Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.
Terminology
The profiles in this specification leverage value sets from both the IPS-UV guide as well as value sets that have been developed according to the principles identified in the Terminology Approach.
Usage Guidance:
Several ValueSets are not available at their canonical URL (e.g., NVC published value sets) or on the terminology servers used in implementation guide publication (i.e., tx.fhir.org).
Primarily, this impacts validation against Canada Health Infoway-hosted ValueSets during the development of derived Implementation Guides. This does not affect deployed systems as these instances will be validated against loaded terminology.
For several of these ValueSets, "stub" resources have been created to stand-in for the unresolvable ValueSets. These stub ValueSets include pointers to the locations where the full value sets can be downloaded.
Current guidance is to manually download the value sets from, for example, the Terminology Gateway. When terminology is not readily available as FHIR® Release 4 ValueSets or CodeSystems, implementers should work with terminology producers to identify options.
Terminology owners often evolve their code systems and value sets over time: retiring concepts, adding new ones, modifying relationships, etc. Terminology content should be "current at time of use," except when specific versions of CodeSystems or ValueSets are identified within PS-CA.
Production implementations should be cautious of recognizing only the terminology in effect at the time of publication of the PS-CA Implementation Guide, or only the terminology in effect at time of system implementation. PS-CA Patient Summary documents should use current-at-time-of-creation terminology. However, since Patient Summary documents may have an extended life, recipient systems should be lenient in accepting out-of-date codes.
Note: The FHIR ValueSet files for the Proposed Pan-Canadian Value Sets in the PS-CA do not include a code system version, rather they point to the subset defining url in the hosting system (e.g., Terminology Gateway). For Projectathon testing of PS-CA v1.0.0 TI, vendors are expected to implement, at a minimum, the version of the terminology that was published at the time of release, but that vendors are encouraged to keep up to date with the most recent releases of terminology as described above.
Value Sets
The table below indicates the various levels of terminology included in PS-CA. Value sets are grouped under three columns:
Global Value Sets: These are value sets that are either required by the HL7® FHIR® specification or are proposed by the IPS-UV specification due to their increased likelihood to be recognized/accessible internationally.
- HL7: Value sets required for data to be exchanged in FHIR are indicated by an (*). In cases where the value is captured from a different terminology, the captured terminology would be supplied as an alternative coding
- IPS: Value sets proposed by the IPS that leverage existing multilingual, globally accessible terminologies that are intended to facilitate interoperable international exchange. IPS defines SNOMED CT as a primary terminology, but also applies other international terminologies (LOINC, EDQM, etc.) in cases where they are deemed more appropriate for progressing the goals of the IPS. Implementers are encouraged to review IPS General Principles.
Proposed Pan-Canadian Value Sets: These are value sets that are proposed by the PS-CA as the national standardized terminologies that implementers are encouraged to align to. SNOMED CT Canadian Edition (SNOMED CT-CA) is the terminology generally recommended for use in Canada, but in some cases the PS-CA will also propose the use of other terminologies (e.g., NVC, CCDD, etc.) that have widespread adoption across Canada.
- Note: The Pan-Canadian value sets are identified as the preferred value sets for this release (except where another value set is required by HL7 FHIR). While adoption of the global value sets is critical for global interoperability, recent feedback from participating jurisdictions has outlined the need to prioritize domestic jurisdictional exchange over global exchange in early versions of the specification. Implementers should align to the proposed pan-Canadian value sets with an understanding that later releases of PS-CA and IPS may apply unique terminology preferences and expectations for systems acting as gateways or portals for international exchange.
Local Value Sets: These are examples of value sets and local terms or non-standardized value sets that were noted in use within the participating jurisdictions. While implementers are encouraged to align to the proposed pan-Canadian value sets, they should be aware that patient summaries may contain concepts from these terminologies.
- Note: This column excludes terminologies that have established mappings to proposed value sets (e.g., DIN codes included in CCDD, or First Data Bank codes mapped to CCDD as part of established workflows) as well as terminologies that are considered local terms/non-standardized value sets. Jurisdictions that require assistance in hosting their local value sets in a location that vendors and implementers can easily review should reach out to standards@infoway-inforoute.ca.
