Pan-Canadian eReferral-eConsult (CA:eReC) v1.3.0-DFT-preBallot
1.3.0-dft-preBallot 
DFT - The specification is currently in development and subject to change. For a full list of available versions, see the Directory of published versions
Change Log
Guide Versions
| Version | Date | Description |
|---|---|---|
| 1.3.0 DFT-preBallot | 05/22/2026 | Incorporating implementer feedback and Jurisdictional change requests |
| 1.2.0 DFT | 10/31/2025 | For the 2026 Projectathon |
| 1.1.0 DFT-Ballot | 4/15/2025 | Incorporating feedback from 2025 Projectathon and Jurisdictional change requests |
| 1.0.3 DFT | 06/12/2024 | For the Feb 2025 Projectathon |
| 1.0.0 DFT-Ballot | 03/27/2024 | First published version of the Draft for ballot review |
Known Issues
Any known issues found within the guide will be documented in the section provided here in future iterations of this guide. To provide your questions or concerns please message Canada Health Infoway on: interoperability@infoway-inforoute.ca.
| # | Description | Status |
|---|---|---|
| 1. | Re-introduced virtualService extension derived from FHIR R5 element and backported the Appointment.class element through a HL7 cross-version extension. Current tooling does not support the rendering of elements that are pre-adopted from later versions of FHIR. This rendering does not impact the ability for implementers to follow the standard convention for expressing and utilizing content in later FHIR versions | Resolved |
| 2. | Some referenced ValueSets are not available at their canonical URL. For some of these ValueSets, "stub" resources have been created to stand-in within this Implementation Guide for the unresolvable ValueSets. - ValueSets that are in the process of promotion for pan-Canadian use and will be maintained on Canada Health Infoway's Terminology Server : TaskCode, ReferralBusinessStatus, ReferralStatusReason, PreferenceTypeCode, MessageChangeReasonCode, MessageEventCode, ReferralCommunicationCategory, CommunicationBarrier. These valueSets have a confirmed CodeSystem and ValueSet canonical URLs as shown on their element bindings in the Resource Profiles. The canonical URLs will resolve to the normative set on Terminology Server in the near-term after which the stub valueSets will be removed from the project | Resolved |
| 3. | ValueSet is targeted for an upcoming SNOMED-CT CA release on Canada Health Infoway's Terminology Server : servicerequest-category - The valueSet canonical URL and/or name is expected to change | Resolved |
| 4. | Some referenced pan-Canadian valueSets that are expected to be available at their canonical URL from the profile element binding and Terminology Binding tables below the profiles, but are resolving to a CA:Core+ valueSet stub due to the package dependency. For now, copy the URL from the Simplifier stub to your browser to access the normative subset on Canada Health Infoway's Terminology Server, which will need an InfoCentral Account to access - e.g. ProcedureCode, etc. | Open |
Specifications Updates
| RELEASE | VERSION No. | DATE | SUMMARY OF CHANGE |
|---|---|---|---|
| CA:eReC v1.3.0 DFT-preBallot | v1.3.0 | 05/22/2026 | Business Context - Expanded workflow edge cases covering appointment modifications, cancellations, revocations, declines, and split/child referral scenarios. -Added guidance for copied participants (CC’d providers) in referral workflows - Added support for 'semi-urgent' priority in addition to the fixed priority codes - Added support for transmitting patient consent to be notified about referral updates - Business Rules: Referenced CA:CSD for additional HealthcareService Business Rules - L3: Communications: Added narrative to clarifying attachment handling and relationship to ServiceRequest and DocumentReference resources; Added narrative clarifying bi-directional Communication Messaging in Route/Split scenarios Technical Context - Clarified routing, splitting, and chaining guidance for ServiceRequest identifiers and requisitions, and message “Slimming Rules” - Ensured consistent MessageHeader population rules across MessageBundles for Central Systems. - Improved consistency in Resource Profile usage notes for optional elements and references. - Fixed sequence diagrams addressing Central System alternate flows for revoke, update and cancel. - Technical Foundation: Referenced HALO for SMART on FHIR guidance; Updated links to reference HL7 FHIR R4 messaging guidance. FHIR Artifacts - Claimed canonical URL http://fhir.infoway-inforoute.ca/io/CA-eReC/ for the project - Updated Examples to fix inconsistencies - Improved consistency in Resource Profile usage notes for optional elements and references. - Ensured consistent MessageHeader population rules across MessageBundles for Central Systems. - Extensions: Referenced CA:CSD for additional HealthcareService and Location Extensions |
