Releases of the PS-CA Implementation Guide may be found on a table on the Home Page of this Project.

Change Log

The following summarizes changes made to the PS-CA Implementation Guide. Changes to the accompanying Pan-Canadian Patient Summary Interoperability Specifications, and companion guides, are provided in those documents.

PS-CA v2.0.0 - Ballot Release

Must Support Definition

  • Must Support Definition has been updated to clarify the definition. This includes clarity on child elements marked as Must Support when the parent is not.

Masked Data Handling

Broken Links to IPS 1.1 ValueSets

Jurisdictional IGs

Stub ValueSet.version format fix

  • Stub ValueSets pointing to Terminology Gateway valuesets have their ValueSet.version format changed from X.Y.Z (semantic versioning) to YYYYMMDD format. Implementers identified that tooling is unable to reconcile when the stub ValueSet coexist with definitive TGateway ValueSets with different version format methods.

Added Known Issue with IGPublisher and Canonicals

  • Added known issue related to IGPublisher misidentifying Canonical URL mismatches with conformance resource URLs

PS-CA v2.0.0 - Pre-Ballot Release

Profiling changes based on jurisdictional needs:

  • Composition (PS-CA) Profile:
    • Data domains AdvanceDirectives & PlanOfCare have been updated to allow for DocumentReference use in composition.sectionAdvanceDirective.entry and composition.sectionPlanOfCare.entry
    • MustSupport flags updated for sectionAdvanceDirective and sectionPlanofCare to allow for some jurisdictions to leverage and others to ignore

Package Dependency Updates

  • Updated package dependencies to use the following:
    • hl7.fhir.uv.ips 2.0.0-ballot (previously 1.1.0)
    • hl7.fhir.ca.baseline 1.1.8 (previously 1.1.7)

Updated Change Log

  • Added context around changes to IPS 2.0 Pregancy Observation profiles, and importance of awareness to Canadian implementers

ValueSet Versions

  • Due to ValueSet version format collisions with the Terminiology Gateway definitive ValueSets (

Jurisdictional IGs

  • Added BC, AB Patient Summary IGs to {{pagelink:

Profiling changes in alignment with IPS 2.0.0-Ballot:

  • AllergyIntolerance (PS-CA) Profile:
    • Updated the Abatement extension to use the global extension instead of deprecated IPS extension
  • Composition (PS-CA) Profile:
    • Added a section notes extension to each section, providing section documentation.
    • Introduced a DocumentReference entry in the Plan of Care section to better align with IPS specification.
    • Added a DocumentReference in the Advance Directives section, improving the representation of patient preferences.
    • Updated to be "based" on Composition instead of ClinicalDocument, as 1) R4/ClinicalDocument is being deprecated in favour of R5/ClinicalDocument and 2) ClinicalDocument applies unnecessary constraints on the PS Composition
  • Condition (PS-CA) Profile:
    • Condition.severity additionalBinding changed from http://hl7.org/fhir/uv/ips/ValueSet-condition-severity-uv-ips.html (deprecated) to Condition/DiagnosisSeverity to align with IPS
  • Observation Laboratory/Pathology (PS-CA) Profiles:

  • LOINC bindings relaxed from Required to Preferred on Observation.valueCodeabeConcept in the following profiles:

    • Observation Tobacco Use (PS-CA)
    • The following two profiles from IPS are being leveraged by PS-CA (referenced via Composition) as there are currently no specific Canadian requirements defined for these areas. Therefore, jurisdictions can use the IPS profiles as-is, and PS-CA will aim to reflect any future changes to the referenced IPS profiles in release notes for implementers.

  • Replacement of IPS FreeSet and IPS Absent/Unknown with SNOMED CT

    • IPS 2.0.0 introduced SNOMED CT codes to represent IPS Absent/Unknown, and also removed the IPS FreeSet bindings. The following IPS 2.0.0 profiles/elements are impacted: Medication.code, AllergyIntolerance.code, Condition.code, Procedure.code, MedicationRequest.medicationCodeableConcept, MedicationStatem.medicationCodeableConcept.
    • PS-CA 2.0.0-DFT-preBallot is assessing these updates before re-alignment, and have identified this temporary divergenge on the relevant PS-CA IG Profile pages in the Usage Notes

Profile 'Key Differences' Section:

Updated the 'Key Differences' section across profiles to reflect the identified gaps between IPS and PS-CA. These gaps are documented and will be reassessed in each release to ensure ongoing alignment and improvement.

