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1.1. Introduction

1.1.1. Overview

The Provincial Client Registry (PCR) is Ontario’s authoritative registry for client demographic information and identifiers associated with individuals who have received health care in Ontario. PCR supports consistent client identification across health care organizations by maintaining demographic attributes, local identifiers, provincial identifiers, and record relationships submitted by authorized contributing organizations.

PCR enables authorized source systems to contribute new or revised patient identity information so that the provincial registry remains accurate, current, and usable across the health system. Contributing systems may create new patient records, update existing demographic information, and perform merge or unmerge activities when duplicate or incorrectly linked patient identities are identified.

Ontario has historically supported PCR integration through HL7 V2-based IHE PIX/PDQ and ADT interfaces, and through HL7 V3-based Pan-Canadian query and update interfaces. This implementation guide introduces a HL7 FHIR R4-based contribution interface for PCR and defines the functional and technical requirements for contributing patient demographic and identifier information to the registry.

The PCR FHIR Contribution Implementation Guide supports four core contribution operations:

• Patient Add
• Patient Update
• Patient Merge
• Patient Unmerge

These operations support the controlled creation, correction, consolidation, and restoration of patient identity information within PCR using approved FHIR profiles, identifier policies, validation rules, and processing requirements.

The guide defines the expected FHIR capabilities, conformance requirements, resource profiles, security obligations, connectivity considerations, and operational behaviours required to support consistent contribution transactions between contributing systems and PCR.

1.1.2. PCR HL7-Based Services Overview

1.1.3. Purpose of this Guide

This implementation guide provides the business and technical framework for contributing patient demographic information to PCR using HL7 FHIR R4.

It establishes:

• Contribution operation requirements
• FHIR profile requirements
• Identifier requirements and policies
• Business and validation rules
• Conformance expectations
• Connectivity requirements and references
• Privacy and security obligations
• Processing outcomes and error handling expectations

The guide should be used together with Ontario Health onboarding materials, connectivity specifications, applicable agreements, and other PCR implementation guidance to support successful integration with the PCR FHIR contribution service.

1.1.3.1. 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. Health information custodians (HIC) are required to ensure that every digital health asset that it selects, develops or uses complies with all applicable interoperability specification, as it may be amended from time to time, within the prescribed timelines.

Compliance with the requirements of the DHIEX framework does not relieve a HIC of their broader obligations under PHIPA and its regulations or under the Freedom of Information and Protection of Privacy Act (FIPPA)

Ontario Health must consult with and consider the recommendations of the Information and Privacy Commissioner of Ontario on any specification that 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.

1.1.4. Copyright Notice

This PCR FHIR contribution specification is copyright protected by Ontario Health or its authorized owner. The content is provided for implementation, integration, and conformance purposes related to the Provincial Client Registry only.

No part of this specification may be altered, deleted, substituted, reproduced, distributed, or transmitted in any form without prior written consent, except where permitted by applicable law, Ontario Health authorization, or approved implementation use. Any use of this specification must preserve the integrity of the PCR contribution requirements and must not imply approval of modified content unless formally authorized.

This specification contains information for which copyright is held by Health Level Seven, Inc. There is no membership requirement for individuals and organizations which merely install or use software with built-in HL7 interfaces.

HL7® and FHIR® are registered trademarks of Health Level Seven, Inc. (https://www.hl7.org).

1.1.5. Legal 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.

1.1.6. Approval History