| CA:eReC v1.2.0 DFT | v1.2.0 | 10/31/2025 | FHIR Artifacts - Updated usage on the Communication and DocumentReference profile pages to reflect use of Communication.payload.contentReference (DocumentReference) instead of Communication.payload.contentAttachment Examples - Added payload examples for chaining |
| CA:eReC v1.1.0 DFT | v1.1.0 | 9/18/2025 | Business Context - Reorganized content under Business Events. - Extensive clarifications added to System Maturity Levels (e.g. L3 - Advanced Workflows) Technical Context - Fixes and clarifications to Sequence Diagrams - Clarifications to Slimming Rules - Updated Informer and Recipient Actor default option to None from L3 - Reorganized content under Constructing Messages page - Cross-links added between Route/Split/Chain content present under different guide sections - Clarifications to Technical Actors in Central Systems Examples - Added payload examples for route/split. chaining will be added soon Terminology - Significant updates to Terminology bindings from CA CDI alignment, and promoting certain valueSets as pan-Canadian |
| CA:eReC v1.1.0 DFT-ballot | v1.1.0 | 4/15/2025 | - Using pan-Canadian Enterprise Template. Technical Context - Fixes to certain transactions in UC-4 Central Access and Triage (CAT), Select Alternate Flows Sequence Diagrams - Updated guidance for how Target Systems shall reference ServiceRequest received from Source systems - MessageTransaction Details: Indicating where focus is variable and appropriate changeReasonCode to use Examples - Adding Examples for all messaging events |
| CA:eReC v1.0.3 DFT | v1.0.3 | 12/06/2024 | Technical Errata - Removed package dependency on ca.on.oh-eReferral-eConsult 0.11.1-alpha1.0.12. - Fixed links pointing to previous ON eServices extensions, codesystems, and valuesets. |
| CA:eReC v1.0.2 DFT | v1.0.2 | 10/30/2024 | Technical Errata - Modified Bundle slicing discriminator from resource type to profile to improve validation capabilities. Fix typos on Messaging Compliance Table (in the Actors and Transactions section) for the following transactions: Notify data correction [eReCm-4] - Maturity Level should be L2 for eReC Requester Send communication from requester [eReCm-9] - Maturity Level should be L3 for eReC Performer Send communication from performer [eReCm-10] - Maturity Level should be L3 for eReC Performer |
| CA:eReC v1.0.1 DFT | v1.0.1 | 10/9/2024 | Technical Errata - Update to the canonical url for task-code. - Updated the profile pages to reflect the correct canonicals for each profile - Added linkage and description to the existing BusinessStatusReason extension in the extension table. |
| CA:eReC v1.0.0 DFT | v1.0.0 | 10/1/2024 | - Updated overall page hierarchy from ballot feedback Business Context - Added Business Models page to describe the people and systems that contribute to a service record in different eReferral and eConsult models supported by the specification. - Updated Use Cases page - Added a use case for Central Access and Triage in addition to Central Intake. Updated flow diagrams for simplicity and consistency with sequence diagrams. - Added Business Events page to describe events supporting eReferral/eConsult workflow associated with different levels of system maturity. Technical Context Updated MustSupport definition from ballot feedback - highlighted 'use case support' guidance on resource profiles. - Added Integration Patterns page to highlight the real-world architectures that support the business models to provide implementable technical specifications. - Updated technical actors, actor options and grouping. - Note: Addition of eReC Informer and eReC Recipient technical actors with updated eReC-m2: Notify new service record , and new eReC-m11: Notify update service record transactions. - Updated Messaging page with new actor definitions and transactions, re-framing transactions in context of maturity levels. Added requirements for reducing message size within a message bundle. - Updated Sequence diagrams with new/updated actors and transactions. Added a diagram to support the Central Access and Triage use case. - Updated Conformance Requirements tables with new/updated actors and transactions. Added a table to support Central Access and Triage use case. |