Bolded notes are used in the below to relay where value sets included in previous releases have been folded into an existing binding.
| Profile | Element | Global Value Sets (if applicable) | Proposed Pan-Canadian Value Sets | Local Value Sets |
|---|---|---|---|---|
| AllergyIntolerance (PS-CA) | clinicalStatus |
AllergyIntoleranceClinicalStatusCodes* (HL7) (Required) | package/valueset-allergyintolerancestatuscode.json (SNOMED CT-CA) (Slice to provide additional coding if desired) | v3.ActStatus (HL7 v3) (Slice to provide additional coding if desired) |
| AllergyIntolerance (PS-CA) | verificationStatus |
AllergyIntoleranceVerificationStatusCodes* (HL7) (Required) | package/valueset-allergyintolerancestatuscode.json (SNOMED CT-CA) (Slice to provide additional coding if desired) | - |
| AllergyIntolerance (PS-CA) | code |
AbsentOrUnknownAllergiesUvIps (IPS) (additionalBinding), Note A, Note B | package/valueset-substanceandpharmaceuticalbiologicproductcode.json (SNOMED CT-CA) (preferred binding) | package/valueset-canadianclinicaldrugdataset.json (CCDD) (additionalBinding), package/valueset-LicensedNaturalHealthProducts.json (LNHP) (additionalBinding) package/valueset-icd10cacode.json (ICD-10 CA) (additionalBinding) |
| AllergyIntolerance (PS-CA) | reaction.manifestation |
Note B | package/valueset-clinicalfindingcode.json (SNOMED CT-CA) (preferred binding) | - |
| Condition (PS-CA) | severity |
ProblemSeverityUvIps (IPS/LOINC) (additionalBinding) | package/valueset-severitycode.json (SNOMED CT-CA) (preferred binding) | - |
| Condition (PS-CA) | code |
NoProbsInfoUvIPS (IPS) (additionalBinding), Note B | package/valueset-clinicalfindingcode.json (SNOMED CT-CA) (preferred binding) | package/valueset-icd9cmcode.json (ICD-9 CM) (additionalBinding), package/valueset-icd10cacode.json (ICD-10 CA) (additionalBinding), BC Health Concerns and Diagnosis Value Set uses values covered under SNOMED CT, ICD-9 CM, ICD-10 CA additionalBindings |
| Condition (PS-CA) | bodySite |
- | package/valueset-anatomicaloracquiredbodystructurecode.json (SNOMED CT-CA) (preferred binding) | - |
| Immunization (PS-CA) | vaccineCode |
Vaccines - SNOMED CT IPS Free Set (IPS Free Set) (additionalBinding), WhoAtcUvIps (IPS/WHO) (additionalBinding), NoImmunizationInfoUvIPS (IPS) (additionalBinding), Note B | package/vaccineadministeredtradenamecode.json (SNOMED CT-CA) (preferred binding) OR package/vaccinehistoricalnamecode.json (SNOMED CT-CA) (equivalently preferred) OR package/passiveadministeredimmunizingagentcode.json (SNOMED CT-CA) (equivalently preferred) OR package/passivehistoricalimmunizingagentcode.json (SNOMED CT-CA) (equivalently preferred) | - |
| Immunization (PS-CA) | site |
- | The development of a FHIR ValueSet & Terminology Gateway subset for this element is underway. Given that the migration of terminology from the CVC to NVC is underway, and that this element is no longer MS in PS-CA or IPS, the profiling on this binding has been temporarily removed and will be reapplied in future updates once there is an established subset to point to. | - |
| Immunization (PS-CA) | route |
MedicineRouteOfAdministrationUvIps (IPS/EDQM) (additionalBinding) | package/valueset-immunizationrouteofadministrationcode.json (SNOMED CT-CA) (preferred binding) | v3.RouteOfAdministration (HL7 v3) (additionalBinding) |
| Immunization (PS-CA) | protocolApplied .targetDisease |
Vaccine Target Diseases - SNOMED CT IPS Free Set (IPS Free Set) (additionalBinding), Note B | package/vaccinepreventablediseasecode.json (SNOMED CT-CA) (preferred binding) | - |
| Medication (PS-CA) | code |
WhoAtcUvIps (IPS/WHO) (additionalBinding), Medications - SNOMED CT IPS Free Set (IPS Free Set/SNOMED CT) (additionalBinding) | package/valueset-canadianclinicaldrugdataset.json (CCDD) (preferred binding) Note C | package/valueset-healthcanadanaturalproductnumber.json (Health Canada) (additionalBinding). Use of DIN, FDB (HICL/HIC4/SEQN), etc. is covered under CCDD, BC Medication Superset still in development |
