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The transactions presented below represent an initial solution to the identified use cases and are expected to evolve, particularly as we hear from the implementer community and use cases are refined and added. We encourage the community to provide feedback on these emerging specifications.

Overview

HL7 characterizes a document by the following properties:

Persistence – Documents are persistent over time. The content of the document does not change from one moment to another. A document represents information stored at a single instance in time.
Wholeness - A document is a whole unit of information. Parts of the document may be created or edited separately, or may also be authenticated or legally authenticated, but the entire document is still to be treated as a whole unit.
Stewardship - A document is maintained over its lifetime by a custodian, either an organization or a person entrusted with its care.
Context - A clinical document establishes the default context for its contents.
Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated.

This specification defines a document as a record (written, printed or electronic) that compiles information about a patient's care for a particular purpose or workflow. Documents are distinct from the medical data that may be included in the document as they provide an additional layer of context and metadata around how and why the pieces of medical data were compiled.

Examples of documents include discharge summaries, history & physical notes, medical imaging reports, patient summaries, and more.

Scope

This specification is starting with the exchange of documents (and their respective resources) in FHIR. As the CA:FeX Interoperability Specifications evolve, it will be expanded to tackle the exchange of individual FHIR resources that can be exchanged independent of a document workflow (e.g., retrieval of last 3 years of dispensed medications).

While HL7 FHIR defines a document format for documents that are authored and assembled in FHIR (See FHIR Composition Resource), this specification also acknowledges that FHIR can be used to exchange documents that are constructed in other formats (e.g., FHIR Binary).

The PS-CA (pan-Canadian Patient Summary) is being used as the first type of document to identify possible transaction patterns and requirements that could be extrapolated to other types of documents.

The CA:FeX Interoperability Specifications will provide detailed information for the following transactions.

Transaction ID	Description
CA:FeX-1	Submit Data
CA:FeX-2	CA:FeX-2A: Search Against FHIR Assembled Documents Repository
CA:FeX-2	CA:FeX-2B: Search Against Hybrid Documents Repository
CA:FeX-3	CA:FeX-3A: Retrieve Document From FHIR Assembled Documents Repository
CA:FeX-3	CA:FeX-3B: Retrieve Document from Hybrid Documents Repository

FHIR Version

FHIR content in this specification is based on on FHIR Release 4 (R4).