The Canadian FHIR^® Registry supports collaborative development in an effort to accelerate sustainable growth of FHIR, locally and internationally. The registry will be the home of national FHIR profiles recommended for use in Canada, including extensions, value sets, URIs and other useful, commonly used components. It is also host to a growing number of national, jurisdictional and locally shared FHIR projects, and is open to all Canadian implementers.

The Canadian FHIR Registry offers:

• seamless integration of profile editing using Forge (free FHIR profile editor)
• designated project space
• supports project teams of up to 100 individuals
• online authoring of implementation guides
• integration with source control tools such as GitHub
• version controlled environment

The Canadian FHIR Registry blends software development best practices with the requirements of modelling in FHIR, essential to delivering successful project requirements while having continuous access to structure validation, rendering and publishing.

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FHIR web services used to access terminology data

FHIR Terminology Service APIs enable automated exchange of clinical terminology content and resources. It allows developers to easily implement healthcare applications that programmatically consume codes and subsets without requiring in-depth expertize in the fine details of terminology.

FHIR Terminology Service API

Open source integration tools useful for health IT integration projects

HAPI FHIR® is a simple-but-powerful library for adding FHIR messaging to applications. It is pure Java compatible and licensed under the business-friendly Apache Software License, version 2.0.

HAPI FHIR

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Open source integration tool useful for health IT integration projects

HAPI for HL7 v2 messages is an open-source, object oriented HL7 v2.x parser developed for the Java platform.

HAPI v2

Standards versions available for viewing in HL7 Explorer

Supporting the Standards Selection Framework, InfoScribe enables teams to collaboratively create, discuss, and publish digital health solutions from clinical requirements to specifications. Featuring templates, versioning, PDF export, inline commenting and HL7 Explorer integration, InfoScribe improves productivity and accelerates the development of healthcare solutions.

Standards Selection Framework

The Standards Selection Framework provides users with the means to plan, choose and document interoperability solutions from concept through to implementation. Starting from the Clinical Requirements identified by clinicians through to business requirements, standards and technical specifications, the framework provides a comprehensive guide through the development of interoperability solutions.

The framework also provides an opportunity for the InfoCentral community to share successful implementation projects, the standards selections made at a point in time of the project and the specifications that result from the selections made. Publishing solutions in this space will help to establish a Canadian repository of references.

Clinical Requirements describe the information and workflow needs of the clinician for a specific clinical context and clinical data exchange. Using the Clinical Interoperability Principles as a guide, a set of requirements expressed in the clinician’s voice will provide the foundation for a well-designed interoperability solution.

Business Requirements are derived from clinical requirements and provide a full picture of the solution that needs to be developed. Use cases, business rules and guidance are used to fully outline the solution design.

Standards Selection refers to the process that has been developed to help guide teams through the selection of terminology and messaging standards. Using the line of inquiry and considerations in the forms provided implementation teams may assess the standards available and determine the best option for the point in time. The process also provides an opportunity for the InfoCentral community to share successful implementation projects, promoting standardization through reuse.

Standards are an integral piece of the interoperability solution, covering both the terminology that defines the data sent, and the messaging structures that define how the data is transferred. The framework provides the access and consideration criteria to the international and Canadian standards to facilitate implementation.

Specifications provide the details for the solution to be implemented. These details include: a review of the data elements used, samples of transferred messages, the system architecture as well as the security specifications including authorization and authentication.

Solution for API integration

Infoway Message Builder allows developers to focus on the business challenges of integrating their solutions with each electronic health record implementation by abstracting the differences between different versions of pan-Canadian HL7 messaging and supporting current implementation constraints. Developers can build interfaces in a familiar development environment, using the programming language of their choice*, while the Message Builder API fosters quick and easy creation, population and access to HL7v3 requests and responses.

Infoway Message Builder v2.0 and later is enhanced to generate JAVA APIs to create, validate, marshal/unmarshal CDA documents.

Key features and benefits

Message Builder offers a number of key features and benefits:

1. Abstracts the complexity of HL7v3 messages and greatly simplifies the work of the developer when implementing them;
2. Reduces the impact on developers from implementation variations;
3. Enables companies to achieve Infoway product certification with greater confidence and reduced time;
4. Enables developers to incorporate future message versions without re-writing their products;
5. Can be embedded in software applications due to its open source distribution under a commercial-friendly Apache 2.0 license.

