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 (Infoway) is facilitating a national collaborative effort to advance interoperability. While there are many interoperability-related challenges, this specification addresses standardized sharing of vital patient information for the benefit of health care providers and patients using FHIR based information exchange. This FHIR based information exchange is similar to and accomplishes the same objectives as a Health Information Exchange (HIE).
The Office of the National Coordinator for Health Information Technology (ONC) defines HIE as:
Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care.
While electronic health information exchange cannot replace provider-patient communication, it can greatly improve the completeness of patient’s records, (which can have a big effect on care), as past history, current medications and other information is jointly reviewed during visits.
Appropriate, timely sharing of vital patient information can better inform decision making at the point of care and allow providers to avoid readmissions, avoid medication errors, improve diagnoses and decrease duplicate testing.
The first priority of this specification will be to define a document exchange interface for CA:FeX, clearly defining how a FHIR document can be transacted with a Clinical Data Repository. The CA:FeX specifications will be carefully planned out and developed according to a multi-phased roadmap. For example, additional components may include:
- Authentication and Authorization Services
- Role Based Access
- Information Data Models
- Security Services
- Audit Services
- Provider Directory
- Patient Registry (i.e., EMPI)
- Patient Consent Services
- Clinical Decision Support
In parallel with these CA:FeX specifications, Infoway is also facilitating a national collaborative effort to develop the pan-Canadian Patient Summary Interoperability Specifications (PS-CA). The PS-CA 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. The PS-CA Reference Architecture will reference this CA:FeX specification as an optional implementation pattern for submitting, searching and retrieving a Patient Summary document.