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1.1. Introduction

1.1.1. Overview

Ontario's current immunization data is fragmented across multiple, disconnected systems, creating significant gaps and inefficiencies for providers and public health. The Provincial Electronic Health Record - Immunization Repository (EHR-IR) is the foundation for Ontario's "One Immunization Record" vision, establishing a scalable, centralized asset to capture, manage, and share immunization records in real-time. The primary goal is to improve the accuracy, accessibility, and timeliness of immunization data, creating a single, comprehensive source of information for all Ontarians.

This FHIR implementation guide supports establishing a provincial FHIR standard for immunization data exchange. The EHR-IR will be built on Ontario Health's existing Clinical Data Foundations (CDF) platform and will integrate with core services like the Provincial Client Registry (PCR), Provincial Provider Registry (PPR), and Consent Management (CMTA). The initial release of this multi-year project will focus on enabling two key data contribution streams: a dedicated interface for ongoing records from the Panorama public health system and direct, real-time submissions from community pharmacy management systems.

1.1.2. 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.

1.1.3. Copyright Notice

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. 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).

LOINC® is a registered trademark of the Regenstrief Institute, Inc. (http://regenstrief.org)

This material includes SNOMED Clinical Terms® (SNOMED CT®) (https://www.snomed.org/use-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/).

1.1.4. 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.

1.1.5. Approval History