Resource Profile Updates
| PROFILE | VERSION No. | DATE | SUMMARY OF CHANGE |
|---|---|---|---|
| ServiceRequest | 1.3.0 | 05/22/2026 | Breaking Change aligned category binding with pan‑Canadian service categories and CA CDI v3 draft alignment - ServiceRequest.category minimum cardinality 1..* - ServiceRequest.category: added slices for referralType: 1..1 required binding to ReferralType (code for ‘eReferral’, ‘eConsult’); serviceType: 0..*: required binding to ReferralServiceCategoryCode (now on Terminology Server) - Added SubPriority Extension - Updated CopiedParticipants extension to allow either a reference to a PractitionerRole or a HealthcareService resource - Added ServiceRequest.supportingInfo Reference to Consent - Clarified .requisition usage - Loosened routing identifier constraints - Improved narrative consistency for supporting information and attachments. |
| Task | 1.3.0 | 05/22/2026 | Breaking Change Task.focus as MustSupport Reference to Consent - Clarified pan-Canadian usage of .businessStatus valueSet (prioritizing code visibility for re-use by implementers), relaxed binding strength to preferred |
| Consent | 1.3.0 | 05/22/2026 | Added Consent profile for consent to receive patient notifications (email/sms) |
| Appointment | 1.3.0 | 05/22/2026 | Breaking Change Appointment.identifier min cardinality 1..* - Fixed unresolvable reference error with AppointmentClass cross-version extension |
| MessageHeader | 1.3.0 | 05/22/2026 | Replicated Central System (scenarios where ServiceRequest.performer is HealthcareService) population rules across all MessageBundle types to ensure consistent .author handling |
| All Profiles | 1.3.0 | 05/22/2026 | Clarified usage notes on Reference elements to be consistent with MessageBundle creation and “Slimming rules” on Constructing Messages page |
| Communication | 1.2.0 | 10/31/2025 | Updated Communication.payload.content[x] choices - added Communication.payload.contentReference (DocumentReference) - removed Communication.payload.contentAttachment |
| all profiles | 1.1.0 | 9/18/2025 | .meta element The MustSupport flag on this element has been added, but not fixed to any profile or version. |
| ServiceRequest | 1.1.0 | 9/18/2025 | ServiceRequest.supportingInfo references CA Core+ AllergyIntolerance and Condition resources ServiceRequest.identifier.use is Must Support ServiceRequesterDelegate extension cardinality changed to 0..* ServiceRequest.code has updated binding to https://fhir.infoway-inforoute.ca/ValueSet/procedurecode (extensible) ServiceRequest.reasonCode has updated binding to https://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode (extensible) ServiceRequest.category has updated binding to servicerequest-category (preferred)- note this is an informative valueSet until the canonical URLs are confirmed, Added RequestStatusReason extension to provide a coded reason for .status, bound the element to https://fhir.infoway-inforoute.ca/ValueSet/ca-referralstatusreason (extensible) Updated ServiceProviderPreference.PreferenceType binding to https://fhir.infoway-inforoute.ca/ValueSet/ca-preferencetypecode Removed ReferralIdentifier extension |
| Task | 1.1.0 | 9/18/2025 | Updated extension name from statusReason to businessStatusReason and added binding to https://fhir.infoway-inforoute.ca/ValueSet/ca-referralstatusreason (extensible) Updated Task.businessStatus binding to https://fhir.infoway-inforoute.ca/ValueSet/ca-referralbusinessstatus (extensible) |
| Appointment | 1.1.0 | 9/18/2025 | AppointmentClass, Appointment Virtual Service extensions added, and virtualService.channelType bound to https://fhir.infoway-inforoute.ca/ValueSet/visitmodalitycode (extensible) |
| Communication | 1.1.0 | 9/18/2025 | Updated Communication.category binding to https://fhir.infoway-inforoute.ca/ValueSet/ca-referralcommunicationcategory (extensible) |
| Practitioner | 1.1.0 | 9/18/2025 | Practitioner.name cardinality updated 1..* |
| PractitionerRole | 1.1.0 | 9/18/2025 | PractitionerRole.telecom.value is MustSupport PractitionerRole.code updated binding to https://fhir.infoway-inforoute.ca/ValueSet/healthcareproviderrolecode (preferred) PractitionerRole.specialty updated binding to https://fhir.infoway-inforoute.ca/ValueSet/healthcareproviderrolecode (preferred) |
| Location | 1.1.0 | 9/18/2025 | Location.telecom.value cardinality updated 1..1 Location.address.line, Location.address.city is MustSupport |