Out of the box support

Infoway Message Builder comes with built-in runtime APIs that support a number of pan-Canadian specifications:

In addition, while developers can easily build custom transport mechanisms without affecting the core, Message Builder includes native support for SOAP and RESTful message transports. Developers can configure and extend the transport as desired.

Detailed product features

• Provides the capability to configure and populate message values that are common to all messages—this allows developers to reuse common message data, shortening the time to configure and create an interoperable system.
• Uses simplified data types that are natural and familiar to the programming language (e.g. String for ST) rather than directly exposing the sometimes complicated HL7v3 data types—yet still allowing access to HL7v3 data types when necessary.
• Allows developers to focus on the business-aspect of a request/response, avoiding many of the complexities of HL7v3.
• Code-generation algorithms merge identical and similar classes together to simplify the generated API—meaning less confusion in the resulting code and an increased ability to write generic handlers for certain types.
• Converts populated objects into HL7v3 XML requests, and converts HL7v3 responses into populated objects.
• Provides flexibility in configuring and performing terminology-code lookups, including code set and database-backed lookups (can mix and match).
• Associations and attributes are strongly typed, given business names when provided, and contain code docs directly from the MIFs (see wiki.hl7.org/index.php?title=MIF).
• The algorithms inline most classes that only have a small number of properties, further simplifying the API.
• Offers both permissive and strict modes—permissive allows many common errors and generates appropriate error comments in the XML or result object.
• A separate validation tool is provided to test ad-hoc messages—this tool reuses the same validation components that are executed during message marshaling and unmarshalling, ensuring consistent processing of the message whether during processing or during conformance validation.

Forward looking

The power of the Message Builder architecture is in its MIF-based generation of the specification API. With Message Builder, any MIF is supported—whether a future release of the pan-Canadian specifications or a modified (constrained) jurisdiction-specific release of an existing specification. 

How it works

Message Builder comprises two parts:

1. Message Builder Generator—a tool used by Infoway to take input MIFs and create Message Sets for use by Message Builder Runtime;
2. Message Builder Runtime—an API used by developers to allow their products to support multiple Message Sets without recoding.

Message Builder Generator

Used by Infoway, Message Builder Generator takes MIFs (as the source of truth for standards specifications) and converts them into a series of Java Classes. This is done by first converting the MIFs to an XML Message Set (a simplified representation of the information present in the original MIFs), then generating Java Classes that reference standard Java data types and use business-friendly names. In the process, groups of related elements are flattened and similar message parts are placed into a single class: these steps increase ease of use and reduce the complexity of the resulting Java Classes.

Using Message Builder Generator, Infoway is able to create multiple Message Sets, each representing the MIFs used in a single jurisdiction, but all for the same HL7v3 version.

Message Builder Runtime

Message Builder Runtime allows developers to quickly adapt to implementations in multiple Jurisdictions: incoming messages are first examined to determine the corresponding source Message Set, once identified, a series of Java Objects that represent the message are instantiated. Next, the Java Objects are turned into an HL7 message for the HL7 version corresponding to the desired destination Message Set. 

Using Message Builder Runtime developers can accept messages over the wire and on-the-fly turn them into a different HL7 message version. Given the capability of Message Builder to support future versions of HL7 messages, developers can easily future proof their products with minimal effort.

*Developer friendly

The Message Builder libraries are available for Java and Microsoft .NET. In addition, a simplified XML message format is available with REST-based services for managing mapping to/from the simplified form to the target specification XML format.

CDA Support

Message Builder CDA API supports the following CDA and data type specifications:

• CCDA specification R1.1 (www.hl7.org/implement/standards/product_brief.cfm?product_id=258)
• Pan Canadian CDA header guideline;
• CDA R2 data types;
• Pan Canadian data types  (MR 2.05).

Message Builder provides  JAVA and .NET APIs for CDA document creation, validation, marshalling/unmarshalling of the following CDA document types:

• Continuity of Care Document (CCD) (Release 1.1)
• Consultation Notes (Release 1.1)
• Discharge Summary (Release 1.1)
• Imaging Integration, and DICOM Diagnostic Imaging Reports (DIR) (Release 1)
• History and Physical (H&P) (Release 1.1)
• Operative Note (Release 1.1)
• Progress Note (Release 1.1)
• Procedure Note (Release 1)
• Unstructured Documents (Release 1.1)
• CDA documents using pan Canadian CDA header template

Clinical applications in JAVA or .NET can use the Message Builder CDA APIs to create, validate or parse above listed types of CDA documents. Potential use cases are document source or document consumer actors in IHE XDS profile, content creator/content consumer in any content module/profile, or report creator/viewer in RIS/PACS/EMR systems.