Conformance Fixes

  • Added ValueSet.status to the following VSets: ImmunizationRouteOfAdministrationCode, VaccinePreventableDiseaseCode, VaccineHistoricalNameCode, VaccineAdministeredTradeNameCode, PassiveHistoricalImmunizingAgentCode, PassiveAdministeredImmunizingAgentCode

Example Updates

  • AllergyIntolerance-free-text-example updated to use global Abatement extension

PS-CA v1.1.0 DFT - Ballot Reconciliation

  • Relaxed Must Support expectation on Composition.attester and updated Composition (PS-CA) to modify the 'Differences to IPS' section (e.g., relaxed Must Support on Composition.attester)
  • Updated Bundle (PS-CA) profile to create a mandatory slice for the Patient resource and increase the minimum cardinality of slices to 2..* (to better align to IPS)
  • In Profiling Conventions and Approach, introduced guidance on managing missing data, including a detailed approach for both coded and non-coded data elements (content from IPS)
  • Created new package/structuredefinition-profile-codeableconcept-ca-ps.json and package/structuredefinition-profile-coding-medication-ca-ps.json data type profiles for medications to ensures compliance in processing and representing medication codes with textual descriptions
  • Removed the Must Support expectation for the version element in the existing package/structuredefinition-profile-coding-ca-ps.json data type profile to provide flexibility and align with current implementation requirements
  • In Medication (PS-CA), MedicationRequest (PS-CA), and MedicationStatement (PS-CA) profiles and Terminology page
    • Updated guidance regarding preferred binding types for medication codes in Canada and clarified the use of international codes for broader interoperability
  • In AllergyIntolerance (PS-CA) profile
    • Added language to provide clarification for Patient.birthDate usage when value is unknown/not available
    • Added the 'Inactive' code and removed 'Canceled' from the Allergy Intolerance Clinical Status ValueSet (used as an additionalBinding to provide original SCT CA coding that was captured if relevant).
  • On Immunization (PS-CA) profile and Terminology:
    • Replaced CVC stub ValueSets (CVC migrating to the National Vaccine Catalogue) with replacement stub ValueSets for the content on Terminology Gateway
  • Updated the Terminology Approach page to provide further clarity on additionalBindings and the continued use of slicing in select cases (e.g., AllergyIntolerance.clinicalStatus)
  • Copyediting of Terminology Page (updated page links, updated table & table notes to align with current IPS practices)

The following technical corrections were also addressed in this release:

  • Updated CA Baseline dependency to newest version
  • Added the History of Past Illness Section pointers to the PS-CA Library of Profiles
  • Updated the Observation Social History (PS-CA) page and profile with an invariant and note to provide further clarity on its distinction from the Observation Alcohol Use (PS-CA) and Observation Tobacco Use (PS-CA) profiles
  • Removed the Must Support flag on the Bundle (PS-CA) top level profile to align with current practices in IPS
  • Removed data type slicing on MedicationRequest.medication and MedicationStatement.medication to align to current practices in IPS
  • Updated Terminology Page to identify additional bindings that were added to AllergyIntolerance in 1.1.0-DFT-Ballot
  • Updated title and urls with 'FHIR Artefacts' to 'FHIR Artifacts' to align to convention in other pan-Canadian specifications
  • On profile pages, replaced individual call-outs of updated profile targets with standard note
  • Removed image from Evolution of Specification that reflected processes from early release cycles (e.g., v0.3, v0.4)
  • Re-included socialized Identifier Version extension on Patient.identifier (previously unintentionally removed)
  • Updated links to CA Baseline Simplifier page to include new url

PS-CA v1.1.0 DFT - Ballot Release (Technical Errata)

  • IGuide Page corrections
    • Updated internal page links to the patient page to use new Simplifier convention (.guide.md->.page.md)
    • Updated terminology page, and terminology descriptions on Medication related pages to include new link to package/valueset-canadianclinicaldrugdataset.json
    • Added sections under Data Type Profiles for SimpleQuantity and Range profiles
  • Profile Corrections
    • Updated sectionResult target references to include new PS-CA lab profiles

Note: The CA Baseline project has an updated package (1.1.6) that was produced following the ballot release. This updated version is expected to be applied to the dependency manifest in future releases.

