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Revision History

VERSION NO. DATE SUMMARY OF CHANGE
v 0.12.0 2024-03-20 In MedicationRequest IG usage note, renamed all occurence of .dosage to .dosageInstruction
In MedicationRequest IG usage note, removed all references to .dosageInstruction.route because its no longer must-support
In Operation:Search Patient Summary in the error codes section specifcally the '401 Unauthorized error' - renamed bundle.custodian to bundle.composition.custodian (ie. "Failed to validate bundle.custodian against UAO")
v 0.12.0 2024-01-29 Added Conditional Update for Update PS-ON
Added Prac/Org datatype options to PracRole slices
Condition.clinicalStatus relaxed
Business error codes added
Removed atcClass slices in both Immunization and Medication profiles
Removed vaccineIPS slice in Immunization profile
Device slice in Composition.author is made as mandatory element
v 0.11.0 2023-10-12 Added slices for additional terminologies to align with PS-CA
Added LOINC ontology
Additional updates based on stakeholder feedback and review
v 0.10.0 2022-10-15 Updates to align with PS-CA v1.0 & IPS CI Build (2022-09)
v 0.9.1 2022-03-03 Incorporate feedback from open review
v 0.9.0 2021-08-12 Draft for provincial open review

v 0.12.0 Release Notes & Change Notes

Operation Changes

Operation: Submit Patient Summary

  • Patient Summary Update Request API uses Conditional Update instead of regular Update, using Bundle.identifier as criteria
  • Patient Summary Update Request API allows for amending + invalidating
  • Error tables updated with business rules error codes
  • Patient Summary Amendment updated to indicate that if the repository does not find an existing matching patient summary, the repository will create a new record instead of giving error code

Profile Changes

Profile: Composition

  • Composition.author:PractitionerRole slice to allow PractitionerRole + Organization
  • Composition.attester.party to allow PractitionerRole + Organization
  • Composition.author.devicePSON slice made mandatory
  • usage notes updated: .meta.profile to use version 0.12.0
  • usage notes updated: .status is set to "amended" when updating patient summaries

Profile: DocumentReference

  • Document.author to allow PractitionerRole + Organization
  • usage notes updated: .meta.profile to use version 0.12.0

Profile: Medication

  • atcClass slice removed

Profile: Immunization

  • usage notes updated: .occurence data expectations elaborated
  • atcClass and vaccineIPS slices removed

Profile: Patient

  • Patient.generalPractitioner slice to allow PractitionerRole + Organization + Practitioner
  • usage notes updated: .meta.profile to use version 0.12.0

Profile: Condition

  • Condition.clinicalStatus relaxed to 0..1, aligned with upcoming IPS + PS-CA
  • usage notes updated: .meta.profile to use version 0.12.0

Profile: Device

  • Usage Notes: Added Device.identifier.system fixed value

v 0.11.0 Release Notes & Change Notes

Operation Changes

Operation: Fetch DocumentReference

  • Example DocumentReference added
  • Expected Behaviour table updated with additional response codes

Operation: Retrieve Patient Summary

  • Expected Behaviour table updated with additional response codes

Operation: Search Patient Summary

  • Expected Behaviour table updated with additional response codes

Operation: Submit Patient Summary

  • Expected Behaviour table updated with additional response codes

Profile Changes

Profile: Bundle

  • Bundle.meta.versionId updated to 0..1 Must Support, to indicate this field is available when retrieving Patient Summaries from the repository
  • Bundle.meta.lastUpdated updated 1..1 to 0..1, to relax requirement for Patient Summary submissions
  • usage notes updated: .identifier additional guidance for patient summary update operation
  • usage notes updated: .identifier.system to be provided by OH

Profile: Composition

  • Composition.subject updated from 0..1 to 1..1, to align with IPS CI Build and other Ontario Health Assets
  • composition.identifier.system and composition.identifier.value updated from 0..1 to 1..1
  • Composition.category, Composition.category.coding, Composition.categorycoding.system, Composition.category.coding.code, Composition.category.coding.display made MustSupport to facilitate search and DocRef
  • Composition.category.* updated with LOINC Document Ontology values
  • Composition.status usage notes updated with link to HL7 FHIR status definitions
  • usage notes updated: .meta.profile to use version 0.11.0
  • usage notes updated: .identifier additional guidance for patient summary update operation
  • usage notes updated: .identifier.system to be provided by OH

Profile: Condition

  • usage notes updated: .meta.profile to use version 0.11.0
  • .code slices added for ICD-9 CM, ICD-10 CA to align with PS-CA

Profile: Device

  • usage notes updated: .meta.profile to use version 0.10.0
  • usage notes updated: .identifier to use ONE ID client IDs

Profile: DocumentReference

  • DocumentReference.category, DocumentReference.category.coding, DocumentReference.categorycoding.system, DocumentReference.category.coding.code, DocumentReference.category.coding.display made MustSupport to align with other OH assets using DocRef
  • DocumentReference.category.* updated with LOINC Document Ontology values
  • usage notes updated: .meta.profile to use version 0.11.0

Profile: Medication

  • usage notes updated: .meta.profile to use version 0.11.0
  • .code slice added for Natural Product Numbers to align with PS-CA

Profile: Patient

  • usage notes updated: .identifier allows for use of ECID

Profile: Procedure

  • .code slices added for ICD-9CM, CCI to align with PS-CA
  • usage notes updated: .meta.profile to use version 0.11.0

Capability Statement

  • CapabilityStatement for Server updated to include _mdm search parameter

  • Added LOINC Ontology Extension, LOINC Ontology ValueSet artifacts to support Composition.category, DocumentReference.category

