Introduction
Interoperability enables information to flow seamlessly between different solutions and devices. When different parts of the health system are interoperable with each other, they can “speak the same language.” Interoperability improves continuity of care, collaboration between health providers and patient access to their health information. By breaking down data silos, it also reduces inefficiencies and redundancies within the health system.
Connection, collaboration and communication have never been more important for the health system. Increased use of virtual care has highlighted the need for safe and efficient electronic sharing of information across the circle of care. Continuing to improve Canadian health care will necessitate work in interoperability — connected systems are healthier systems.
In support of the provinces and territories, Canada Health Infoway is facilitating a national collaborative effort to advance interoperability. While there are many interoperability-related challenges, this specification addresses sharing of Patient Summaries.
Canada is not alone in trying to solve for this challenge. The International Patient Summary (IPS) project started in Europe several years ago and has been adopted by ISO, IHE and HL7 International. In addition, there is an active working group led by the Office of the National Coordinator (ONC) in the United States called the Global Digital Health Partnership (GDHP) that is actively working with member countries to find solutions for scaling Patient Summary exchanges at an international scale. Canada is an active participant in this partnership and has made a commitment at the G7 meeting in June, 2021 to collaboratively work on aligning Patient Summary implementations to the IPS standard. This project is part of those efforts.
The overarching principle adopted for the project is to maintain as close of an alignment to the IPS profiles as possible while creating the instruments to allow jurisdictions to properly represent their desired clinical workflows. In alignment with the IPS, the pan-Canadian Patient Summary specification will need to include support for unscheduled/scheduled local care and unscheduled/scheduled cross-border care, such that vendor systems will not have to change to support either-or and change management associated with adoption activities will make it a worthwhile investment.
The implementation approach the for alignment with the IPS will span a number of releases on a roadmap. Release 1 will focus on three use cases, that have been identified as priority for Canadian jurisdictions, and their supporting requirements, reference architecture, terminology and FHIR profiles. This release will include supports for sharing Patient Summaries for scheduled or unscheduled local care with information from a single source.
Future releases will incorporate additional use cases and their supporting requirements, reference architecture, terminology and FHIR profiles. For example, the implementation roadmap will include a use case for creating the Patient Summary with information from more than one source and additional scenarios for supporting scheduled or unscheduled cross-border care.
Pan-Canadian Patient Summary Interoperability Bundle:
The Pan-Canadian Patient Summary Interoperability bundle is composed of the following four documents:
pan-Canadian Patient Summary Interoperability Specifications (PS-CA Specifications)
The Pan-Canadian Patient Summary Interoperability Specification is an implementable, testable specification, based on the IHE International Patient Summary specification and the HL7 IPS Implementation Guide. It defines building blocks to create and share condition-independent and specialty-agnostic patient summaries, irrespective of the condition of the patient or the treatment sought or specialty of the provider delivery care. PS-CA building blocks are configurable to address necessary Canadian jurisdictional variances. A patient summary is a health record extract, at a point in time, comprised of a standardized collection of clinical and contextual information (retrospective, concurrent, prospective), including the minimum necessary and sufficient data to inform a patient's treatment at the point of care.
The PS-CA implementable specification contains the information necessary for an implementer to consume and develop the components necessary for creating, consuming and sharing a Patient Summary.
Target Audience: Solution Developers
pan-Canadian Patient Summary – FHIR Implementation Guide
The pan-Canadian Patient Summary - FHIR Implementation Guide is an implementable, testable specification for the HL7 FHIR composition that defines the data payload of the PS-CA specification, based on the HL7 FHIR IPS implementation guide. It contains information for solution developers to implement the PS-CA content data model using the HL7® Fast Healthcare Interoperability Resources (FHIR®) standard. It describes the data elements & types, cardinality, constraints, and code system references - all of the details needed for two systems to be semantically interoperable with each other when a PS-CA compliant patient summary is exchanged.
Target Audience: Solution Developers
pan-Canadian Patient Summary - Companion Guide to Use Cases & Definitions
The pan-Canadian Patient Summary - Companion Guide to Use Cases & Definitions, is a companion document to the pan-Canadian Patient Summary Interoperability Specification that presents the broader context for clinical, business, interoperability and solution development considerations that were discovered during the development of the PS-CA. It defines the healthcare problem that the PS-CA addresses and includes healthcare use cases and interoperability requirements in terms that will be traceable to the content in the pan-Canadian Patient Summary - Companion Guide to Reference Architecture, which defines the actors and their interactions with other actors and the pan-Canadian Patient Summary – FHIR Implementation Guide, which defines the contents and semantic interoperability of the PS-CA.
This document will also support upcoming releases and roadmap elements of the PS-CA specification.
Target Audience: CTOs, CMIOs, CIOs, PTs and vendors
pan-Canadian Patient Summary - Companion Guide to Reference Architecture
The pan-Canadian Patient Summary - Companion Guide to Reference Architecture contains background information on the abstracted PS-CA actors and transactions for the Pan-Canadian Patient Summary Interoperable Specifications for stakeholders who are not familiar with the IHE Methodology. It describes baseline information on the recommended IHE profiles and includes links to the IHE source documentation where stakeholders can get additional details on each PS-CA actor and transaction. This document also includes descriptions of alternatives and choices for implementation patterns and ecosystem architectures to support the Patient Summary-CA in current state, including sequence diagrams that demonstrate the relationship and dependencies between the PS-CA actors and transactions.
Target Audience: CTOs, CMIOs, CIOs, PTs and vendors