Implémentations FHIR

À propos de nous

Welcome to the Canadian FHIR implementation community forum. The purpose of this forum is to collaborate on areas of FHIR implementation that will advance implementations across Canada, while contributing to the global adoption of FHIR. The objective is to develop pan-Canadian approaches to constraining and extending FHIR. The community has been active since January 2016 and has been growing ever since!

The community currently has five streams of activity:
1. Topical workstreams
2. Monthly community calls to share workstream progress and other FHIR-related news
3. A general forum to ask questions and share information

The table below provides more details on the workstream activity:

Workstream	Co-Chairs	Objective	Progress to date
Solution Architecture	Igor Sirkovich (OMHLTC) Ken Sinn (Ontario Health Team)	Serve as a forum for all architectural questions about implemention of FHIR based solutions Discuss Canadian URI (incl. mapping to OIDs), profiles and extensions	Currently hosting governance calls for the FHIR Profiling Stream
eReferrals	Tim Berezny (CareDove) Caryn Harris (Orion Health)	Build eReferral use cases Prototype eReferral use cases Select Resources to include in Specifications Write preliminary Specifications for broader use	Assembled stakeholders from across the e-referral spectrum to build a community led e-Referral specification. Published an e-referral implementation guide that has been adopted by various integrations across Ontario: https://simplifier.net/guide/eReferral-Ontario/Introduction
Community Monthly Calls	Gavin Tong (Gevity Inc.) Yaron Derman (eHealth Ontario)	Share progress within the workstreams within the broader FHIR community Identify and promote FHIR education and implementation activities	Informative updates and discussions about FHIR globally and progress across the workstreams Average 17 participants per call.
Canadian Baseline Profiles	Sheridan Cook (Gevity Inc.) Michael Savage (Ontario MD)	Create of a set of national FHIR profiles that can be leveraged by implementers and jurisdictions to promote re-use and interoperability Establish a common baseline / starting point for Canadian FHIR Implementations	Organization of workstream into Profiling and Governance Streams, to allow for ample time to explore different types of issues Total of 78 proposed changes to draft Profiles received from FHIR Community Organization of Profiling Stream into sub-streams based on thematic groupings of FHIR Profiles: Entities, Medications, and Clinical Average 10 participants per call
Canadian FHIR Baseline Profiles – Individuals & Entities Sub Stream	Shamil Nizamov (BC MOH)	Creation of a set of Patient, Practitioner, Organization, Location, PractitionerRole national profiles.	The work is based on US Core profiles with analysis of other existing profiles (Netherlands, Australian)The work is based on US Core profiles with analysis of other existing profiles (Netherlands, Australian)
Canadian FHIR Baseline Profiles - Immunization & Medication Sub Stream	Igor Sirkovich	Creation of a set of Immunization, Medication, MedicationRequest, MedicationStatement national profiles	The work is based on US Core profiles with analysis of other existing profiles (Netherlands, Australian)The work is based on US Core profiles with analysis of other existing profiles (Netherlands, Australian)
SMART on FHIR Community of Practice	Paula Lee/Open	Develop Canadian specific SMART on FHIR guidance and specification documentation and best practices	This group has been recently established and is beginning with business use cases around which to develop an implementation guide and specification. Current SMART on FHIR implementers from across Canada are welcome to join.

The FHIR community forum is a great place to learn, share and collaborate, whether you are new to FHIR or are already have deep FHIR experience.

Canadian Core Profiles

Activité

Marcy Antonio s'est joint(e) à un groupe

FHIR® Implementations

Dedicated to the discovery, definition and publishing of HL7® FHIR® Implementation Guides, Conformance, Profiles, Extensions and ValueSets serving the Canadian context.

Francis Lau a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question on Ethnicity and Race-based Value Sets

Hi Finnie, thanks for your support to create the race extension, and to point out the Canadian edition SNOMED codes in the CRDM toolkit for the race categories.

