.meta.profile is mandatory and MustSupport.
DiagnosticReport profile:
| Change | Rationale | Note |
|---|---|---|
| DiagnosticReport.identifier.assigner reference changed to Organization instead of OrganizationAssigner | OrganizationAssigner is not necessary as identifier.assigner provides the meaning. | |
| DiagnosticReport.performer.actor removes slicing definition | The reference supports either Practitioner or Organization, and no slice is necessary | |
| DiagnosticReport.result removes ObservationMicroBiology reference | ObservationMicroBiology has been consolidated into the new Observation profile, and therefore not needed for the reference | |
| DiagnosticReport.codedDiagnosis is no longer used for diagnosis information. DG1.3 will be mapped to ServiceRequest.reasonCode | Based on DG1 usage in OLIS, labs may send DG1 for diagnosis related to the order. Therefore it should be mapped to ServiceRequest. |
Observation profile:
| Change | Rationale | Note |
|---|---|---|
| Removed Observation-SubID and note extension | SubID will be part of Observation.identifier. Note can be represented in standard element and Observation.note | FHIR R4 changes Observation.comment to Observation.note |
| Removed slicing definition on Observation.performer | The elements supports either Practitioner or Organization. No slice is necessary | |
| Observation.value[x] contains an extension to support valueAttachment | FHIR R4 removes attachment from value[x] choice types. In order to support binary data observation value, Observation.value[x] will contain an inter-version extension to support binary observation value. | This is a change in FHIR R4. |
ProcedureRequest profile (now changed to ServiceRequest):
| Change | Rationale | Note |
|---|---|---|
| ProcedureRequest changed to ServiceRequest. | FHIR R4 changes ProcedureRequest to ServiceRequest. | This is a change in FHIR R4. |
| Removed request-replace extension | Replace flag can be represented by ServiceRequest.replaces | |
| Changed mapping for OBR.25 to ServiceRequest.status.extension:ext-OLISLabRequestStatus | There is a need to support full OBR.25 values in FHIR output. In STU3, we map multiple values to "completed" which is not sufficient. We have introduced an extension with value set that maps to all OBR.25 values | |
| Removed note extension | Note can be represented by ServiceRequest.note | |
| Removed RequestTiming extension | OBR.27.6 is mapped to ServiceRequest.occurrenceTiming | |
| Added ServiceRequest.reasonCode | This field will be populated with ICD-10-CA code if lab sends diagnosis related to the test request | |
| Added ServiceRequest.reasonReference | A test request may be ordered as the result of an observation. For example, if urine culture identifies bacteria, an antibiotic sensitivity panel may be ordered. The panel test request will reference the bacteria observation. | |
| Added ServiceRequest.specimen | specimen now can be referenced from ServiceRequest, in addition to reference from observation in STU3 |
Specimen profile
| Change | Rationale | Note |
|---|---|---|
| Replaced OrganizationSpecimenCollector extension with PractitionerRole reference in Specimen.collector | FHIR R4 added support for PractitionerRole which can support organization as specimen collector | This is a change in FHIR R4. |
| Added Specimen.container.identifier.type and system to support specimen identifiers | STU3 only provides specimen identifier values. R4 will add type value "SID" and organization specific URIs for identifier system. |
Encounter profile
| Change | Rationale |
|---|---|
| Encounter.participant references Practitioner Profile instead of PractitionerAttending and PractitionerAdmitting profile | The role of practitioner is expressed in Encounter.participant.role |
| Added Encounter.class | OLIS suppports PV1.2 which will be mapped to Encounter.class |
| Added Encounter.subject (Patient) | Create a direct reference between Encounter and Patient in R4 |
| Added Encounter.location | OLIS supports PV1.3 which will be mapped to Encounter.location.location.display |
Practitioner Profile
| Change | Rationale | Note |
|---|---|---|
| Encounter.participant references Practitioner Profile instead of PractitionerAttending and PractitionerAdmitting profile | The role of practitioner is expressed in Encounter.participant.role | |
| Removed Practitioner.telecom and address elements as MustSupport | Provider call back number and address will be mapped to PractitionerRole.telecom and PractitionerRole.location.address |
PractitionerRole Profile
This profile is added to support Specimen Collector Organization. Refer to Specimen profile change details.
PractitionerRole.telecom is MustSupport and mapped to OBR.17 (Practitioner Call Back Number)
PractitionerRole.location.address is MustSupport and mapped to ORC.24 (Ordering Practitioner address)
Location Profile
- This profile is added to support ORC.24 (Ordering practitioner address).
Patient Profile
- Patient.address.use and Patient.address.type cardinality are changed from 1..1 to 0..1.
- Patient.contact.address is added to support patient emergency contact address. This is changed from patient.address.