| Medication (PS-CA) | form |
MedicineDoseFormUvIps (IPS/EDQM) (additionalBinding) | package/valueset-pharmaceuticaldoseformcode.json (SNOMED CT-CA) (preferred binding) | package/valueset-prescriptiondrugform.json (PrescribeIT/HL7 v3) (additionalBinding) |
| Medication (PS-CA) | ingredient .itemCodeableConcept |
Note D | package/valueset-drugormedicamentsubstancecode.json (SNOMED CT-CA) (preferred binding) | Use of DIN, FDB (HICL/GCN), etc. which is covered under CCDD |
| MedicationRequest (PS-CA) | medicationCodeableConcept |
- | package/valueset-canadianclinicaldrugdataset.json (CCDD) (preferred binding) Note C | - |
| MedicationRequest (PS-CA) | dosageInstruction.route |
MedicineRouteOfAdministrationUvIps (IPS/EDQM) (additionalBinding) | package/valueset-routeofadministration.json (SNOMED CT-CA) (preferred binding) | package/valueset-prescriptionrouteofadministration.json (PrescribeIT/HL7 v3) (additionalBinding) |
| MedicationStatement (PS-CA) | medicationCodeableConcept |
AbsentOrUnknownMedicationUvIps (IPS) (additionalBinding) | package/valueset-canadianclinicaldrugdataset.json (CCDD) (preferred binding) Note C | package/valueset-healthcanadanaturalproductnumber.json (Health Canada) (additionalBinding). Use of DIN, FDB (HICL/HIC4/SEQN/GCN), etc. is covered under CCDD |
| MedicationStatement (PS-CA) | dosage.route |
MedicineRouteOfAdministrationUvIps (IPS/EDQM) (additionalBinding) | package/valueset-routeofadministration.json (SNOMED CT-CA) (preferred binding) | package/valueset-prescriptionrouteofadministration.json (PrescribeIT/HL7 v3) (additionalBinding) |
| Procedure (PS-CA) | code |
AbsentOrUnknownProceduresUvIps (IPS) (additionalBinding), Note E | package/valueset-procedurecode.json (SNOMED CT-CA) (preferred binding) | package/valueset-ccicode.json (additionalBinding), ICD9CMAllCode (ICD-9 CM) (additionalBinding), ICD10CAAllCode (ICD-10 CA) (additionalBinding) |
Note A The AllergyIntoleranceSubstanceConditionUvIps value set put forth in IPS-UV was not included in the table above because it is made up of SNOMED CT values are included in the SNOMED CT-CA binding
Note B This guide previously socialized GPS terminology alongside IPS SNOMED CT CA slices to align to earlier versions of IPS. IPS has since moved away from the use of GPS for the purposes of clearly recommending the IPS SNOMED Free Set which was developed and maintained for international use. In places where the IPS Free Set conflicts or is subsumed by the SNOMED CT CA binding - it has been removed
Note C In Canada, CCDD is the preferred binding type for medication codes. However, for broader international comprehension, it's recommended that, where mappings exist, implementers also include IPS free-set concepts alongside CCDD. This approach aims to balance national preferences with the need for international interoperability. Additionally, systems have the flexibility to send other Canadian codes, such as SNOMED CT CA, DIN, and NPN.
Note D The MedicineActiveSubstancesUvIps value set put forth in IPS-UV was not included in the table above because it is made up of SNOMED CT values are included in the SNOMED CT-CA binding
Note E The ProceduresSnomedCtUvIps value set put forth in IPS-UV was not included in the table above because it is made up of SNOMED CT values are included in the SNOMED CT-CA binding
Code Systems
Previous versions of this guide included the ContentNotSupported codeSystem which were developed in the PS-CA Implementation Guide. It has since been been retired.
Additional Terminology Resources
Concept Maps
Implementers are encouraged to review the ConceptMaps defined in the IPS-UV Implementation Guide: