Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.
PS-CA Library of Profiles
PS-CA Structure
A patient summary, as defined in both the IPS-UV and PS-CA specifications, is a document. The Composition (PS-CA)
Composition profile dictates the structure of the patient summary document in a way that combines information about the creation of the patient summary (e.g., header information) with clinical information about the patient (e.g., composition sections).
The Composition (PS-CA) profile relies on the capability in FHIR® to reference other FHIR resources to establish a link between the Composition resource and the other resources that belong to each of its sections.
All the resources that make up the Patient Summary document (e.g., Composition, Immunization, Condition, MedicationRequest, etc.) are transported together using a FHIR Bundle. This Bundle SHALL include all the resources that are referenced directly or indirectly by the PS-CA Composition.
Note: Reviewers are encouraged to review the section definitions on the Composition profile to understand how the FHIR profiles below are used to populate the sections (e.g., how Condition PS-CA is used in the Problems Section as well as the History of Past Illness Section).
List of Profiles in PS-CA
Pages have been developed for the profiles in PS-CA Version 2.0.0 DFT-preBallot. Each of the pages include the:
- profile differential table
- extensions (if applicable)
- description of the differences between this profile and the corresponding IPS profile
Bundle
This profile represents the constraints applied to the Bundle resource by the PS-CA project.
Composition
This profile represents the constraints applied to the Composition resource by the PS-CA project. A Canadian Patient Summary (PS-CA) document is an electronic health record extract containing essential healthcare information about a subject of care. It is informed by the IPS-UV Composition profile but differs primarily in its application of Must Support flags on some of the sections to allow jurisdictional implementers to have flexibility in which sections systems must support in order to show conformance to their respective patient summaries.
Header Section
This profile represents the constraints applied to the Patient resource by the PS-CA project to represent the minimum expectations for the Patient resource when used in the PS-CA composition profile or in one of the referred resources. It is informed by the constraints of the Patient (IPS) profile and the Canadian Baseline package/structuredefinition-profile-patient.json.
The determination of which profiles (e.g., practitioner, practitionerRole, organization, device) are used to convey header details (e.g., author, attester, custodian, etc.) is determined by the workflow of the implementing jurisdiction. Readers are encouraged to review the Jurisdictional Context to review the approaches that jurisdictions are implementing.
Note: Some elements in the Header section (author, attester, custodian) reference resources that do not currently have appropriate equivalent profiles in the current PS-CA specification; implementers are encouraged to utilize the minimal profiling expectations outlined in the Canadian Baseline profiles in these cases:
- package/structuredefinition-profile-practitioner.json
- package/structuredefinition-profile-practitionerrole.json
- package/structuredefinition-profile-organization.json
Medications Section
This profile represents the constraints applied to the Medication resource by the PS-CA project to represent a medication in the patient summary. It is informed by the constraints of the Medication (IPS) profile and the Canadian Baseline package/structuredefinition-profile-medication.json to allow for cross-border and cross-jurisdiction sharing of Medication Summary information.
This profile represents the constraints applied to the MedicationRequest resource by the PS-CA project, which is informed by the constraints of the more recent direction of the IPS-UV September 2021 Connectathon Build and by the constraints of the Canadian Baseline package/structuredefinition-profile-medicationrequest.json to allow for cross-border and cross-jurisdiction sharing of information record of a medication request information in the patient summary.
This profile represents the constraints applied to the MedicationStatement resource by the PS-CA project to represent a record of a medication statement in the patient summary. It is informed by the constraints of the Medication Statement (IPS) profile and the Canadian Baseline package/structuredefinition-profile-medicationstatement.json to allow for cross-border and cross-jurisdiction sharing of Medication Summary information.
Allergies Section
This profile represents the constraints applied to the AllergyIntolerance resource by the PS-CA project, which is informed by the constraints of the Allergy Intolerance (IPS) profile and the Canadian Baseline package/structuredefinition-profile-allergyintolerance.json to allow for cross-border and cross-jurisdiction sharing of Allergies and Intolerances. It documents the relevant allergies or intolerances (conditions) for a patient, describing the kind of reaction (e.g., rash, anaphylaxis); preferably the agents that cause it; and optionally the criticality and the certainty of the allergy.
Problems Section
This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the Condition (IPS) profile and the Canadian Baseline package/structuredefinition-profile-condition.json to allow for cross-border and cross-jurisdiction sharing of patient conditions. A record of a problem is represented in the patient summary as an instance of the Condition resource constrained by this profile.
Procedure History Section
This profile represents the constraints applied to the Procedure resource by the PS-CA project, which is informed by the constraints of the Procedure (IPS) profile and the Canadian Baseline package/structuredefinition-profile-procedure.json to allow for cross-border and cross-jurisdiction sharing of History of Procedure information.
