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Overview

This Ontario Patient Summary HL7® FHIR® Implementation Guide (IG) supports implementers of digital health assets that will use HL7 FHIR to enable electronic sharing of an Ontario Patient Summary among health care practitioners and their patients. The guide specifies a set of rules for using FHIR resources to publish and retrieve Patient Summaries to/from a provincial repository provisioned by Ontario Health. The guide includes:

  • a description of the Patient Summary’s intended use, data elements and terminologies,
  • considerations for system-to-system integration using FHIR, and
  • conformance expectations.

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.

Patient Summary Background

A patient summary is defined by ISO/TR 12773-1:2009 (Business Requirements for Health Summary Records) as a “health record extract comprising a standardized collection of clinical and contextual information (retrospective, concurrent, prospective) that provides a snapshot in time of a subject of care’s health information and healthcare.”

A patient summary benefits both clinicians and patients. A patient summary:

  • is concise and minimal
  • is location/care-setting independent
  • is specialty-agnostic (i.e., information in the patient summary is not filtered for a specialty)
  • is condition-independent (i.e., patient summary is not specific to a particular condition)
  • is a consistent and easy way for health care practitioners to see their patients’ most important health facts at a specific point in time.
  • reduces risks to patient safety by providing essential health care information to the health care practitioners who deliver care to a patient.
  • reduces the need for patients (and their caregivers) to answer the same questions by different health care practitioners.
  • improves the patient and practitioner experience by reducing the fragmented approach to accessing health information.

A patient summary is not:

  • an exhaustive, comprehensive, longitudinal patient record
  • a billing record (transaction level)
  • an encounter-specific record

This version of the IG pertains to Release 1 of the Ontario Patient Summary which is the simplest form and data set for a patient summary that clinicians and patients would consider valuable. Future releases will include additional data categories for expanded clinical use.

Content and Organization

The implementation guide is organized into the following sections:

Alignment with the International Patient Summary & Other Pan-Canadian Specifications

The Ontario Patient Summary is based on the International Patient Summary standard and was developed in collaboration with Canada Health Infoway and other jurisdictions and with preliminary input from primary care clinicians and solution vendors.

The Ontario Patient Summary (PS-ON) Standard aligns, where applicable, to the International Patient Summary (IPS) HL7 FHIR standard, the Pan-Canadian Patient Summary (PS-CA) Standard (under concurrent development), and the Canadian Baseline (CA-Baseline).

Notably, the PS-ON Standard is scoped for patient summaries generated, stored, and transmitted within Ontario. This is in contrast to the PS-CA Standard, which is intended to support intra-jurisdictional use, cross-jurisdictional use, and cross-border use. This difference in scope is the root of most of the variances between PS-CA and PS-ON.

PS-ON and PS-CA both take a similar approach to aligning to the IPS specification, although PS-ON focuses on practical implementation within Ontario; PS-CA takes a broader pan-Canadian view and so may be less tightly constrained in some areas. Both PS-ON and PS-CA draw on - and are aligned with - CA-Baseline, although both patient summary standards are expected to be more tightly constrained than CA-Baseline.

The PS-ON specification attempts to profile in a way that allows the patient summary instances to be conformant to the IPS, PS-CA, and CA-Baseline without having to formally derive from the profiles in these specifications. PS-ON instances should conform to the IPS specification even if the generating implementation does not fully meet the IPS expectations. For example, the ability to generate all optional slices and demonstrate support of all must support elements, etc. Moreover, the PS-ON specification is generally more tightly constrained than PS-CA, and so a patient summary instance that conforms to PS-ON should inherently conform to the PS-CA.

Ontario Health will continue to work with Canada Health Infoway to to maintain alignment where applicable between PS-ON and PS-CA.

A few notable variances include:

PS-ON PS-CA Additional Description
Scoped for patient summaries internal to Ontario​ Scoped for intra-jurisdiction, cross-jurisdiction, and cross-border exchange of patient summaries​ Difference in scoping is core rationale behind many other differences​
Tighter MustSupport constraints Looser MustSupport constraints PS-ON MustSupport elements are a superset of PS-CA MustSupport elements; PS-ON includes some additional MustSupport elements on top of those specified by PS-CA
Considers CodeableConcept.coding MustSupport​ Does not consider CodeableConcept.coding MustSupport​ PS-ON expects vendors to show they at least have the capability to produce coded data, although does not require coded data in individual resource instances​
Tighter cardinality constraints​ Looser cardinality constraints​ PS-ON applies additional cardinality constraints on a handful of elements to support integration with provincial digital health assets (including identification of patients and health care practitioners in Ontario) and privacy requirements
Narrower reference target profiles​ Broader reference target profiles​ PS-ON provides constraints in target of a Reference to support integration with provincial digital health assets (including identification of patients and health care practitioners in Ontario) and Canadian terminology requirements.​​
Expects vendors to prove ability to support all mandatory PS sections​ Includes a “Content Not Supported” profile for Allergy, Medication, and Problem List sections for use when vendor cannot support a mandatory PS section​ PS-ON inherited the IPS-UV approach for mandatory PS sections, while PS-CA supports additional "Content Not Supported" profiles to accommodate jurisdictions that have limitation in supporting mandatory PS 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 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) TITLE/DEPARTMENT APPROVED DATE
Ontario DHISC 2022-03-15

Revision History

VERSION NO. DATE SUMMARY OF CHANGE CHANGED BY
v0.9.1 2022-03-15 First version based on FHIR R4 Ontario Health
v0.10.0 2022-10-15 Updates to align with PS-CA v1 Trial Use Ontario Health