Finnie Flores a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question on Ethnicity and Race-based Value Sets

Hi Francis, I support creating an extension in CA Core/Baseline for race/racialized group. With regards to SNOMED CT codes for the answer list/concepts, please see the CIHI Reference Data Model (CRDM) document https://www.cihi.ca/sites/default/files/document/cihi-reference-data-model-toolkit-en.pdf on page 92. If you are searching in SNOMED CT browser, please be sure to search in the CA extension. To mention, we do not use LOINC codes for the race/racialized group answer list/concepts. Finnie

Finnie Flores a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question on Ethnicity and Race-based Value Sets

Hi Sheridan. We have not created a value set yet that FHIR can use. So you are welcome to create one using the concepts from the Racialized Group in CRDM. Thanks

Francis Lau a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question on Ethnicity and Race-based Value Sets

Hi thanks for continuing this discussion. Here are my additional comments about ethnicity, race and CA baseline: CIHI's proposed race-based data standard is consistent with the race question-responses used in Pinto's SPARK study currently underway on the collection and use of SDOH data to address inequities -see https://upstreamlab.org/spark-study/ I believe the reason CIHI's race categories have a mixture of race, ethnicity and geographic values is a pragmatic one to reflect the changing mix of the Canadian populations. Some people have difficulty distinguishing the difference between race and ethnicity, and identifying which categories they belong tom especially if they are of mixed heritage. We did some initial mapping of CIHI's race categories to SNOMED codes and LOINC-answers, and found not all categories are covered. So some new values and/or value set(s) will likely be needed. One added benefit of using SNOMED to encode race categories is the ability to include subtypes for each category if finer distinction is required. Race is just one of the data elements in the social determinants of health (SDOH) standards that are still evolving. As such, I wonder if it is possible to create a race extension in the Canadian FHIR baseline, along with an initial value set drawing on existing and extension SNOMED CT concepts and LOINC-answer lists as needed. This will allow us to pilot the use of the race value set(s) in specific settings. BTW, Dr. Andrew Pinto will be doing a virtual presentation of their SPARK study on May 19 as part of a mini-conference organized by UVic, CIHI and Infoway. Join us if you wish to learn more about SDOH. Here is the link https://www.uvic.ca/hsd/hinf/home/news/current/hts-virtual-miniconference.php Thanks -Francis

Sheridan Cook a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question on Ethnicity and Race-based Value Sets

We're still porting over the issues from our old CA-Core (now CA Baseline) repo into Simplifier, but the issues and discussion around inclusion/exclusion of Race and Ethnicity extensions that Shamil is referring to can be found here. https://simplifier.net/CanadianFHIRBaselineProfilesCA-Core/ExtensionEthnicity/~issues Essentially, we did not originally include race or ethnicity extensions in the CA Baseline because we were waiting for confirmation that it was actually be collected and used by Canadian systems (issue #5). Later on, our members in BC identified that ethnicity is in fact collected and used in Panorama and requested that ethnicity extension(s) be added to the Baseline (Issue #64). I believe Panorama uses a mixture of CDC and local codes, but as Shamil pointed out, the CDC codes that Panorama starts with (~6 codes) are far from completely representing the span of 900+ ethnicity codes we see in the full value set that the US Core references in its "detailed" ethnicity slice. Igor suggested we point to an established Canadian value set that draws from SNOMED CT & SNOMED CT CA codes that is more fulsome (216 codes) :https://tgateway.infoway-inforoute.ca/singlesubset.html?id=2.16.840.1.113883.2.20.3.208&versionid=20190930. 3/6 CDC codes map 1:1 to terms in the Canadian ethnicity value set, the other three do not (Aboriginal, Latino, Other Ethnicity). My suggestion is that the keepers of the Ethnicity VS determine whether or not those CDC codes should be extended into the ethnicity VS or whether they are more appropriately aligned to a racialized group value set. Changes should happen at the source, rather than at the Baseline to prevent proliferation of value sets that only further confuse implementers. Finnie - will there be a source FHIR value set that the Baseline can point to for racialized groups or are you suggesting the Baseline will need to create the value set using the permissible values outlined in the CIHI reference model: https://www.cihi.ca/sites/default/files/document/cihi-reference-data-model-toolkit-en.pdf ?

Michael Savage a lancé une nouvelle discussion dans le groupe FHIR® Implementations

Canadian FHIR Baseline Profiles - Due Diligence Review - IPS – April 23rd, 2-3pm EST

Hi all! For this Friday's Profiling / Due Diligence Review meeting, we will be continuing with our DDR comparing CA Baseline to IPS FHIR iGuide, and will look at the following profiles: (quick recap of recent reviews) AllergyIntolerance Device Thanks!