Message Builder is available for Java and .NET

Message Builder for Java

System Requirements

• Java 1.5 or higher
• Maven 3.0.3 or higher (can be removed after installing Message Builder if working with a non-Maven project)

Download

• Sample Message Builder Java project for HL7 v3 - includes all the required libraries of the latest Message Builder.
• Sample Message Builder .NET project for HL7v3- includes all the required libraries of the latest Message Builder.
• Sample Message Builder Java project for CDA - includes all the required libraries of the latest Message Builder.
• Sample Message Builder .NET project for CDA - includes all the required libraries of the latest Message Builder.

Message Builder is licensed under Apache License, Version 2.0. To use Message Builder, you will need

1. Message Builder Core and
2. one or more Message Builder API release(s)—depending on your implementation requirements.

Select a Message Builder Version:

Select one or more Message Builder API releases:

Optional Message Builder components:

Message Builder pom.xml file:

Message Builder for .NET

System Requirements

• .Net Framework 3.5 or higher

Download

• Sample Message Builder .NET project for HL7v3 - includes all the required assemblies of the latest Message Builder
• Sample Message Builder Java project for CDA - includes all the required assemblies of the latest Message Builder

Message Builder v2.1 for .NET

Message Builder is licensed under Apache License, Version 2.0. To use Message Builder:

1. Download Message Builder .NET Core 2.1.0 setup
2. Unzip and pull out the dll files that you need:
    \ → root location of required Message Builder core assemblies (Mandatory - required all)
    \releases\ → location of Message Builder release assemblies (Mandatory - choose one or more)
3. Copy them to your .NET project 
4. Download Message Builder .NET 3rd-Party libraries, unzip it, and copy the files to your .NET project

Message Builder v1.5.8.1 for .NET

Message Builder is licensed under Apache License, Version 2.0. To use Message Builder:

1. Download Message Builder .NET Core 1.5.8.1 setup
2. Unzip and pull out the dll files that you need:
    \ → root location of required Message Builder core assemblies (Mandatory - required all)
    \releases\ → location of Message Builder release assemblies (Mandatory - choose one or more)
3. Copy them to your .NET project 
4. Download Message Builder .NET 3rd-Party libraries, unzip it, and copy the files to your .NET project

Message Builder v1.4.6 for .NET

Message Builder is licensed under Apache License, Version 2.0. To use Message Builder, you will need

1. Download Message Builder .NET Core 1.4.6 setup
2. Unzip and run SetupCore.msi file
3. Choose a installation location <install dir>.  The setup execution should place the following directories in <install dir>:
    \lib\ → location of required Message Builder core assemblies (Mandatory - required all)
     \releases\ → location of Message Builder release assemblies (Mandatory - choose one or more)
    \src\ → location of all source code and project files required to load them into visual studios
    \debug\ → location of debug symbol files
4. Pull out files the dll files from the \lib\ and \releases\ folders, and copy them to your .NET project 
5. Download Message Builder .NET 3rd-Party libraries, unzip it, and copy the files to your .NET project

Localization of pan-Canadian Standards

Infoway Message ReMixer is a web-based application that allows for the localization of pan-Canadian Standards (pCS) messages to meet jurisdictional requirements, all while maintaining the integrity of the original, standard message.

Access Message ReMixer Now

Pan-Canadian Standards use Object Identifiers (OIDs) to distinguish between objects by assigning a numeric string that enables other systems to understand the unique information that is being shared between various systems.

Canada Health Infoway has an arrangement in place with HL7 International that allows Infoway to submit OIDs to HL7 International on behalf of Canadian Implementers free of charge. There is a $250 USD fee per OID request if done directly with HL7 International.

To submit an OID, download the registration form that corresponds to your OID request. Email the completed form to This email address is being protected from spambots. You need JavaScript enabled to view it.

Browse International and Canadian Content

SNOMED International's SNOMED CT browser allows users to browse and search the SNOMED CT International Edition to explore concepts and relationships. It also provides access to browse national extensions from SNOMED International member countries including the Canadian Edition of SNOMED CT in English and French.

