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This eHealth Ontario eReferral implementation guide provides support for integrating HL7 FHIR to submit,communicate,and book appointments for patients . It supports submitting new eReferrals to an eReferral server and includes functional business context and design guidance for implementing eReferral FHIR profiles to send electronic referrals.

Version 0.10.0 of the eReferral FHIR implementation guide is based on FHIR R4.

The MIME type for FHIR resources in this project is application/fhir+json; charset=utf-8.

It is assumed that the reader of this specification has the following knowledge

  • An overall understanding of the FHIR standard
  • An overall knowledge of RESTful API architecture
  • A basic understanding of healthcare referral processes


This FHIR eReferral implementation guide is the product of a group of stakeholders that are dedicated to improving patient care delivery through standards-based integration. The workgroup recognizes that seamless eReferrals between care providers – regardless of their eReferral platform - will improve patient care, experience and outcomes, while removing the administrative burden from providers. The founding co-chairs – Tim Berezny (Caredove) and Caryn Harris (Orion Health) – and workstream members represent many eReferral vendors and jurisdictional stakeholders (please see the list below).

The FHIR eReferral workstream kicked off in 2016 with the goal of developing a flexible, standards-based implementation guide for eReferral workflow and communication. Our scope is from the time a provider is selected for a referral through the closing of the referral by the referral recipient. This includes initial acceptance, request for further information, scheduling of the appointment and sending updates before or after care is provided by the referral recipient. Ad-hoc communications and document exchange between requester and referral recipient is also in scope. Future scope may include contacting a service directory for resource matching, deeper integration with the patient’s digital health record (e.g. to provide richer information with the referral) and consent management. For more details, please see the eReferral design canvas.

Our goal has been to profile FHIR resources in a manner that will accelerate the work of a specific referral pathway, but is still broad enough to be used for future pathways within multiple care sectors across Canada. We have been fortunate to have an Ontario business sponsor provide use cases and specific pathways to drive our profiling of relevant FHIR resources. The current version of the eReferral implementation guide has been built around referrals to home and community care service providers in Ontario. As additional use cases/pathways implement eReferral, our vision is that the emerging eReferral ecosystems will build on the shoulders of this specification, with further insights incorporated into the implementation guide on an ongoing basis, across all Canadian jurisdictions.

The breadth of stakeholder representation provides multiple perspectives to the FHIR resource profiling that is the core of the implementation guide. The analysis, discussions and recommendations are conducted via the biweekly workstream web conference calls and this collaboration site. There are occasional out-of-cycle workshops when a project requires more intensive deliberation or deliverables within a set timeframe.

You are welcome to join us on the eReferral FHIR workstream to share your ideas, comments and questions.

Implementation Guide Contributors:

  • Co-Chair: Tim Berezny (Caredove)
  • Co-Chair: Caryn Harris (Orion Health)
  • Alfred Wong (Think Research)
  • Amadou Tall (Strata Health Solutions)
  • Cindy Jiang (eHealth Ontario)
  • Dustin Doan (CognisantMD)
  • Fariba Behzadi (eHealth Ontario)
  • Geoff Ramsay (Think Research)
  • Ion Moraru (Health Shared Services Ontario)
  • Janice Spence (eHealth Ontario)
  • Jeff Kavanagh (CognisantMD)
  • John Wills (System Coordinated Access Program, eHealth Centre of Excellence)
  • Matt Atwood (Novari Health)
  • Radhika Verma (eHealth Ontario)
  • Shamhad Abdi (eHealth Ontario)
  • Smita Kachroo (eHealth Ontario)
  • Ted Jin (eHealth Ontario)
  • Yaron Derman (eHealth Ontario)

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