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Intended Audience

This guide is intended to provide jurisdictional FHIR implementation guide (iGuide) authors with the tips, patterns, and messaging needed to ensure their iGuides are properly harmonized and aligned with pan-Canadian standards (e.g., PS-CA, CA:FeX).

Background

When specifications in use within Canada are working together as part of a collaborative standards development lifecycle (cSDLC), each of our jurisdictions gain the benefit of economies of scale and are better positioned for pan-Canadian collective bargaining on foundational requirements for the implementation of a given use case. This approach also results in a foundation of technical artefacts that meet the needs of jurisdictional authors and implementers, thereby reducing the time needed to author and develop against jurisdictional guides.

Most importantly, aligning to a common standard moves us towards a connected health care system that yields better health outcomes and improves human resource efficiency.

Working together does not mean that the details in the international and national specification, that don't quite fit your needs, can't be changed - it means that we all participate in a predictable process to address the needs of our implementations to ensure they are reflected upstream and downstream of the national and international specifications.

A good example of this is International Patient Summary (IPS), pan-Canadian Patient Summary (PS-CA) and the jurisdictional guidance documentation (e.g. PS-AB). The IPS specification is in its early years and was developed to provide guidance that supports cross-border exchange. Implementing countries were expected to use it as a foundation, and to identify where national challenges could not support the specification. Feedback from countries adopting it will continue to refine the specification based on implementation realities.

The same is true for jurisdictions implementing a national specification. The goal is for the national and international specifications to mature and evolve to a place where they converge to become a single implementable specification with the necessary optionality that covers for local realities, including country borders and their jurisdictional requirements (e.g., local, regional, state/provincial, national). This convergence comes based on jurisdictional and solution-specific input is critical in ensuring bi-directional improvements of all levels of specification.

When we do not work together, we will not be able to achieve an interoperable health care system. When consistent specifications are not used, this will undercut the value of standardization, raise costs of IT solutions and implementations due to customization requirements, and ultimately make it more difficult for a patient's healthcare data to be exchanged.

Understanding the Landscape of Standards

In every national health information exchange ecosystem – there is a landscape of standards that provide rules and guidance that influence the design and behavior of systems.

A single use case may have the following layers of standards applied: international specifications, national specifications, regional/jurisdictional specifications, and potentially implementation-level guidance. This is due to the nature of how standards are designed and enforced.

  • Designed: Specifications that touch on use cases typically have more flexibility in International specifications due to differences in workflows/delivery of healthcare across nations. ​This makes international use case specifications difficult to adopt “out-of-the-box”​.

  • Enforced: International standards development organizations (e.g., HL7 International, IHE) have testing & conformance events but rely on national and jurisdictional programs to enforce and incentivize adoption of the standards​. International specifications also rely on an engaged community of trial implementers at the national and jurisdictional level to help refine the international specifications​.

Multiple Layers of a Specification Can Be Incredibly Effective When:

  • Specification layers are synchronized with each other (in content and in process)
    • For example, avoiding the introduction of options that are not defined (or are not in the process of being defined) in the layers below
  • Each layer performs its proper functions
    • For example, reducing the gaps in functions that have to be passed on to the next layer of specifications
  • Functions provided at each layer do not overlap or contradict each other
    • For example, avoiding duplication or contradiction of efforts that create inefficiencies and overwhelm vendors

Specification Layer Functions:

JIST-purpose

We recommend reviewing the content (as sequenced) below before you start to explore relevant Pan-Canadian FHIR iGuides and other jurisdictional iGuides on the Canadian FHIR Registry.