Immunization Section
This profile represents the constraints applied to the Immunization resource by the PS-CA project to represent a record of immunization in the patient summary. It is informed by the constraints of the Immunization (IPS) profile and the Canadian Baseline package/structuredefinition-profile-immunization.json to allow for cross-border and cross-jurisdiction sharing of Medication Summary information. It describes the event of a patient being administered a vaccination or a record of a vaccination as reported by a patient, a clinician, or another party.
Diagnostic Results Section
This profile represents the constraints applied to the DiagnosticReport resource by the PS-CA project, which is informed by the constraints of the IPS-UV DiagnosticReport profile to represent diagnostic test and procedure reports in a patient summary.
Observation Laboratory/Pathology (PS-CA)
This profile represents the constraints applied to the Observation resource by the PS-CA project, which is informed by the constraints of the IPS-UV Observation Laboratory/Pathology profile to represent results produced by laboratory (including pathology) tests or panels/studies in a patient summary. This observation may represent the result of a simple laboratory test such as hematocrit or it may group the set of results produced by a multi-test study or panel such as a complete blood count, a dynamic function test, or a urine specimen study. In the latter case, the observation carries the overall conclusion of the study and or a global interpretation by the producer of the study, in the comment element; and references the atomic results of the study as "has-member" child observations. Notably there is no equivalent Canadian Baseline Profile at the time of this draft.
This profile represents the constraints applied to the Observation resource by the PS-CA project, which is informed by the constraints of the IPS-UV Observation Radiology profile to specify a radiology observation for a patient summary based on the FHIR standard R4. This observation may represent the conclusions of a diagnostic procedure such a Chest RX, or it may group the set of results produced by that single or multi-modality procedure. In the latter case, the main observation (this one) carries the overall conclusion of the study and/or a global interpretation by the observer of the study as value of this observation; and may reference the atomic results of the study as "child observations". It also allows providing details about the related study using the partOf element referring to an ImagingStudy resource.
Vital Signs Section
The Vital Signs section in both IPS-UV and PS-CA defer to the base R4 FHIR profiles for vital signs.
Implementers are expected to meet the base expectations for receiving/producing content modeled after the FHIR vital signs profiles, however it is up to the jurisdiction to determine which of the vital signs sub-profiles from the base R4 specification they are expecting to support in the first version (e.g., Observation Body Mass Index Profile, Observation Body Height Profile, Observation Body Weight Profile, Observation Blood Pressure Profile, Observation Heart Rate Profile, etc.).
History of Past Illness Section
The History of Past Illness section in both IPS-UV and PS-CA point to the Condition profile that is used in the Problem Section as well. In PS-CA, this profile is Condition (PS-CA).
This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the Condition (IPS) profile and the package/structuredefinition-profile-condition.json to allow for cross-border and cross-jurisdiction sharing of A record of a problem is represented in the patient summary as an instance of the Condition resource constrained by this profile.
Social History Section
Observation Tobacco Use (PS-CA)
This profile represents the constraints applied to the Observation resource by the PS-CA project to represent a tobacco use assessment in a patient summary. It is informed by the constraints of the IPS Observation - SH: tobacco use profile and the Canadian Baseline package/structuredefinition-profile-smokingstatus.json to allow for cross-border and cross-jurisdiction sharing of Social History Information.
Observation Alcohol Use (PS-CA)
This profile represents the constraints applied to the Observation resource by the PS-CA project to represent Alcohol use assessment in a patient summary. It is informed by the constraints of the IPS Observation - SH: alcohol use to allow for cross-border and cross-jurisdiction sharing of Social History Information. No equivalent Canadian Baseline Profile exists at the time of this draft, although the more general package/structuredefinition-profile-observation.json provides some insight.
Observation Social History (PS-CA)
This profile represents the constraints applied to the Observation resource by the PS-CA project to represent a broader set of social history observations, and to house coded and non-coded lifestyle risk factors (e.g. amount of exercise, etc.) in a patient summary. It is informed by the constraints of the US Core, Cyprus Core, Malaysia Core to allow for cross-border and cross-jurisdiction sharing of Social History Information. No equivalent Canadian Baseline Profile exists at the time of this draft, although the more general package/structuredefinition-profile-observation.json provides some insight.
Note: This profile is being used for conformance requirements on generic social history (instances that aren't intended for tobacco or alcohol use profiles). If instance asserts conformance of instance to generic social history profile, observation.code SHALL NOT be 74013-4 or 72166-2 LOINC codes. This is done to prevent the instance matching multiple slices on Composition.section
Family History
This profile represents the constraints applied to the FamilyMemberHistory resource by the PS-CA project to represent details and notes regarding the relevant family member conditions that recorded for a patient. It does not have an IPS or CA Baseline equivalent but may be surfaced for inclusion following a successful pilot period.
Other Sections
Remaining sections that are identified in the Composition (PS-CA) are considered out of scope for the profiling efforts of Version 2.0.0 DFT-preBallot The following sections remain in the Composition profile but maintain their original references to the IPS-UV profiles: MedicalDevices, FunctionalStatus, PlanOfCare, PregnancyHx, AdvanceDirectives.
These sections may be profiled in future releases.