| Patient | 1.1.0 | 9/18/2025 | Patient.address.line, Patient.address.city is MustSupport Removed MustSupport from CommunicationBarrier extension, moved it to Patient.extension and updated valueSet binding to https://fhir.infoway-inforoute.ca/ValueSet/ca-communicationbarrier (extensible) patient.communication.language updated binding to http://hl7.org/fhir/ValueSet/languages (preferred) Patient.contact.relationship updated binding to https://fhir.infoway-inforoute.ca/ValueSet/personalrelationshipcodes (extensible) |
| DocumentReference | 1.1.0 | 9/18/2025 | DocumentReference.content cardinality updated to 1..1 DocumentReference.context.related.identifier.use: updated to be MustSupport and 1..1 cardinality |
| MessageHeader | 1.1.0 | 9/18/2025 | MessageHeader.destination updated cardinality to 1..* MessageHeader.event[x] updated binding to https://fhir.infoway-inforoute.ca/ValueSet/ca-messageeventcode (extensible) MessageHeader.reason updated binding to https://fhir.infoway-inforoute.ca/ValueSet/ca-messagechangereasoncode (extensible) |
| QuestionnaireResponse | 1.1.0 | 9/18/2025 | QuestionnaireResponse.partOf cardinality updated to 0..1 |
| HealthcareService | 1.1.0 | 9/18/2025 | HealthcareService.type cardinality updated to 1..* and has updated binding to servicerequest-category (preferred)- note this is an informative valueSet until the canonical URLs are confirmed |
| Task | 1.1.0 | 4/15/2025 | HealthcareService is an allowable reference in Task.owner Task.output can use String and Code as allowable data-types |
| Communication | 1.1.0 | 4/15/2025 | HealthcareService is an allowable reference in Communication.sender |
| ServiceRequest | 1.1.0 | 4/15/2025 | Every ServiceRequest SHALL have a single official business identifier where ServiceRequest.identifier.use = "official" Changed BindingStrength for ServiceRequest.category to preferred Added ServiceProviderPreference extension to ServiceRequest to indicate preference for provider or location Added ServiceRequesterDelegate extension to ServiceRequest to identify person or provider that is the delegate Added back RoutingOptions and ReferralIdentifier extensions Added back PerformerIdentifier extension to ServiceRequest.performer |
| Patient | 1.1.0 | 4/15/2025 | Patient.identifier is an optional, must-support element |
| MessageHeader | 1.1.0 | 4/15/2025 | MessageChangeReasonCode valueset has extensible binding with MessageHeader.reason to provide context on the trigger for ‘notify-update’ messages Added back RoutingOptions and ReferralIdentifier extensions |
| Bundle | 1.0.2 | 10/30/2024 | Technical Errata - Modified Bundle slicing discriminator from resource type to profile to improve validation capabilities |
| Task | 1.0.1 | 10/9/2024 | Technical Errata - Update to the canonical url for task-code |
| HealthcareService | 1.0.0 | 9/18/2024 | HealthcareService profile added from ballot feedback |
| Questionnaire | 1.0.0 | 9/18/2024 | Questionnaire profile removed from ballot feedback |
| Appointment, Bundle, Communication, DocumentReference, Location, MessageHeader, Organization, Patient, Practitioner, PractitionerRole, QuestionnaireResponse, ServiceRequest, and Task profiles | 1.0.0 | 9/18/2024 | Updated these profiles and version numbers based on ballot feedback |
| CommunicationBarrier, CopiedParticipants, DARC, DART, HCNV Code, PatientPresentLocation, PerformerIdentifier, ReasonForNoHCN, ReferralIdentifier, and RoutingOptions extensions | 1.0.0 | 9/18/2024 | Removed mustsupport and updated version numbers on these extensions |
| all profiles | .meta element The MustSupport flag on this element has been relaxed in this version until further confirmation of the use of meta.profile (outside of use for certain validation suites) and impact can be assessed by the working group. Please note that this relaxation is based on the IG Best Practices highlighted here of avoiding forcing the mustSupport constraint on .meta in profiles unless absolutely necessary. |
||
| all profiles | .coding Elements .coding.system and .coding.display have been relaxed, while the elements .coding and .coding.code will maintain their constraints as discussed within the eReferral interoperability working group, pending further discussion based on the mustSupport definition (TBC). |
Terminology Updates
| VALUE SET/CODE SYSTEM | Guide VERSION No. | DATE | SUMMARY OF CHANGE |
|---|---|---|---|
| ReferralBusinessStatus | 1.3.0 | 05/22/2026 | - Added deferred-by-performer, cancelled-by-central-triage; completed-with-advice concepts |
| ReferralType | 1.3.0 | 05/22/2026 | - Adopted as the “required” binding target for ServiceRequest.category:referralType |
