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FHIR® Implementations

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

Membres: 293

Personne-ressource: Joel Francis

Administration: Joan Harper, Linda Monico

Type: Ouvert

Accès: Public

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

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À propos de nous

HL7 Canada 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 has several streams of activity:

Topical workstreams
Monthly community calls to share workstream progress and other FHIR-related news
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/ca-on-eReferral-r4-iguide-v0.10.1/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.

Key Resources

Canadian Core Profiles

Activité

Lloyd Mckenzie a répondu au cours d'une discussion dans le groupe FHIR® Implementations

FHIR software development

There are no Canadian exceptions (and can't be). If a country wishes to call their implementation FHIR conformant, it must fully comply with the international specification, no variation permitted. However, countries can define extensions and set constraints on things like what elements and extensions need to be present, what terminologies need to be used, etc. None of that will change any of the base classes. In theory, you could define derived classes that enforced the Canadian constraints, but that's a challenging endeavor and, to my knowledge, not one that many, if any, has done successfully. Thus far, all Canadian implementation has focused on R4. R5 is still in development and not stable and therefore not really suitable for implementation. Once it comes out in a year or so, I expect there'll be some discussion around when/if to migrate to it. Terminology is typically retrieved as FHIR resources from a terminology server (https://tgateway.infoway-inforoute.ca/). I know the Infoway tx server can source CCDD codes. I'm not sure whether it provides DINs as well. Lloyd

Dennis Brox a lancé une nouvelle discussion dans le groupe FHIR® Implementations

FHIR software development

I am developing a FHIR/Mongodb application so community pharmacy has a tool to accept, support, and communicate treatment goals. I'm working in C# and Python with the R4 FHIR SDK library from Firely and have meetings with the Ministry of Health groups in BC that are involved with planning. I'm not missing documentation on standards, discussions of changes, etc. I'm missing actual things to use and someone who knows the details of how SDK FHIR classes should be utilized to meet a consistent national Canadian solution. For example, if Canadian exceptions to the international R4 version are to be had, where is the class library I can download to use them or what are the specific attribute changes in R4 classes to incorporate them? Or are they in the international R5? Where is the national Medication database using DINs that I can download as a csv (or similar) file to use in my application (as referenced from the Request and Dispense medication resources). Companies specializing in FHIR C#, Python, and Java dictionaries support the international standard, what is the solution here? There are a number of other low-level detail questions that need answering but those will do for a start.

Michael Savage a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Canadian FHIR Baseline Profiles - Profile Updates - Jan 14th, 2-3pm EST

Attendees: Michael Savage Elliot Silver Joan Harper Sheridan Cook Adesh Maharaj Harsh Sharma Ken Sinn Randy Nonay Rita Pyle Shamil Nizamov Thomas Zhou The group compared the CA Baseline Profiles to the relevant profiles defined in the Covid 19 At-Home Test Report Spec: https://trifolia-fhir.lantanagroup.com/igs/lantana_hapi_r4/homeCovid/index.html Lab Results Observation Profile • .code uses LOINC o Thoughts from Canadian Realm? o CAB looks to LOINC as preferred, where COVID IG flags as extensible; not a true gap but Canada is a bit more flexible, just worth noting • .value uses a SNOMED subset o Binding is required o CAB binding mandates that IF a codeable system is used, it SHOULD be SNOMED CT o Worth flagging for further discussion • .specimen and .device o They provide a 1..1 cardinality for .id element o CAB doesn’t have these cardinalities o Need to know more about how Device and Specimen are meant to be used in the COVID IG (overall workflow) o Appears that there are specific types of rapid test kits that the IG authors have in mind for .device – likely would need to look further at opening this up for other at-home test kit manufacturers when broadening this out (though did look at some test kits available in Canada and they are found in this registry) o Even if it does have products that are accessible in Canada, likely a Canadian realm version of this should have a Canadian/global database it points to rather than a US one • Overall, several CAB elements have MS flags not found in US COVID IG Will continue the comparison next session (2 weeks from now) with the other common profiles defined in both IGs

Lorraine Constable a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question about FHIR lab modelling

Also, consult the v2 - FHIR project, their confluence page can be found at: https://confluence.hl7.org/display/OO/2-To-FHIR+Project Their conference calls are at 11 am ET on Thursdays, but there will not be a call next week due to the virtual HL7 conference. Lorraine Constable

Fang Cao a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question about FHIR lab modelling

Makes sense. The concept of "collection of ServiceRequests" is similar to ORC to support a group of requests in one requisition, but the challenge is how to support OBRs in the ORC. If we map OBR to DiagnosticReport, we can't have DiagnosticReport reference other DiagnosticReports. If we map to ServiceRequest, ServiceRequest.status does not support common OBR status values (partial, final, corrected). Should we look at mapping OBRs to observations?