Narrative Changes

Introduction

  • updated DHIEX, Copyright Notice, Disclaimer verbiage

Known Issues

  • Rendering issue for data-absent-reason extension has been fixed in Simplifier
  • Rendering issue for medicationrequest.medicationreference binding has been fixed in Simplifier

Business Rules

  • Details added around use of business identifiers for updating and invalidating patient summaries
  • Details added around the effect of invalidation on the entire series of patient summaries sharing the same business identifiers

Opeation: Submit Patient Summary

  • bundle.identifier and composition.identifier used in an update must match the original submission. once invalidated, new bundle.identifier and composition.identifier must be used

Opeation: Search Patient Summary

  • updated for clarity around expected behaviour for returned "Bundle of Bundles"
  • updated to allow for use of ECID as patient identifier

Terminology

  • updated table format and sortable
  • see Terminology Updates for additional terminology change notes

Identifiers

  • URI added for Ontario Health Enterprise Client IDs

Response Handling

  • updated layout and formatting of tables

Navigation Changes

  • Operations and Profiles pages are alphabetically sorted

Package Changes

  • Updated dependency to use ca.baseline 1.1.3 instead of 1.0.0

v 0.10.0 Release Notes & Change Notes

Glossary Page: Breadcumbs updated from "Acryonyms/Abbrev" to "Glossary"

Added StructureDefinition.fhirVersion="4.0.1" to the following profiles (previously absent from these profiles): Composition, PractitionerRole, Patient, Practitioner, Organization, MedicationStatement

Approval History added to landing page, in alignment with other Ontario Health FHIR Specification IGs

Renamed IG root from "Home" to "Table of Contents"

Remove MS from the following elements, based on MS relaxation in IPS and PS-CA:

  • Composition profile parent element
  • Composition.encounter
  • Composition.confidentiality
  • Composition.relatesTo(backbone)
  • Composition.relatesTo.code
  • Composition.relatesTo.target[x]
  • Composition.event(backbone)
  • Composition.event.careProvisioningEvent
  • Patient profile parent element
  • Patient.contact(backbone)
  • Patient.contact.relationship
  • Patient.contact.name
  • Patient.contact.telecom
  • Patient.contact.address
  • Patient.contact.organization
  • Patient.communication
  • Patient.language
  • Allergyintolerance.abatementDateTime(extension)
  • Allergyintolerance.asserter
  • Condition profile parent element
  • Condition.abatement(backbone)
  • Condition.abatementDateTime
  • Condition.asserter
  • Medication profile parent element
  • MedicationStatement profile parent element
  • MedicationStatement.informationSource
  • MedicationStatement.dosage.route
  • MedicationRequest profile parent element
  • MedicationRequest.dosageInstruction.route
  • Immunization profile parent element
  • Immunization.site
  • Immunization.route

Removed non-substative changes in order to improve differential view. Removed elements listed in StructureDefinition.differential with no changes in cardinality, binding, or must-support. Non-substantive descriptions/texts moved to Usage Notes on respective IG page:

  • Procedure profile parent element
  • Procedure.id definition
  • Patient.id definition
  • Composition.id definition
  • AllergyIntolerance profile parent element definition
  • AllergyIntolerance.id definition
  • AllergyIntolerance.note (empty diff)
  • AllergyIntolerance.clinicalStatus (empty diff)
  • conditionprofile parent element definition
  • Procedure.id definition
  • Medication profile parent element
  • Medication.id definition
  • MedicationStatement.id definition
  • MedicationRequest.id definition
  • Immunization profile parent element definition
  • Immunization.id definition
  • Immunization.lotNumber (empty diff)
  • PractitionerRole profile parent element
  • PractitionerRole.id
  • Practitioner profile parent element
  • Practitioner.id
  • Organization profile parent element
  • Organization.id
  • Device profile parent element
  • Coding profile parent element

Updated Profile Metadata value in PractitionerRole.publisher

Update of Composition.section All Slice to make the 1..1 cardinality on section.text and section.code clearer - this change was made in alignment with PS-CA and IPS-UV change

Patient.contact.relationship.code binding relaxed from required to extensible (same as base FHIR 4.0.1).

Composition.event.code (all slices) and Composition.event:careProvisioningEvent.code - binding to v3.ActClass(preferred) has been removed, and reverted to base FHIR R4.0.1 binding v3.ActCode(example)

Composition.event:careProvisioningEvent.code.coding.system+code usage note added re: fixedValues

Updated Composition.event:careProvisioningEvent.code.coding.system FixedCode to FixedUri (wrong data type)

Medication.form.coding:formSCTCA Slice binding updated from https://fhir.infoway-inforoute.ca/ValueSet/PharmaceuticalDoseFormCode to https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticaldoseformcode

Removed PractitionerRole constraint ca-baseline-pracRole-1 "PractitionerRole.code or PracitionerRole.specialty SHOULD be present"

Updated Examples (all three), due to invalid codes (not in ValueSet)

  • Medication.form.coding.code=385057009 to 421026006
  • Medication.form.coding.display="Film-coated tablet" to "Oral tablet"
  • Immunization.site.coding.code=11207009 to 32696007
  • Immunization.site.coding.display="Right thigh" to "Right leg"
  • Immunization.site.text="Right thigh" to "Right leg"

Updated Examples (all three), removing elements that no longer have MustSupport flags in v0.10.0 (see list above).

Addition of $DocRef operation IGuide Page & CapabilityStatement