Coordination of Care Standards

Hi Ken,

Regarding the eConsult FHIR spec for the OntarioMD/OTN/eHealth Ontario proof of concept, the payload of the consult was pure FHIR. The resources used in the entire end-to-end eConsult lifecycle (request-respond-more info-close the eConsult) were:

1. ReferralRequest
2. Practitioner
3. Organization
4. Patient
5. Composition - this is where the payload (the consult question and response) was stored
6. Document Reference - this allowed the requestor to append a URL to an attachment (which was uploaded to the OTN eConsult platform) to to provide further context to the eConsult
7. Bundle
8. OperationOutcome

As you mentioned, Ontario does have a published CDA-like clinical document standard and some production assets that are using CDA and pan-Canadian CDA standards. Going forward, especially for green field (as Attila suggested), you can expect to see a lot of FHIR in Ontario. One example of this might be eReferrals (of which eConsults is a subset).

Hi Ken,

We have several members on this community from Ontario so I will leave it with them to respond to your question.

Finnie

Thanks Finnie!

I don't think we need to do a survey right now, though it would be interesting.

Do you know what the plans are for Ontario? I heard something about OntarioMD and OTN piloting a FHIR based CCD for the eConsult initiative... But I've also seen a CDA-based CCD from eHealth Ontario (many years ago.) Just curious what direction Canadians are going for CCD standards, and in particular what the plan is for Ontario.

Full disclosure, my experience with CDA-based CCD in the U.S. is that it doesn't achieve interoperability and so I would advise against going with a CDA-based approach for CCD..

Ken

Hi Ken,

Back in SCWG 2 days, we maintained a list of CDA adoption for use in referral, discharge summary, etc. by jurisdictions. I don't believe that link is available anymore, but we may be able to request access to it. Is that the type of information you are looking for? If not, we will be happy to facilitate a survey in the Coordination of Care community if this is something of interest to others as well.

Finnie

Has anyone done a survey of coordination of care document standards in use in Canada? Is that available on the Infoway website somewhere? If documents aren't moving yet, are there plans to use a particular standard for this in Canada?

Thanks,
Ken Stevens
VP Healthcare, Intelliware
Co-Chair Interoperability and Standards Committee, ITAC Health
c.416.576.4096

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