Introduction

The pan-Canadian Patient Summary - Companion Guide to Reference Architecture provides guidance on how to apply specific IHE patterns and pan Canadian Interoperability Specifications to address interoperability needs pertaining to the Patient Summary-CA use cases. It defines the rules of engagement and defines the interoperability landscape as well as developing a connectivity platform, linked to the virtual care implementation specification package development to allow external vendors to test solutions.

Intended Audience 

The intended audience of the pan-Canadian Patient Summary - Companion Guide to 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.

Overview

This document is a Reference Architecture for the Patient Summary-CA project. It contains a list of recommended IHE candidate profiles and pan Canadian Interoperability Specifications that can meet specific needs of the PS-CA project.  These sequence diagrams group together actors and transactions from multiple profiles to address the business requirements of the in-scope Patient Summary-CA use cases.

How to Read the pan-Canadian Patient Summary - Companion Guide to Reference Architecture 

• This document lists required and optional actors and transactions from candidate IHE profiles, included in the PS-CA v1 Trial Implementation, that can enable secure exchange of health information (e.g., Patient Summary-CA) in Canada. 
• The relationship between consuming and recipient actors 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.  
  • Dark green actors are required actors showcasing different roles within the clinical systems that are required for this release 
  • Light green actors are optional actors showcasing different roles within the clinical systems that are optional for this release 
  • Dark blue actors are required actors showcasing different roles within the jurisdictional systems that are required for this release 
  • Light blue actors are optional actors showcasing different roles within the jurisdictional systems that are optional for this release 
• Within the Reference Architecture, two 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: FHIR HIE Implementation
  • Option 3: XDS implementation 
  • A preferred option is indicated with an asterisk* (e.g. Option 1, Scenario #1) 
• The black lines are the interactions and standardized transactions of the actors and their association with one another as defined by the IHE methodology framework. 
• A list of all the IHE profiles are included at the bottom of the Reference Architecture.
• A list of pan Canadian Interoperability Specifications  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 help readers orient themselves to the diagram. 

How to Use the pan-Canadian Patient Summary - Companion Guide to Reference Architecture 

Below list summarizes how to use this 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 for the Patient Summary-CA project.
• Gap Identification: Based on the role(s) identified from the Reference Architecture and sequence diagrams, potential assessment is needed for identification of gaps for meeting the requirements of the standardized actors and transactions needed to satisfy particular PS-CA 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 is a living document and will evolve based on feedback and refinements to the PS-CA uses cases and business requirements, as well as from other workstreams such as the pan-Canadian Cross-Solution Secure Communications (SMX-CA) . This document is published on InfoScribe 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 of the Patient Summary-CA Standard via 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: It’s expected that the reader should have a moderate degree of familiarity with IHE profiles, especially MHD, MHDS, PMIR, PIQm, PDQm, mCSD, ATNA, CT and IUA.

High Level View - Reference Architecture for Patient Summary-CA 

This is a high-level view of relevant IHE Profiles and pan Canadian Interoperability Specifications to support the Patient Summary-CA project. The view contains a superset of profiles that offer alternatives to exchanging Patient Summaries, depending on Jurisdictional service type and availability. Required and optional capability support is described in the sequence diagrams associated with each Use Case analysis.  

In order to view a high resolution image of the Reference Architecture, please view this link for the online version .