PS-CA v1.1.0 DFT - Ballot Release

  • IGuide version clean up to host all current and historical versions of PS-CA as a table on the home page
    • Published Historical Guides and known urls, removed their visibility from the Guides page of Simplifier to opt for the table view for simplicity
    • Updated headers on the guides to point to home page table for past versions
  • Introduce emptyReason into Composition in alignment with choice in IPS to offer an alternative to pseudo resources
    • Re-introduce emptyReason (previously 0..0)
    • Relax section.entry on all sections to allow for emptyReason or text to be used as a means of conveying the information in limited scenarios
    • Introduce new invariant on Condition, Medication, and Allergies sections that ensures either section.emptyReason or section.entry is populated
    • Retired "Content Not Supported Profiles" and removed the "Content Not Supported" guide page from this version
    • Updated Profiling Conventions and Approach to describe new shift towards emptyReason
  • Updated Terminology Approach to call out new conventions for emptyReason and the use of additionalBinding extension (replacing previous terminology slicing approach)
    • Updated all profiles and profile pages to replace previously slices valueSets with the use of additionalBinding (no change in valuesets)
    • Updated Terminology page to reflect use of additionalBinding instead of slicing
  • Introduced new Stub valueSet for HC-CCDD indicating new canonical URI for the preferred code system (http://terminology.hl7.org/CodeSystem/hc-CCDD), Updated Stub valueSet for NPN to include new canonical URI for the preferred code system (http://terminology.hl7.org/CodeSystem/v3-hc-npn)
    • Replaced any prior pointers to PrescriptionMedicinalProduct (Terminology Gateway subset developed for PrescribeIT) to the new HC-CCDD Stub valueSet with updated code system
    • Added HC-CCDD Stub valueSet and LNHP Stub valueSet as additionalBindings under AllergyIntollerance.code to convey additional terminology that may be in use locally
  • Introduced new Stub valueSet for pCLOCD with notation on new lab profiles regarding future development of constrained valueSets
  • Added Observation Results (Laboratory), Observation Results (Pathology), Observation Results (Radiology), DiagnosticReport profiles.
  • Corrected cardinality on Composition.subject to a minimum of 1.
    • This was a technical correction added into IPS and PS-CA that aligned to existing expectations
  • Relaxed cardinality on Patient.gender to align with IPS and jurisdictional needs (e.g., recordedSexorGender extension)
  • Relaxed cardinality on Condition.clinicalStatus (maintaining MS flag) to accommodate R4 deficiency in valueSet not allowing an unknown option to accommodate legacy data
  • Updated Exchanging Patient Summaries to call out new CA:FeX version that can be leveraged
  • Updated the Known Issues & Future Development page to introduce temporary issue rendering additionalBinding extensions, as well as to reflect changes made to close known issues and provide to provide linkage to closed issues in previous PS-CA guides

PS-CA Implementation Guide v1.0.0 TI (Projectathon Release)

  • Updated dependency on IPS to point to newly published IPS v1.1.0 package
  • Updated Bundle Examples to improve Projectathon validation (e.g., included meta.profiles, included SNOMED CT CA version)
  • Updated the Composition profile to remove the vital sign parent profile slice to provide better validation against individual vital signs profiles - with added comment with rationale of the change
  • Updated inclusion statement for PharmaceuticalBiologicProductAndSubstanceCode value set to align to changes in how intersections are evaluated in HL7 validator
  • Updated known issues & Future Development to remove issues that have been resolved

