Ontario Provincial Consent Override Interface HL7® FHIR® Implementation Guide v1.0.0-draft1
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This model is linked to Ontario’s Electronic Health Record (EHR) Conceptual Information Model 2.0 (CIM 2.0). See: https://ehealthontario.on.ca/files/public/support/Architecture/Ontario_EHR_CIM_2.0.pdf
To support the use of structured data through the adoption of data content and health terminology standards in the solution, this CDM also includes high-level entity relationships and attributes discovered in versions of FHIR interoperability standard for patient summary specifications. The model does not repeat the structure of the messages laid out in FHIR. Links to FHIR specs are included for entity definitions and field code values. In any difference of meaning between cited FHIR elements and this model, FHIR is the authoritative voice. This model relies on the following specifications:
Entity Relationship Diagrams (ERDs) follow. These include:
Note: The concepts and definitions presented below are derived from the Ontario Electronic Health Record (EHR) Conceptual Information Model (CIM) and are included to provide a common business context for the PCOI specification. These concepts are not intended to represent PCOI-specific information entities. Where applicable, the concepts have been mapped to corresponding FHIR resources.
| Entity Name | Description | Corresponding FHIR Resource |
|---|---|---|
| Client Supporter | A person who provides care to a health care client who needs supervision or assistance. He or she may provide the care in the home, in a hospital, or in an institution. Although caregivers include trained medical, nursing, and other health personnel, the concept also refers to parents, spouses, or other family members, friends, members of the clergy, teachers, social workers, fellow health care clients. This could be an informal care giver: unpaid, unlicensed, often untrained, often a friend or family member of the health care client. It includes information about contact method (e.g. geographic or virtual address, telephone number and other demographics). |
Patient.contact (Contact element within Patient Resource) |
| Health Care Provider | A person or an organization that provides health care or other health-related services or products. It includes information about contact method: • geographic address • virtual address • telephone number • other demographics |
Practitioner, Organization |
| Health Care Provider Role | A part played by a health care provider (regulated or unregulated) that provides a type of care to a particular health care client. Examples: |
N/A |
| Healthcare Client | An individual participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. (U.S. National Library of Medicine - Medical Subject Headings) A natural person (i.e. a human being) who: This entity covers personal identifying information but not health information. It includes information about: The health care client's identity may be unknown e.g. for a protected person or if the identity of the health care client is unknown. A health care client may be a VIP whose identity must be omitted from reporting. A health care client may be identified by an alias. Health care client-identifying information could include a photograph. May be elated genetically or by physical co-location (e.g. residential, occupational, travel, etc.) to another person not necessarily a health care client. Depending on care setting, a health care client may be referred to as: |
Patient |
| Provider Organization | An organization that provides health care or other health-related services or products. Includes e.g. insurers and transcription services. May have information on service classification e.g. Regional Cancer Centre. (For Single Sign on application, a Provider Organization may be a Sponsoring Organization, a Health Care organization that has users that require access to at least one Federated Service. 2015-6-15) |
Organization |
| Provider Person | Describes a health care provider involved in the delivery of healthcare services. Encompasses both professional and non-professional members. Has professions, areas of practice for which the provider is qualified. May have information on clinician credentialing and privileging as defined by the applicable professional and governing organizations. This includes remote participation (e.g., via tele-health activities such as tele-consultation, home health monitoring.) Includes any information about licensing status and license suspension. May be an author, authenticator or scribe/transcriber of clinical documentation. Has a Unique Provider Identifier, a key assigned by eHealth to uniquely identify each Provider. May have a health system universal ID. May have a license number or national provider identifier (U.S.). May have multiple unique identifiers. |
Practitioner |
| Information Consent Directive | A directive received from a health care client or health client for the purpose of restricting access to Personal Health Information (PHI) by Health Information Custodians (i.e. implied consent directive). If a consent directive is in place, it is only to prevent access to PHI in the EHR for health care purposes. Consent directives will apply only in respect of sharing of PHI for provision of health care (since EHR is to be accessed only for this purpose). Consent directives do not have a time limit. May be overridden by Consent Override in a 'break the glass' scenario. Consent overrides may be permitted only for the following purposes as authorized by law: Additional purposes are not permitted. |
Consent |
| Permission Override | In Temporary Override with Client’s Consent a Client allows a Provider temporary access to the Client’s restricted Personal Health Information (PHI). In Temporary Override without Client’s Consent a Provider temporarily accesses a Client’s restricted Personal Health Information without the Client’s consent. This scenario may play out in an Emergency setting where the Providers do not have the ability to obtain consent from the Client (or the Client’s SDM) but must access their PHI for the purpose of providing care. For example, normally the 'Dietician' role can only view (not update) the Health Care Client's diary. A Health Care Client may grant special permission to his/her dietician to enable him/her to update the nutritional intake portion of the diary. In another example an ER physician may gain temporarily access to PHI to treat a non-communicative emergency patient. Override permission is only allowed under 3 circumstances: |
Consent (Action + Purpose) |
For details on:
For Details on: