Standards Selection Guide

    Standards Selection Guide

    Represents a collection of the recommended Standards, Resources, Implementation Guides created to satisfy a specific set of Clinical Requirement at a moment in time, following the discovery process presented in the guidance section of this site.

    Maturity Level
    • Under Development
    • Pilot
    • Draft For Use
    • Normative
    • Superseded (by MR)
    • Retired
    Market Guidance

    PAN-CANADIAN STANDARD

    Guide Status:

    • Draft
    • Published
    Effective Date

    December, 2013

    Key Contributors

    The following individuals/organizations contributed to the creation of this resource:

    NameTitleOrganization
       
    Table of Contents

    MaturityNormative, Superseded
    StatusPublished
    StandardsHL7® v3
    DomainPublic Health
    JurisdictionNational

    Purpose

    This document provides an overview of available standards and a recommended approach to support the requirements identified below.  The intent is to simplify standards selection decisions in future projects and, in turn, to promote standardization of solutions across projects by providing useful information to support decision making in a readily consumable format. 

    Content in this guide was generated through a document review of immunization related messaging in different versions of the pan-Canadian messaging specifications and HL7 v2 to provide an accessible overview of the standards considered and selected to support the immunization related requirements.  Detailed requirements and discussion of standards localization decisions can be found on InfoCentral.

    Business Context

    This guide relates to standards used to track and manage of immunizations records for public health purposes.  Given the various settings where immunizations can be administered, the migration of people between jurisdictions and certain public health needs, immunization data is often collected retrospectively and may be collected or used outside of traditional care settings such as hospitals or physicians’ offices.

    Typical Use Cases

    The use cases outlined below are intended to provide additional context and frame the needs that the candidate standards must meet. The use cases here are summarized and excerpted from a discussion document of the HL7 v3 pan-Canadian Messaging Standards Implementation Guide (Volume 10 – Immunization).

    The use cases identify different activities related to immunization events and access to an immunization record:

    Table of Contents

    UC-1 Record an Immunization Event

    The purpose of this use case is to describe the activities involved in recording an immunization event.

    Trigger: Immunization has been administered

    • A healthcare provider administers a vaccine to a patient.
    • The healthcare provider records the vaccination event in the local EMR System
    • The EMR sends a request to add the immunization event details to the repository.
    • The event is recorded in the repository and the message is acknowledged.

    (The above flow represents a successful transaction, alternate flows exist.)

    UC-2 Query an Immunization Repository

    The purpose of this use case is to describe the activities involved in retrieving immunization records for a patient from a repository.

    Trigger: Immunization information for a patient needs to be retrieved from an immunization repository.

    • A user of an EMR (or other client system) requests detailed information about a patient's immunization history, potentially filtered by:
      • time-range of the immunization, 
      • time-range the immunization was last updated, and/or
      •  type of immunization.
    • The EMR sends the query to the repository.
    • The repository returns the requested list of past immunization events.

    (The above flow represents a successful transaction, alternate flows exist.)

    UC-3 Update an Immunization Record

    The purpose of this use case is to describe the activities involved in updating an immunization event.

    Trigger: A healthcare provider needs to add additional information related to an immunization event to a record.

    • Healthcare provider wishes to update information related to a vaccination event:
      • additional information in the textual comment,
      • add/change the vaccine dose number, and/or
      • mark the immunization course as complete.
    • The healthcare provider records the vaccination event in the local EMR System
    • The EMR sends a request to update the immunization event details in the repository.
    • The update is recorded in the repository and the message is acknowledged.

    (The above flow represents a successful transaction, alternate flows exist.)

    UC-4 Retract an Immunization Record

    The purpose of this use case is to describe the activities involved in retracting an erroneous immunization event.

    Trigger: A healthcare provider identifies an erroneous immunization record.

    • Healthcare provider wishes to remove an erroneous immunization event from the patient's record.
    • The erroneous information is removed (or flagged as removed) in the local EMR system.
    • The EMR sends a request to remove the immunization event from the repository.
    • The record is removed (or flagged as removed) in the repository and the message is acknowledged.

    (The above flow represents a successful transaction, alternate flows exist.)

    Evaluated Standards

    This guide focuses on the selection of messaging standards to support the in scope use cases.

    Messaging

    The following standards were considered to communicate vaccination events and to query immunization repositories.

     

     

    Standard

    Fit for Purpose

    Stewardship

    Quality

    Fits
    Requirements

    Implementation
    Type 

    Vendor Support

    Canadian
    Steward

    SDO
    Maintained

    Complexity

    Standard
    Maturity

    Training,
    Support
    and Tooling

    CeRx HL7 V3.0 - Immunizations

    Purpose Built

    Production
    in Canada 
    High (DIS vendors)YesYesHighHighAvailable

    HLv2 

    Partial

    No known implementations
    in Canada 

    High

    No

    Yes

    Medium

    High

    Unknown

    Architectural Constraints and Considerations

    Secondary Benefits

    The Canadian HL7 V3 CeRx specification was designed to support the in scope use cases in a manner consistent with the design principles of Canada's digital health blueprint.

    The CeRx specification is widely adopted for drug domain messaging.

    Version 3 uses rigorous analytic and message building techniques and eliminates areas of optionality that could negatively impact semantic interoperability.

    Recommendation

    Supporting Rationale

    CeRx implementers may use the latest CeRx specification for immunization messaging. (Note that the newer HL7 v3 public health messaging supports a broader range of transactions.)The specification was designed to meet the in-scope use cases and conforms with the architectural design of Canada's digital health blueprint.

    Recommended Standards

    The following standards and related specifications were identified as the recommended approach to support the in-scope requirements. The table lists the summary with the rationale.

     

    Standardization Requirement

    Options

    Choice

    Rationale

    Messaging

    CeRx HL7 V3.0 - Immunizations

    X

    The specification was designed to meet the in-scope use cases and conforms with the architectural design of Canada's digital health blueprint.

    HL7 v2  Inconsistent with Canada's blueprint. Not known implementations in Canada.

    Implementation Resources

    Community Pages

    Matters related to Immunization messaging in Canada are handled through a active Communities on InfoCentral.

    InfoCentral - Community Page

    Public Health Surveillance - Community Site

    Health Level Seven International (HL7) - Community Site

    Clinical Requirements

    Material from the Canadian Public Health community can be found on the Public Health Surveillance community site on InfoCentral.

    Implementation Guides

    The latest Implementation Guide can be found on InfoCentral.

    Technical Resources

    The Infoway Message Builder allows developers to focus on their business problem by providing APIs that foster quick and easy creation, population and access to HL7 v3 requests and responses and CDA documents.

    For further technical support please contact project teams listed in the header section or seek support through the community site.

    Existing Implementations

    The following Canadian jurisdictions have implemented HL7 v3 CeRx - Immunizations.

    Implementing JurisdictionNotes
    Prince Edward IslandCeRx 4.2
    Newfoundland and LabrodorCeRx 4.3-3