PS-CA Implementation Guide v1.0.0 TI

  • Refinement of language describing relationship with evolving IPS and CA Baseline Specifications
  • Removal of GPS terminology in accordance with the changes in IPS to recommend the IPS SNOMED Free Set which was developed and maintained for international use.
  • Inclusion of comment on Composition.encounter element to clarify optional use
  • Modification of slice name & value set name for licensed natural products (NPN -> LNHP)
  • Update of artifact versions & statuses to prepare for Version 1.0.0 package
  • Update of Composition.section All Slice to make the 1..1 cardinality on section.text and section.code clearer - this change was made in alignment with IPS-UV change
  • Inclusion of additional examples in project that were developed to support projectathon testing
  • Refresh Terminology Approach with updated language on IPS approach to must support
  • Refresh IPS page to indicate any relevant changes in IPS that are due to the feedback from PS-CA and PS-ON
  • Refresh of the individual guide pages to remove IPS differences that have been resolved in the IPS UV August 2022 CI Build
  • Inclusion of FamilyMemberHistory profile (and update of Composition to include as optional section and profile)
  • Inclusion of a more generalized Social History Observation profile (and update of Composition to include as optional section and profile)
  • Update of Composition.section.entry to remove MS on SHx Tobacco Use & SHx Alcohol Use profiles under the Social History Section
  • Inclusion of separate IGuide section for Jurisdictional Context and page added for AB Jurisdictional Context (e.g., use of FamilyMemberHistory, business identifiers used, etc.)
  • Update of the Must Support page to include a comment regarding jurisdictional scope and provide clarifying note regarding MS expectations for backbone elements
  • Pointers to Supportive Reference Architecture pages added to the Exchanging Patient Summaries page
  • Added clarifying note regarding Projectathon testing expectations for terminology version use to the Usage Guidance Section on the Terminology page.

Changes From Prior Minor Releases

Version 0.3.0

  • Shift to new version convention in profiles and IGuide to align to the rest of the specification material, Evolution of Specification has been updated accordingly with new version convention in addition to the inclusion of a new interim v0.3.0 release.
  • Introduction of narrative describing the current evolutions that IPS-UV is undergoing for their own terminology and slice modeling approach in the next IPS release.
  • PS-CA and PS-ON worked with IPS to identify and test challenges with the slicing model currently put forward in IPS. These resulted in changes to the way all three specifications will model this slicing moving forward.
    • After extensive testing, this specification has shifted slicing from being applied on CodeableConcept to being applied on Coding. This was done in order to eliminate the risk of validation errors that arise under the previous slicing model.
    • Removed redundant profiling (e.g., claiming the base cardinality) on the new coding slices
    • Changed AllergyIntolerance.onset(x) and Condition.onset(x) rules from "closed" to "open" given the evidence from implementers for the need to supply for string and potentially other data types.
    • Temporary removal of slice pointing to three GPS Value Sets until modeling is corrected by IPS to ensure validator tools can identify and distinguish use of the value set. Added details on this challenge into Known Issues & Future Development :
  • Updated pointers to CA Baseline and PS-CA packages to align to most recent package updates (1.0.1 and 0.3.0) respectively
  • Removal of JPID and PPN slices in accordance with the recent removal of these slices from the CA Baseline (and the removal of the JPID type from the Canadian URI Registry)
  • Socialization of a MRN identifier type slice to ensure implementers are aware that some jurisdictions may use MRN as an alternative to JHN identifier types in some scenarios.
  • Inclusion of PrescribeIT extensions for medication strength and renderedDosageInstruction as these are extensions that directly impact elements that are profiled by the patient summary
  • Comment added to the medicationRequest.intent element to ensure it shows up in the differential view and isn't missed by implementers as an element that is required in the R4 FHIR specification
  • Comment added to CodeableConcept to further reiterate that the contribution of CodeableConcepts assumes at least one of coding or text will be present. If coding contains only a display value (no code) then CodeableConcept must include text to ensure the human readable description is present when there is no true coding.
  • Minor editing corrections (e.g., SNOMED changed to SNOMED CT, removal of spelling error in element description, modified CVC value set descriptions for easier differentiation between download and view links)
  • Updated a few examples that were demonstrating conformance to the Condition (PS-CA) profile and ConditionNotSupported (PS-CA) profile to more accurately reflect nuances of those profiles