Lloyd Mckenzie a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question about FHIR lab modelling

What constitutes a distinct DiagnosticReport is sort of up to the business process. It may be "one DiagnosticReport per ServiceRequest", "one DiagnosticReport per ServiceRequest.requisition - i.e. a collection of ServiceRequests", or it might be split other ways based on lab processes or regulations. Whether you transmit a bunch of DiagnosticReports together in a Bundle (e.g. transaction or document) or send them separately is also a business choice, though here there'd ideally be some standardization driven by local implementation guides.

Lorraine Constable a répondu au cours d'une discussion dans le groupe FHIR® Implementations

Question about FHIR lab modelling

Hi Fang, Hi Fang, The order catalog work provides a framework for publishing a lab compendium of tests that you can order, and how to describe the definition of what can be ordered. An actual order should be a Service Request, and the report is a Diagnostic Report that contains Observations. More detail can be obtained from the HL7 Orders and Observations (OO) workgroup, either on the listserv (ord@listserv.hl7.org), which you need to join in order to send messages, or on Zulip at chat.fhir.org Lorraine Constable OO Co-chair lorraine@constable.ca 780 951 4853 Mountain Standard Time (UTC -7)

Événements à venir :

Ven Jan 21 @ 2:00PM - 03:00PM
CA Baseline Governance Stream

Lun Jan 24 @ 4:00PM - 05:00PM
Canadian SMART on FHIR Community of Practice

Mar Fév 01 @11:00AM - 12:00PM
eReferral FHIR Working Group

Forum

Lloyd Mckenzie

Déconnecté(e)

FHIR software development 01/16/22

Dennis Brox

Déconnecté(e)

FHIR software development 01/16/22

Michael Savage

Déconnecté(e)

Canadian FHIR Baseline Profiles - Profile Updates - Jan 14th, 2-3pm EST 01/14/22

Lorraine Constable

Déconnecté(e)

Question about FHIR lab modelling 01/13/22

Fang Cao

Déconnecté(e)

Question about FHIR lab modelling 01/13/22

Lloyd Mckenzie

Déconnecté(e)

Question about FHIR lab modelling 01/13/22

Lorraine Constable

Déconnecté(e)

Question about FHIR lab modelling 01/13/22

Shamil Nizamov

Déconnecté(e)

Question about FHIR lab modelling 01/13/22

Hi Fang, you may explore an Order Catalog IG to see how others built it: https://build.fhir.org/ig/HL7/fhir-order-catalog/index.html

Fang Cao

Déconnecté(e)

Question about FHIR lab modelling 01/13/22

Hello. Does the working group have any recommendation on the best practice of FHIR modelling for returning lab reports? Typically a lab report consists of test request and each test request consists of lab results. Should a lab report be mapped to on...

Michael Savage

Déconnecté(e)

Canadian FHIR Baseline Profiles - Profile Updates - Jan 14th, 2-3pm EST 01/12/22

Hey all! For this Friday's 'Profile Updates' session from 2-3pm EST, we'll do a quick review of how we'll be using these bi-weekly sessions going forward, as the majority of Profile Updates / fixes are now complete, and the Maturity Level 1 Packag...

Michael Savage

Déconnecté(e)

Canadian FHIR Baseline Profiles - Governance Stream Meeting - January 7th, 2-3pm EST 01/05/22

Happy New Year all! Please see below for our agenda for our first CA Baseline Governance Call since the holiday break, occurring on Friday Jan 7th 2-3pm EST: 1. Welcome back! 2. Recap of items completed and current work in front of us/this gro...

Thomas Zhou

Déconnecté(e)

eReferral Spec Development work stream 01/04/22

Hi Tim, The quotation of the previous content is: Discussion 2: extending identifier element, to allow for multiple identifiers. - TODO: Radhika to draft extension, share with group and also discuss on chat.fhir.org because it may be eligible t...

Paula Lee

Déconnecté(e)

Canadian SMART on FHIR CoP - Meetings 12/14/21

Our next call on January 24th will feature presentations by SMART Health IT, with regards to their app gallery and Igor Sirkovich on Smart Health Cards and the Verify Vaccine app. Happy Holidays and Best Wishes for 2022!

Tim Berezny

Déconnecté(e)

eReferral Spec Development work stream 12/07/21

Notes for FHIR eReferal Meeting - Dec 7 2021 ======================================== Discussion 1: ValueSets - Radhika walked us through a number of changes to value sets for which everybody was in agreement.   - TODO: The main item of interes...

Cindy Jiang

Déconnecté(e)

XPost - Ontario Provincial Review Notice | Patient Summary & Mental Health and Addictions Provincial Data Set 12/06/21

Starting December 8, 2021 to Jan 20, 2022, we will be launching two provincial reviews for the following iGuides: Ontario Patient Summary – HL7® FHIR® Implementation Guide (Release 1) The Patient Summary document is a “health record extract c...

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