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Overview

This Ontario Surgical Efficiency Reporting Information System ("SERIS") HL7® FHIR® Implementation Guide (IG) supports implementers of digital health assets that will use HL7 FHIR to enable electronic sharing of Ontario surgical services case scheduling and completion information for the purposes of evaluating surgical services capacity and operational efficiency. The guide specifies a set of rules for using FHIR resources to publish and retrieve SERIS data to/from a provincial repository provisioned by Ontario Health. The guide includes:

  • a description of the SERIS'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.

The goal of the SERIS & OR Data initiative is to enhance and incorporate the availability of surgical efficiency data (SETP) reporting.

Digital Health Information Exchange (DHIEX)

On January 1, 2021, the regulation to the Personal Health Information Protection Act, 2004 (PHIPA), O. Reg. 329/04 (“the regulation”), was amended to provide a regulatory framework (Digital Health Information Exchange (DHIEX) framework) for Ontario Health, as directed by the Minister of Health, to establish, maintain and amend interoperability specifications, as set out in sections 26 to 34 of the regulation. Ontario Health refers to its authorities under the regulation (specifically sections 26 to 34) as the Digital Health Information Exchange (DHIEX).

Ontario Health guides and supports the adoption of modern interoperability specifications for seamless access to integrated records of personal health information. In accordance with O. Reg. 329/04, the interoperability specifications are applicable to digital health assets selected, developed or used by health information custodians. In addition, a health information custodian 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 this requirement does not relieve a health information custodian of its obligation to comply with the other provisions of PHIPA and its regulations."

The following will also be included in the glossary of each spec and at the first instance of the term "DHIEX framework" in each spec "Ontario Health refers to its authorities under the regulation (specifically sections 26 to 34) as the Digital Health Information Exchange (DHIEX).

Ontario Health is required to consult with and consider the recommendations of the Information and Privacy Commissioner (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.

SETP Background

The SETP collects data relevant to the day-to-day operations of surgical suites. Operational data are recorded in three main data submission types: Case information, Cancellation information, and OR Schedule information. Standard Code Mappings are also maintained by Ontario Health.

The SETP has been in production since 2010. Data files have previously been uploaded manually from flat files with standard file specifications as documented in the Data Standardization Guide. In order to streamline the process of collection and processes to allow for the business objectives of OH and allow for near real time analysis of OR operations with an Ontario-wide lens, the Conceptual Information Model has been created to allow for data exchange of these files to occur.

The Surgical Efficiency Targets Program (SETP) uses data about Operating Room (OR) performance to monitor processes, identify and analyze areas where opportunities for improvement may exist in the perioperative portion of the continuum of care. This program helps to optimize surgical capacity in Ontario, increase access to surgical services and maintain high-quality patient care.

The CWM program is a multi-year provincial program striving to provide system stakeholders with enhanced visibility into provincial surgical data, timely information to support the facilitation of active load management and KPI visualizations to assist in performance management.

Strategic Pillar Alignment of the CWM initiative:

  • Drive system performance

  • Enable coordinated patient flow

  • Ensure equitable access

CWM Tactical Area of focus Alignment

  • Growing visibility to real-time capacity and demand

  • Leveraging real-time visibility

Content and Organization

The implementation guide is organized into the following sections:

Home includes general background information about the SETP and this implementation guide.

Business Context includes pages that provide an overview of the business model, business data, use cases and business rules that this implementation guide supports

Implementation Guidance includes pages that provide high level guidance to implementers related to the responsibility of participating systems, conformance rules, and connectivity summary.

Profiles & Operations provides details on the FHIR profiles included in the scope of this guide, including profile-specific implementation guidance and message definitions. This section also details the operations implemented by the SERIS Solution.

Capability Statement provides a description of the expected response codes as well as links to download the Capability Statement that defines the behaviour of systems associated with this guide.

Terminology provides a full list of terminology artifacts used in this implementation guide with a revision history

Downloads allows download of this and other specifications as well as other useful tools

Alignment with the International Standards & Other Pan-Canadian Specifications

The SERIS is based on the work of the Perioperative coaching teams between 2005 and 2010. It was desgined with Ontario clinician input by the Surgical Process Analysis and Improvement Expert Panel ("SPAI").

Notably, the SERIS is scoped for surgical efficiency data to be generated, stored, and transmitted within Ontario. Most of the SERIS data standards and terminiology are not aligned to international or Ontario-specific data standards and terminology. Where possible, this IG has been developed to align to the following standards:

• HL7 FHIR value sets, and

• SNOMED CT

This alignment is detailed below:

Full Name of Terminology Standard Version Domain/Chapter/Descripton of Reference Set Date of Release Release Identifier
HL7 FHIR Value sets​ 4.0.1 Various FHIR-defined value sets used throughout the SERIS profiles October 30, 2019
SNOMED CT Healthcare Professional codes and the concept for the American Society of Anesthesiologists physical status class (observable entity) September 30, 2021

This specification is fully copyright protected by the owner. The owner has the exclusive right to make copies of this specification. No alterations, deletions or substitutions may be made without the prior written consent of the owner. No part of it may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, email or any information storage and retrieval system, without the prior written consent of the owner.

This specification contains information for which copyright is held by Health Level Seven Inc. Implementors of the standards (those developing software or otherwise making use of the specification) are required to be members of either Health Level Seven Inc., HL7 Canada or one of the other HL7 affiliates. There is no such 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).

This material includes SNOMED Clinical Terms® (SNOMED CT®) (https://www.snomed.org/snomed-ct/) which is used by permission SNOMED International. All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists.

“SNOMED” and “SNOMED CT” are registered trademarks of SNOMED International (https://www.snomed.org/).

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
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Revision History

VERSION NO. DATE SUMMARY OF CHANGE CHANGED BY
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