| ReferralServiceCategoryCode | 1.3.0 | 05/22/2026 | - Adopted as the “required” binding target for ServiceRequest.category:serviceType and "preferred" binding target for HealthcareService.type from previous ServiceRequestCategory stub since Value Set is now available on the Infoway Terminology Server. (Intensional definition has not changed) |
| Multiple ValueSet & CodeSystem stubs | 1.3.0 | 05/22/2026 | - Removed deprecated stub ValueSets & CodeSystems that are now available on the Infoway Terminology Server: CommunicationBarrier, CommunicationCategory, MessageChangeReasonCode, MessageEventCode, PreferenceTypeCode, ServiceRequestCategory, TaskBusinessStatus, TaskBusinessStatusReason, TaskCode |
| MessageChangeReasonCode | 1.1.0 | 9/18/2025 | Updated with new pan-Canadian canonicals to be maintained on Terminology Server |
| PreferenceTypeCode | 1.1.0 | 9/18/2025 | Updated with new pan-Canadian canonicals to be maintained on Terminology Server |
| CommunicationBarrier | 1.1.0 | 9/18/2025 | Updated with new pan-Canadian canonicals to be maintained on Terminology Server |
| ReferralCommunicationCategory | 1.1.0 | 9/18/2025 | Updated with new pan-Canadian canonicals to be maintained on Terminology Server (old name:CommunicationCategory) |
| MessageEventCode | 1.1.0 | 9/18/2025 | Updated with new pan-Canadian canonicals to be maintained on Terminology Server |
| ReferralBusinessStatus | 1.1.0 | 9/18/2025 | Added new pan-Canadian valueSet and codeSystem to be maintained on Terminology Server |
| ReferralStatusReason | 1.1.0 | 9/18/2025 | Added new pan-Canadian valueSet with codes from ReferralBusinessStatus and TaskStatus to be maintained on Terminology Server |
| TaskCode | 1.1.0 | 9/18/2025 | Updated with new pan-Canadian canonicals to be maintained on Terminology Server |
| MessageChangeReasonCode | 1.1.0 | 4/15/2025 | Added MessageChangeReasonCode valueset to MessageHeader.reason to provide context on the trigger for ‘notify-update’ messages |
| PreferenceTypeCode | 1.1.0 | 4/15/2025 | Used with the ServiceProviderPreference extension to indicate a preference type |
| All valueSets | 9/18/2024 | ValueSets were refined to include correct canonicals, with Canada Health Infoway owned codesystems created for each valueSet (with exception of human-language valueSet). Version numbers were removed | |
| CommunicationBarrier | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes codes from https://ehealthontario.ca/fhir/CodeSystem/communication-barrier until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems |
| CommunicationCategory | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes codes from https://ehealthontario.ca/fhir/CodeSystem/communication-category until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems |
| DARC DART Reason | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes codes from https://ehealthontario.ca/fhir/CodeSystem/darc-dart-reason until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems |
| eReferralIdentifierType | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes the code from http://ehealthontario.ca/fhir/CodeSystem/ereferral-identifier-type until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems |
| HumanLanguage | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention |
| MessageEventCode | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes codes from https://ehealthontario.ca/fhir/CodeSystem/message-event-code until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems |
| PatientContactRelationships | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes codes from http://ehealthontario.ca/fhir/CodeSystem/patient-contact-relationship until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems. Note that these codes in particular may also evolve as part of the requirements for emergency contact relationship codes in the pan-Canadian Health Data Content Framework |
| TaskBusinessStatus | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes codes from https://ehealthontario.ca/fhir/CodeSystem/task-business-status until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems |
| TaskCode | 0.1 | 11/28/2023 | Replaced eHealthOntario ValueSet Canonical with IGuide Canonical convention, still includes codes from https://ehealthontario.ca/fhir/CodeSystem/task-code until further feedback from the eReferral Interoperability Working Group is collected to address the impact of changing the code system on production systems |
Package Downloads
Please refer to Downloads