Purpose

The Reference Architecture (RA) content, to support interoperability, provides guidance on how to apply specific integration patterns that improve the way computer systems in healthcare share information in Canada. Systems that implement these capabilities can be represented by standardized interoperability patterns that are reusable across a wider array of eco-system solutions. The RA focuses on highlighting key elements of standardization that can be employed in solution design at system level. The elements presented in here are patterns that will be referred to in Companion Guides and Interoperability Specification documentation of specific priority areas (e.g., Patient Summary, e-Referral, etc.).

A large number of the integration patterns presented herein are interoperability profiles developed by IHE International. These patterns are based on open standards and are regularly tested at international interoperability testing events - Connectathons. This provides great value to both vendors and purchasers in that it creates a catalog of capabilities that can be used for system wide eco-system design. By following best practices and international standards, this Reference Architecture can grow over time to represent a pan-Canadian point of view and become an approach to interoperability.

In addition to existing published IHE profiles, the Reference Architecture also provides detailed implementation guidance for areas that contain Canadian specific implementation requirements (e.g., how to use IDP profiles - IUA, guidance on security and auditing - ATNA, etc.).

Intended Audience

The intended audience of the Reference Architecture includes but is not limited to the following: 

  • IT departments of healthcare institutions (technical product managers, IT managers, operations staff)
  • Technical staff of vendors participating in the IHE initiative
  • Experts involved in standards development
  • Individuals and teams responsible for implementing software solutions such as project managers, CTOs, CISOs, software engineers, technical product managers, IT managers, operations staff, and other similar roles.

The Reference Architecture Overview

The Reference Architecture contains  information relevant to system level integration patterns, supporting interoperability. Other interoperability specifications (e.g., PS-CA, CA:FeX) may contain project-specific references to architecture and/or refer directly to this Reference Architecture document.

Program-level: The RA is a living document that describes IHE profiles that have been recommended to be adopted by jurisdictions and vendors to improve the way computer systems in healthcare share information in Canada. Additional IHE profiles will be added over the long-term as new priorities are included. Program level information of the Reference Architecture can be found in this space and page (see diagram below), where summarized information for the IHE profiles have been included and grouped under the following categories:

  • Foundational Profiles: Includes a list of foundational IHE profiles that perform basic functions within the ecosystem such as authorized log-in, audit event logging, consistent time synchronization, etc.

  • Document/Data Sharing Profiles: Includes a list of IHE profiles that provide recommended standards for document and data sharing between clinical solutions.

  • Patient Identity Profiles: Includes a list of IHE profiles that enable confirming the identity of the patient or subject of care.

Project-specific: In addition to the Reference Architecture, there may also be project-specific references to architecture that contain a subset of the recommended profiles from this document. These project specific guides will list sequence diagrams that support the needs of those projects. Actors and transactions can be grouped together from multiple profiles to address the business requirements of the project specific use cases. 

How to Read the Reference Architecture

  • The Reference Architecture lists the actors and transactions from the IHE profiles that can enable secure exchange of health information in Canada. 
  • The interactions and standardized transactions between the actors as defined by the IHE methodology framework are indicated by black lines. 
  • There are two swim lanes that group together the actors and transactions: Clinical systems and Jurisdictional systems. It is assumed that vendors will take on roles from the clinical systems while provinces and territories will take on roles from the jurisdictional systems, however, these latter roles can also be assumed by vendor systems, the RA does not prevent this.
  • Within the Reference Architecture, options for implementation have been highlighted, with Option 1 having two scenarios. 
    • Option 1, Scenario #1: MHD implementation, where the Document Repository is Central
    • Option 1, Scenario #2: MHD implementation, where the Document Repository is Local
    • Option 2: CA:FeX (Canadian FHIR Exchange) Implementation
  • A preferred option is indicated with an asterisk *(e.g. Option 1, Scenario #1) 
  • A list of all the IHE profiles are included at the bottom of the Reference Architecture
  • A list of Canadian National Integration Specifications and Guidance are listed at the bottom of the Reference Architecture, where national extensions to existing IHE profiles and net new profiles for Canada are labelled distinctly. 
  • A legend is found at the bottom of the Reference Architecture to inform readers about the details of the diagram. 

How to Use the Reference Architecture

The list below summarizes how to use this Reference Architecture document:

  • Role Identification: Jurisdictions and vendors will need to identify their role (e.g. actors) from the Reference Architecture and sequence diagrams for each of the use cases in scope.

  • Gap Identification: Based on the role(s) identified, potential assessment is needed for identification of gaps for meeting the requirements of the standardized actors and transactions needed to satisfy particular use cases. 

  • Provincial Reference Architecture: Provinces and jurisdictions may need to draft their own version of Reference Architecture specific to their needs. Current technology landscape, existing architecture and current business priorities will help in developing a version for the province.

  • Document Evolution and Feedback: This Reference Architecture is a living document and will evolve based on feedback from all stakeholders and further refinements driven by implementation specific uses cases. This document is published to capture comments and feedback from all key stakeholders. Additionally, multiple sessions will be conducted to discuss and update the content of this document.

  • Vendor Conformance Testing (Connectathon / Projectathon): This document will provide an opportunity for vendors to prepare for conformance testing on the IHE Gazelle platform. IHE Gazelle is an open-source, web-based test platform supporting a wide portfolio of interoperability test tools suited to validate interface conformity to IHE Profiles and project-specific standards-based interoperability specifications. Vendors can validate their products and eHealth projects to procure interfaces they deploy. For additional information on Gazelle, please refer to the following link: IHE Gazelle.

*Note: The reader is expected to have a moderate degree of familiarity with IHE profiles, especially the ones listed in the Reference Architecture Overview diagram (e.g. IUA, ATNA, CT, MHD).

IHE Profile Versions 

The following describes the published versions in scope for the IHE Profiles that have been referenced in this Reference Architecture.

  • MHD: v4.1.0: Trial Implementation (2022-03-01), based on FHIR R4
  • IUA: Revision 2.2 – Trial Implementation (2022-06-17)
  • ATNA: Revision 19.0 – Final Text (2022-06-17)
  • RESTful ATNA Supplement: Rev. 3.3 – Trial Implementation (2021-07-02), based on FHIR R4
  • CT: Revision 19.0 – Final Text (2022-06-17)
  • mCSD: v3.8.0 – Trial-Implementation (2022-08-12), based on FHIR R4

For any other IHE profiles that are referenced in the Reference Architecture, but not mentioned in the above list, the latest version is considered. 

High-Level View of the Reference Architecture

This is a high-level view of relevant IHE Profiles and Interoperability Specifications to support the Reference Architecture. The view contains a superset of profiles that offer alternatives to exchanging documents and data, depending on Jurisdictional service type and availability.

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