Forum

Francis Lau

Connecté(e)

Question on Ethnicity and Race-based Value Sets 04/22/21

Hi Finnie, thanks for your support to create the race extension, and to point out the Canadian edition SNOMED codes in the CRDM toolkit for the race categories.

Finnie Flores

Connecté(e)

Question on Ethnicity and Race-based Value Sets 04/22/21

Finnie Flores

Connecté(e)

Question on Ethnicity and Race-based Value Sets 04/22/21

Hi Sheridan. We have not created a value set yet that FHIR can use. So you are welcome to create one using the concepts from the Racialized Group in CRDM. Thanks

Francis Lau

Connecté(e)

Question on Ethnicity and Race-based Value Sets 04/22/21

Sheridan Cook

Connecté(e)

Question on Ethnicity and Race-based Value Sets 04/22/21

Michael Savage

Déconnecté(e)

Canadian FHIR Baseline Profiles - Due Diligence Review - IPS – April 23rd, 2-3pm EST 04/21/21

Finnie Flores

Connecté(e)

Question on Ethnicity and Race-based Value Sets 04/21/21

Hi Lloyd, Please see the other thread for further info on what CIHI has been doing with regards to this. https://infocentral.infoway-inforoute.ca/en/forum/254-health-terminologies/3834-ethnicity-and-race-related-concepts-terms-and-value-sets#6773...

Shamil Nizamov

Déconnecté(e)

Question on Ethnicity and Race-based Value Sets 04/20/21

The initial discussion should be in issues #5, #64 but I cannot find them any longer. https://github.com/scratch-fhir-profiles/CA-Core/issues/5 https://github.com/scratch-fhir-profiles/CA-Core/issues/64 I remember we decided not to use CDC val...

Lloyd Mckenzie

Déconnecté(e)

Question on Ethnicity and Race-based Value Sets 04/20/21

I wouldn't worry about the v2 mappings - they're in no way influential around what the codes need to be. Given that ethnicity will primarily be relevant for reporting and not clinical purposes, aligning with the CIHI value set makes sense. Does CIH...

Francis Lau

Connecté(e)

Question on Ethnicity and Race-based Value Sets 04/20/21

Hi all, at today's Health Terminologies Community meeting, Marcy Antonio from UVic did a short presentation of ongoing and upcoming work in social determinants of health (SDOH). There were some discussion and questions about race and ethnicity coding...

Michael Savage

Déconnecté(e)

CA Base Governance Stream Meeting - Friday April 16th, 2-3pm EST 04/16/21

Attendees: Michael Savage Sheridan Cook Shamil Nizamov Harsh Sharma Joan Harper Joel Francis Ken Sinn Randy Nonay • Sheridan walked the group through the progress on the Due Diligence Review – currently working through the IPS FHIR iGuid...

Michael Savage

Déconnecté(e)

CA Base Governance Stream Meeting - Friday April 16th, 2-3pm EST 04/14/21

Hi all! The agenda for this Friday's CA Baseline Governance meeting: 1. Update on Due Diligence Review Progress 2. Plans beyond the Pitch Deck - What are the initial committees we want to pitch this to? And how do we get on the identified Juri...

Michael Savage

Déconnecté(e)

Canadian FHIR Baseline Profiles - Due Diligence Review - IPS – April 9th, 2-3pm EST 04/09/21

Attendees: Michael Savage Sheridan Cook Rita Pyle Dan Simic Thomas Zhou Shamil Nizamov Randy Nonay Ken Sinn Joel Francis Jason Lin Harsh Sharma Fariba Behzadi Anne Belford Joan Harper • The group continued the Due Diligence Review...

Michael Savage

Déconnecté(e)

Canadian FHIR Baseline Profiles - Due Diligence Review - IPS – April 9th, 2-3pm EST 04/07/21

Hi all! For our upcoming meeting on Friday April 9th, we will be continuing our Due Diligence Review of the International Patient Summary, specifically looking at the following profiles: MedicationStatement AllergyIntolerance Condition Tha...

Sheridan Cook

Connecté(e)

CANCELLED - Friday April 2nd's CA Baseline Governance Meeting 04/02/21

Hey folks, as a reminder we will not be having our CA Baseline Governance call today. Instead, please take a few minutes to review the latest update of the business oriented call for advocates/endorsement deck that we will be putting in front of...

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