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 | FHIR Immunization | x | The FHIR Immunization Resource supports the use cases described above without further extension or localization. In the event that extension is required to support future requirements, FHIR provides a straightforward mechanism for creating extensions. Canada-specific terminology value sets can be used while remaining “FHIR conformant”, as the FHIR Immunization resource only specifies examples; implementers are free to use any value set they choose. FHIR has significant momentum among vendors and developers, meaning the long-term sustainability of FHIR-based implementations will likely be superior. There is a substantial ecosystem of open-source tools and reference implementations for FHIR that implementers can leverage to accelerate their projects. |
Canada Health Infoway pan-Canadian Immunization Standard |
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Terminology
| pan-Canadian Public Health Immunization Subsets (SNOMED-CT) | x | The pan-Canadian Public Health Immunization Subsets reflect Canadian requirements (e.g. Canadian vaccine lists), and is aligned with the PHAC Canadian Immunization Guide. It is being adopted in additional projects across Canada (including AB, SK, MB, Canadian Forces, CIHI), so additional implementations that adopt the Ontario standard will be well positioned for interoperability with these groups or organizations. |
iTerm value sets |
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| Single Sign On (SSO) | OAuth 2.0 | x | OAuth provides better support for mobile applications. |
| SAML 2.0 | |||
Document and Image Sharing | IHE Cross-Enterprise Document Sharing - Imaging (XDS/XDS-I) | X | The IHE XDS-I.b profile specifies the use of existing standards including HL7 and DICOM to enable registration and sharing of images and reports. A Canadian XDS Affinity domain guide is available to support implementation of the profile. |
DICOM / HL7 |
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Imaging Report Format | Clinical Document Architecture (CDA) R2 | X | It is the goal of the Canadian XDS Affinity domain that reports will be stored in HL7 CDA format (using the pan-Canadian header format) as these reports (a) support required metadata, and (b) can be transformed to all other formats.
* Raw text based HL7 ORU and DICOM SR are widely used and present in DI-R systems. |
Portable Document Format (PDF) |
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DICOM SR / SC* |
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Raw Text* |
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Anatomic Region Code | Coarse Body Parts (SNOMED CT subset) | X | The DICOM CID 4 value set is very detailed and generally inconsistent with the general approach of “casting a wide net” employed when fetching content within the FEM use cases. |