Canadian FHIR Baseline Profiles - Governance Stream Meeting - August 30th, 2-3pm EST

Hi Ken,

Apologies first for the delayed response and any thanks to Gavin and Beverly for chiming in with their thoughts and perspectives. We agree with Gavin’s reply.

How will we establish endorsement of this Canadian Baseline standard, to give assurance to vendors and implementers confidence and legitimacy to this work?

A large part of the issue at hand is adoption of the Baseline and not just merely the creation of one. As Gavin has stated, awareness is key to driving adoption. It is crucial for driver’s like eHealth and the new Ontario Health Agency, along with other provincial/territorial agencies to spread awareness and promote the CA-Core adoption in any future RFPs.

As for governance, one approach may be to leverage the FHIR Maturity Model (FMM). National connectathons can serve as testing grounds that bump up the FMM numbers for the profiles but ultimately, the stamp of approval needs to come from the vendor/implementer community.

What is the criteria to consider the CA-Core on FHIR R4 "complete" for approval/endorsement and adoption, and what is the estimate of additional work effort (beyond this first pass of profile reviews) for any changes, including ongoing maintenance and evolution to R5 and beyond?

One possible way to do this is to throw a use case at the baseline. This will engage clinical domain experts who can then add to completeness of the profiles. It is also apparent that the CA-Core calls are mostly Ontario based. We need consensus from the other jurisdictions in-order to make this a successful and worth while endeavour. Perhaps engaging the Canada council and having jurisdictional representatives from each province serve as members so we can get a feel about National consensus.

While we really appreciate the question being raised about maintenance, the roadmap and evolution beyond R5 as these questions are often not considered as part of a project plan until the very end, it is still too early to say anything definitive, but keeping this conversation alive with all of us weighing in with possible approaches and solutions is a great way to start.

We wondered about having a face to face conversation (hosted at the Infoway Office) that discusses past approaches - what has worked and what has failed and how we can proceed to come up with a plan for the governance structure is a step in the right direction. We would not be able to fund travel, but we would be willing to host at our office as attendance numbers permit. For those who are not able to travel, we could leverage Zoom and its video component.

Thank you,

Joel Francis & Andrea MacLean

hi guys
To add my perspective and lessons learned to this thread....
Based on what i have read below, would clearly separate discussions into 3 categories; maintenance, conformance and overall governance. what i see below is a combination of all 3.

To build on Gavin's comments regarding conformance or "adoption aspirations", i would suggest "conformance considerations" type of documentation is a definite first step.

thx
beverly

Hi Ken,

All good questions driving at the heart of the chicken and egg challenges associated with traditional standards development and adoption exercises. I feel like you might be looking for someone from Infoway to respond - particularly your point re: funding - but I'll share my personal perspectives on some of your questions below:

How will we establish endorsement of this Canadian Baseline standard, to give assurance to vendors and implementers confidence and legitimacy to this work?
GT: I’m still hoping we’ll be able to put it through the HL7 Canada balloting process. However, I don’t think any vendor is going to care about the endorsement processes. They’re going to care if their exchange partners are using it, if clients are asking for it, if their competitors are using it, and if the profiles make sense for their system/applications and business models.

Will the governance process clearly identify how the CA-Core will be approved/endorsed as an approved Canadian product with defined adoption targets (at the national level -- Canada Health Infoway? HL7 Canada?) and maintained for future releases?
GT: I don’t think the HL7 Canada balloting process will describe adoption targets. Maybe adoption aspirations ? However, I think what you’re getting at is there needs to be a stream of work to raise awareness of the profiles and drive adoption. To do that, we need to get to a stage where we have at least the draft profiles in order to start those efforts. Re: Maintenance, I would think if approved by HL7 Canada we’d follow their maintenance processes with this community as one of the key resources to support evaluation of requests.

