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Introduction

Overview

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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, an amendment to Ontario Regulation 329/04 (“O. Reg. 329/04” or the “regulation”) came into force to establish the DHIEX framework for interoperability specifications, as set out in sections 26 to 34 of the regulation. As a cornerstone of the Ministry of Health’s Digital First for Health Strategy, the DHIEX framework is intended to guide and support adoption of modern interoperability specifications for seamless access to integrated records of personal health information. In accordance with the regulation, Ontario Health is required to, subject to the review and approval of the Minister, establish, maintain and amend interoperability specifications for digital health assets selected, developed or used by health information custodians.

In accordance with O. Reg. 329/04, 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.

{Insert Project Name] Background

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Content and Organization

The implementation guide is organized into the following sections:

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Alignment with the International Standards & Other Pan-Canadian Specifications

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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​

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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 this interoperability specification available to the public by posting it on Ontario Health’s website or by such other means as Ontario Health considers advisable.

You understand and agree that:

  1. This specification is provided “AS IS” without any warranties or representations of any kind, express or implied, in fact or in law;
  2. 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
  3. 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.