Browse SNOMED CT Now

Browse, download and leverage the terminology used in Canada

Terminology Gateway is a web based solution framework that enables the distribution and sharing of terminology concepts, subsets and concept maps, making them available for web browsing, download or real time query.

Browse Terminology Gateway Now

RESTful web services used to browse terminology data

Terminology Service RESTful APIs enable automated exchange of clinical terminology content and resources. It allows developers to easily implement healthcare applications that programmatically consume codes and subsets without requiring in-depth expertise in the details of terminology.

Terminology Service API

Apelon’s TermWorks is an easy-to-use data mapping solution that is provided by request (free of charge) to individuals who have Standards Access. It brings powerful terminology capabilities directly to the desktop. TermWorks combines Microsoft® Excel® spreadsheet software with web services-based terminology processing to give organizations comprehensive mapping capability to SNOMED CT and the Canadian Edition of SNOMED CT.

Automated notifications of new content in Terminology Gateway

A WebHook is an HTTP callback. When new content is published in the Terminology Gateway, a publishing event will be POSTed to each registered WebHook, notifying their respective owners about the publication.

WebHook registration

Individual users can register for WebHook notifications by sending an email to: This email address is being protected from spambots. You need JavaScript enabled to view it. and specifying the WebHook endpoint. Upon registration, a unique api_id will be assigned to the WebHook. Each notification POSTed by the Terminology Gateway will contain the api_id, allowing the endpoint to verify that the notification was indeed issued by the Terminology Gateway. The api_id must be echoed back by the WebHook endpoint in the body of the notification response.

WebHook interface

The WebHook endpoint must serve HTTP requests conforming to the following interface:

HTTP Request

{
  "api_id": "cb570e5a2748f349f9119431db836b3a23fdb6571afee34c0432d87220f2431b",
  "base_url": "https://termapi.infoway-inforoute.ca/rest/v1/",
  "notification_time": "2017110711:07:00",
  "targets": [
    {
      "id": "2.16.840.1.113883.2.20.6.1",
      "name": "Canadian Clinical Drug Data Set (CCDD)",
      "type": "package",
      "version": "20171016",
      "effective_date": "20171016",
      "publication_time": "2017103015:20:23",
      "message": "Monthly CCDD update for October 2017"
    },
    {
      "id": "2.16.840.1.113883.2.20.3.443",
      "name": "PrescribeIT",
      "type": "package",
      "version": "LPR2",
      "effective_date": "20171103",
      "publication_time": "2017110309:37:22",
      "message": "PrescriptionMedicinalCode version reflecting the October 2017 CCDD update"
    }
  ]
}
				

• api_id: as previously mentioned, each notification POST contains the api_id granted at registration.
• base_url: the base URL for the native REST API endpoint of the originating system. This can be used to call back the Terminology Gateway via APIs in order to programmatically download updated content.
• notification_time: the timestamp of the WebHook notification in yyyyMMddHH:mm:ss format.
• targets: list of updated targets. Each entry in this array corresponds to a Terminology Gateway artifact (subset, codesystem, map, package) that was updated and is therefore subject to the notification. The target list will only include artifacts for which the user has registered to receive notifications. Users can register to receive notifications about content updates using the Terminology Gateway User Interface or by invoking the native REST APIs.
  
  Each of the notification targets contains the following fields:
  • id: the artifact id, typically an OID
  • name: the artifact name
  • type: the artifact type: subset, codesystem, package or map
  • version: the published version id
  • effective_date: the effective date associated to the artifact version, in yyyyMMdd format
  • publication_time: the publication time in yyyyMMddHH:mm:ss format
  • message: optional message describing the published artifact version

HTTP Response

HTTP Response code: 200 for success, any other response code will be interpreted as an error
Sample HTTP Response Body:

{
  "api_id": "cb570e5a2748f349f9119431db836b3a23fdb6571afee34c0432d87220f2431b",
  "result": "success",
  "message": "Successful processing of the WebHook notification"
}

• api_id: as previously mentioned, each notification response must echo back the api_id granted at registration.
• result: success if the web hook notification was successful, any other value will be interpreted as an error.
• message: optional response message.

Error handling

When receiving an error as a result of a WebHook notification, the Terminology Gateway will retry the notification four times at 15 minutes intervals. If still unsuccessful after four notification attempts, the system will drop the notification and will notify the user by email that the WebHook couldn't be invoked.

Sample code

Demo code for a sample WebHook endpoint can be found here: 

https://github.com/CanadaHealthInfoway/tgateway-webhook