What is the criteria to consider the CA-Core on FHIR R4 "complete" for approval/endorsement and adoption, and what is the estimate of additional work effort (beyond this first pass of profile reviews) for any changes, including ongoing maintenance and evolution to R5 and beyond?
GT: Please always keep in mind this is a grass roots initiative – the community works on items community members want to work on, community members can choose not to work on things, anyone can suggest roadmaps and plans, etc. I think it’s safe to say that there are no defined plans as of yet for maintenance and evolution to R5 until we have some draft profiles and potential implementers start putting some signals out to the marketplace about their intentions to adopt. In the days of the Standards Collaborative we had well defined governance and maintenance processes, and funding to drive adoption of the pan-Canadian EHR standards, but that didn’t lead to the wide spread adoption of those standards nor did it stop implementers from pursuing other standards that worked for their systems/apps and business models.

We wanted to raise some thoughts and questions around the Canadian Baseline work, in pursuit of a better final product, so please consider the following as opportunities to improve the process.

We recognize that the Canadian Baseline work is important -- the alternative would be either adopting the US-Core as is, or working separately with vendors resulting in a fragmented Canadian/Provincial/Territorial/Regional/Local FHIR landscape. The goal for the Canadian Baseline is to establish a common set of profiles for those vendors/implementers to adopt, based on known differences between Canada and the US.

We understand that the governance process for endorsement and maintenance is still developing. How will we establish endorsement of this Canadian Baseline standard, to give assurance to vendors and implementers confidence and legitimacy to this work? Will the governance process clearly identify how the CA-Core will be approved/endorsed as an approved Canadian product with defined adoption targets (at the national level -- Canada Health Infoway? HL7 Canada?) and maintained for future releases?

The profile review effort to date has been significant, to ensure the necessary rigour and alignment with existing standards in use and developing, and we're only halfway to completion of the first pass as of September 2019. What is the criteria to consider the CA-Core on FHIR R4 "complete" for approval/endorsement and adoption? What is the roadmap to have CA-Core R4 "complete", and what is the estimate of additional work effort (beyond this first pass of profile reviews) for any changes, including ongoing maintenance and evolution to R5 and beyond? Despite being a Canadian baseline, jurisdictions are volunteering and putting in substantial hours to develop this national standard. The current approach is unsustainable in terms of workload and limited governance structures (see above),in addition to existing responsibilities and operations, unless Infoway secures appropriate funding to resource the Canadian Baseline work for all F/T/P/R/L organizations involved in this pan-Canadian initiative to ensure delivery of a high quality, viable and adoptable standard and the necessary evolution and maintenance.

eHealth Ontario is open to working with the community and engaging in additional discussions around some of these comments and questions above.

Attendees

Ken Sinn
Michael Savage
John Wills
Scott Prior
Shamil Nizamov
Raman Dhanoa
Fariba Behzadi
Mini Riar
Sheridan Cook
Igor Sirkovich
Russ Buchanan

• Re-emphasis on national / organizational endorsement of this work; will be very important to have a body that ‘signs-off’ on the work eventually

• How to ‘test’ core profiles in the connectathon context – typically these contexts deal with testing implementations, which use more constrained and specialized profiles
o Core profiles have ‘broad’ use cases; i.e. the broad use case for the core patient profile is ‘retrieval of patient data’
o Suggestion is to look at the existing IHE profiles and the use cases there
o The IHE profiles map the technical frameworks to business cases
o For us, would retrieve and send back the patient resource as defined in the Canadian Core profile
o Re-use the fundamental workflows already established by other groups (i.e. IHE), and basically work to determine (and show) that the Canadian Core profiles support these existing, broad, business / use cases

• FHIR North as an opportunity – some emphasis on transition to Ontario Health Teams model
• Anyone from the FHIR Community testing out FHIR implementations? And/or demo-ing these implementations at FHIR north?
• Action Item: Mike to post to forum to get responses on this from larger community
• Action Item: Mike to post link from Ken to forum, re: HL7v2 to FHIR mapping
• confluence.hl7.org/display/OO/Connectathon+-+v2-to-FHIR%3A+May+2019

• How to get feedback from vendors and other testers of the core profiles
o Look at what the existing procedures are out there
o Look at role of connectathon monitors; can gather questions from testers in real-time, helps vendors implement
o gazelle.ihe.net/content/connectathon-monitors
o Will look at best practices out there for connectathons

Thanks, Mike for the details!

Shamil- Joel and I would try our best to help you out with your queries in regards to the tooling (Simplifier and Forge) if needed. Please feel free to reach out to us anytime.

Regards,
Smita