Ontario Subscription HL7® FHIR® Implementation Guide -v1.0.0-ballot1
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This Implementation Guide (IG) will provide comprehensive guidance on leveraging the advanced Subscription capabilities of FHIR R5 within an existing FHIR R4 infrastructure. Specifically, the IG will focus on the use of the R5 Subscription Backport to enable Health Information Custodians (HICs) in Ontario to implement real-time, event-driven data exchange notifications using FHIR. This approach allows for the adoption of key R5 features, such as SubscriptionTopic and SubscriptionStatus resources, enhanced filtering and standardized notification bundles, without requiring a full migration to R5.
In Scope
This IG is focused on use cases, system interactions and FHIR profiles for integration between Point of Service (PoS) such as primary care electronic medical records (EMRs), Hospital Information System (HIS), Clinical Portals and the Ontario Health Subscription Service.
Out of Scope
Following items are excluded from the scope of this IG and shall not be a concern for the system integrators:
The creation of subscription topics (queues) and publishing of event notifications to the Subscription Service by OH digital health assets.
Creation of subscriptions and event notifications where a Publisher and/or a Subscriber is outside of Ontario Health ecosystem (not OH digital health assets).
The guidance will be tailored to the Ontario healthcare context, addressing relevant provincial standards, policies and use cases. This IG aims to empower stakeholders in the Ontario healthcare ecosystem to enhance the efficiency, reliability and interoperability of their FHIR-based solutions through the adoption of R5 Pub/Sub capabilities.
Ontario Health will be establishing the HL7 FHIR Subscription IG as an interoperability specification under Ontario’s Digital Health Information Exchange (DHIEX) framework.
The following information is provided in accordance with O. Reg. 329/04 under Personal Health Information Protection Act (PHIPA), 2004, section 28 Application of Specifications.
| Requirement | Details |
|---|---|
| Specification effective date (Note: This is the date by which all applicable HICs are required to be compliantly contributing and/or consuming the approved interoperability specification. OH will work with the applicable HICs to establish the implementation plan in order to meet the effective date.) | N/A - Balloted Draft |
| Name, description, or class of Health Information Custodians that must select, develop, or use digital health assets that comply with the specification: | Health Information Custodians that implement the pan-Canadian HALO Specification and utilize the SMART on FHIR Accelerator functionality as defined in HALO: - Clinicians, including primary care providers (also GPs and NPs) and Specialists who are classified as health care practitioners under PHIPA s3(1) and s 2(1) - Hospitals as per the Public Hospitals Act, R.R.O. 1990, Reg. 965. Health Information Custodians that are the recipient of the clinical data delivered by the Ontario Clinical Reports Exchange (OCRE) from hospitals and ICHSC to clinicians: - Clinicians, including primary care providers (also GPs and NPs) and Specialists who are classified as health care practitioners under PHIPA s3(1) and s 2(1) - Hospitals as per the Public Hospitals Act, R.R.O. 1990, Reg. 965. - Pharmacy as per the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4 - A health facility, including a community surgical and diagnostic centre, in which one or more members of the public receive services for or in respect of which facility costs are charged or paid, as per Integrated Community Health Services Centres Act, 2023, S.O. 2023, c. 4, Sched. 1. |
| Types of digital health assets to which the specification applies. | Digital health assets used by Health Information Custodians for the following purpose: - Point of Service systems used by the HICs above that subscribe to Ontario Health Enterprise Publish and Subscribe service for receiving notifications |
| Circumstances, if any, when a Health Information Custodian may be exempted from the requirement to select, develop or use digital health assets that comply with the specification: | TBD |