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    • Superseded (by...)
    • Retired
    Market Guidance

    WIP

    Guide Status:

    • Draft
    • Published

     

    Effective Date

    TBD

    Key Contributors

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

    NameTitleOrganizationContact Information

    Shamil Nizamov

     British Columbia - Ministry of Health 

    Yaron Derman

    Manager, Standards & Data ExchangeeHealth Ontario 
    Mihir Patel Alberta Health 

     

    Kris LewisTechnology PrincipalSierra Systems 
    Gavin TongAssociate Managing Partner - Architecture & StandardsGevity Consulting 

     

    *Please note that the actual FHIR artifacts associated with this guide are being developed through the FHIR® Implementations Working Group on InfoCentral.

    Table of Contents

    MaturityUnder development
    StatusDraft
    StandardsHL7® FHIR
    DomainProvider Registry
    JurisdictionAlberta, BC, Ontario

    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.

    Business Context

    The Provider Registry (PR) is a foundational component of the Electronic Health Record (EHR) which provides a trusted and centralized source of regulated health service provider information to authorized consumers.  Health Service Provider Identifiers (HSPID) within the PR enable unique identification of individual health care providers across the systems participating in the EHR.  Demographic and licensing information for all providers is stored within the PR for validation and/or retrieval by source and consumer systems and organizations.

    The guide is concerned with extending information exchange with existing, provincial Provider Registries to support contribution and consumption use cases including those that enable consumer applications. The guide is proposing the development of FHIR artefacts (e.g. implementation guides, profiles, extensions, valuesets, etc.)  that reflect and interact with Canadian content in a standardized manner.

    Typical Use Cases

    The use cases outlined below are intended to provide context and frame which the standard must meet.

    The use cases identify different activities related to a provider registry:

    Table of Contents

    Source Systems

    Sources systems - examples

    Consumer Systems

    Consumer systems - examples

    UC-1 Maintain provider information

    Data received from source systems is used to add or update provider information within the registry, including secondary identifiers and licensing information.

    Multiple business events relate to provider maintenance including:

    • Addition of a new provider
    • Update of provider demographic information
    • Association of a license with a provider
    • Nullification of a license with a provider

    Information updates in the registry then trigger notifications to distribute updated provider information to client systems UC-4.

    UC-2 Logically delete provider record

    Identify and logically delete a provider added to the registry in error.

    Information updates in the registry then trigger notifications to distribute updated provider information to consumer systems UC-4.

    UC-3 Merge provider records

    Two provider records are combined in the registry.

    Information updates in the registry then trigger notifications to distribute updated provider information to consumer systems UC-4.

    UC-4 Notify consumer of information updates (passive)

    Events in the PR trigger notification messages which are distributed to subscribing applications.

    • Add provider
    • Update provider
    • Merge provider
    • Nullify license

    UC-5 Consumer search for provider information (active)

    A consumer system sends a query to the provider registry:

    • Get provider details using HSPID
    • Get provider details using License and Role
    • Identify provider using License when HSPID role isn't known
    • Find candidate providers matching a set of search criteria

    If the request is authorized, the PR responds with the requested information.

    UC-6 Request transaction history

    A source system requests a history of provider record changes by date range or other criteria.

    If the request is authorized, the PR responds with the requested information.

    Evaluated Standards

    This guide focuses on establishing a new set of HL7 FHIR interfaces to existing EHR resources. Provider Registries have been implemented in various provinces and are mostly employing HL7 v3 messaging standards with sporadic HL7 v2. This guide is proposing extensions of interfaces to these systems using HL7 FHIR and reusing these in a broader, Canadian context.

    • Consumer messaging
    • Source messaging

    Consumer messaging

    A primary role of the Provider Registry is to enable provider identification within consumer systems contributing data to or consuming data from provincial EHR solutions.  The predominant means for exchanging data with the EHR is HL7 version 3 messaging.

     

    Standard

    Fit for Purpose

    Stewardship

    Quality

    Fits
    Requirements

    Implementation
    Type 

    Vendor Support

    Canadian
    Steward

    SDO
    Maintained

    Complexity

    Standard
    Maturity

    Training,
    Support
    and Tooling

    HL7 FHIR

    Closely

    Under Development 

    High

    Yes

    Yes

     

    Draft

    AB MR2009 (HL7 v3)

    Closely

    Production
    in Canada 

    High

    Yes (AB)

    Localized

    High

     

    High

    Available

    pan-Canadian MR2009 (HL7 v3)

    PartiallyProduction
    in Canada 
    YesLocalizedHighHighAvailable

    ON (v3, v2)

     

     

     

     

     

     

     

     

    BC (v3)

     

     

     

     

     

     

     

     

    Architectural Constraints and Considerations

    Secondary Benefits

    Use of HL7v3 conforms with the architectural design of Canada's digital health blueprint.

    AB MR2009 extends the Canadian specification with the ability to merge and logically delete providers.

    BC has an implementation that should be described here

    Ontario has an implementation that should be described here

    HL7v3 messaging does not provide the means to transmit a the history of changes to a provider records.

    The PRS XML Messaging specification is proprietary to the registry solution but is shared across several provinces.

    Standardizing on new FHIR interfaces across EHR applications reduces complexity within the infostructure and for implementers by minimizing variability in models and vocabulary.

    Recommendation

    Supporting Rationale

    HL7 FHIRIdentify FHIR resources required to implement new interfaces to existing provincial assets to accelerate and ease adoption of content in these Provider Registries.

     

     

    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

    Extending EHR PR assets with FHIR interfaces

     

    FHIR assets

    X

     

     

     

      

    Implementation Resources

    Community Pages

    Matters related to Provider Registry messaging in Canada are handled through the following Community on InfoCentral.

    InfoCentral - Community Page

    Health Level Seven International (HL7) - Community Site

    Link to the new FHIR Working Group to be added here

    Implementation Guides and Specifications

    Placeholder for linking in newly created FHIR content (profiles, extensions, valuesets, etc.)

    Technical Resources

    Any and every relevant tooling that might be of use to developers and implementers will be listed here.

    Existing Implementations

    The following organizations have been or are involved in implementing the solution outlined in this Guide:

    Implementing OrganizationContact InformationNotes