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1.2. Introduction

1.2.1. Overview

This Implementation Guide details the Ontario Health (OH) Provenance model, a critical component for ensuring the traceability and integrity of health data within the province's digital health ecosystem. Provenance, as defined by the FHIR standard and rooted in the World Wide Web Consortium (W3C) Provenance specification, provides essential "Who, What, When" information about the creation, modification, and deletion of health resources. By meticulously documenting the entities and agents involved in data transactions, this guide aims to establish a robust framework for assessing the quality, reliability, and trustworthiness of health information.

The core objective of this guide is to support comprehensive traceability of repository-versioned content to its contributors and the transactions that led to its contribution. The Clinical Data Repository (CDR) will play a pivotal role by injecting Provenance resources during data ingestion, ensuring that these records are stored alongside the contributed data. This strategic approach facilitates powerful traceability queries, allowing for a clear understanding of the data's lifecycle and its journey through various systems and processes.

This document will delve into the specifics of the OH Provenance Profile, detailing key elements such as Provenance.target, Provenance.agent.who, and Provenance.entity.what. It will also outline the proposed Clinical Data Foundation (CDF) and HALO mappings, including the handling of system URIs for identifiers like MSH-10, X-Request-ID, MSH-3.2, and azp. Furthermore, the guide will provide practical search examples and illustrative diagrams to demonstrate how Provenance records can be effectively utilized for data quality, clinical documentation, and clinical data traceability within Ontario Health's evolving digital infrastructure.

This guide is based on FHIR R4.0.1.

1.2.2. Ontario Health Provenance Background

• FHIR Provenance resource tracks information about an activity that created, revised, deleted, or signed a version of a resource, describing the entities and agents involved

• This information can be used to form assessments about its quality, reliability, trustworthiness, or to provide pointers for where to go to further investigate the origins of the resource and the information in it

• Provenance resources are a record-keeping assertion that gathers information about the context in which the information in a resource was obtained

• Provenance resource is based on the World Wide Web Consortium (W3C) Provenance specification

• Provenance resources are prepared by the application that initiates the create/update etc. of the resource

• AuditEvent resource contains overlapping information, but is created as events occur, to track and audit the events

• AuditEvent resources are often (though not exclusively) created by the application responding to the read/query/create/update/etc. event

In terms of W3C Provenance:

• FHIR Provenance resource covers "Generation" of "Entity" with respect to FHIR defined resources for creation or updating;
  
• whereas AuditEvent covers "Usage" of "Entity" and all other "Activity" as defined in W3C Provenance

1.2.4. Legal Disclaimer

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.

1.2.6. Document Control

The electronic version of this specification is recognized as the only valid version.

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