Standards Selection Guide
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:
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 | Implementation | Vendor Support | Canadian | SDO | Complexity | Standard | Training, Support and Tooling | |
HL7 FHIR |
| Under Development |
| Yes | Yes | 
| Draft |  |
AB MR2009 (HL7 v3) |
| Production |
| Yes (AB) | Localized |
| High |  |
pan-Canadian MR2009 (HL7 v3) |  | Production in Canada | | Yes | Localized | | High | |
ON (v3, v2) |
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BC (v3) |
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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 FHIR | Identify FHIR resources required to implement new interfaces to existing provincial assets to accelerate and ease adoption of content in these Provider Registries. | |||||||
Recommended Standards
Standardization Requirement | Options | Choice | Rationale |
Extending EHR PR assets with FHIR interfaces
| FHIR assets | X |
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Implementation Resources
Community Pages
Matters related to Provider Registry messaging in Canada are handled through the following Community on InfoCentral.
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
| Implementing Organization | Contact Information | Notes |
|---|---|---|