General Canadian FHIR Baseline Feedback

Hi Gavin: the 'health card number version code' would go in Coverage.class (.type=sequence, .value=version code/number).

Regards
Paul

I'd limit it to human medicine with primary focus on information relevant to outpatients as part of a cross-practitioner shared record. In addition to SMART, I'd list CDS Hooks. So standardizing terminologies where we can (reflecting existing pan-Canadian agreed terminologies) would be helpful. This is also the set of information currently shared with Apple and likely relevent for other PHRs.

Hi,

If you have use cases for Canadian Baseline profiles can you please share them here? We'd like to frame the next FHIR WG call about assessing the value of creating national FHIR profiles. There is concern that if the scope is too broad, then the profiles will have little to no mandatory elements leaving almost everything else optional. For example, we could try limit their use to SMART on FHIR, which is still broad but provides some boundaries.

Alternatively, if you have thoughts on some items that might be commonly needed for Canadian implementations please share them. One example could be an extension for health card number version code (if not included in the FHIR core in future releases).

Thanks,

Gavin

HL7 International is working on refactoring the IGPublisher to make it easier to use and to allow "standardized" publishing frameworks. It might be best to wait for that to be complete before locking down to anything.

Hi,

In addition to creating baseline profiles, there was discussion on the FHIR WG call about encouraging people to use a common implementation guide framework (general headings, publication format, etc.). eHealth Ontario has proposed a layout and are open to feedback. You can see an example here:
simplifier.net/guide/draftpcriguide/home

If you haven't checked the Canadian registry in a while there are other projects starting to post there as well:
simplifier.net/organization/canadianfhirregistry

Thanks,

Gavin

The purpose of a baseline is to serve a similar for Argonaut/US Core in the U.S. It serves as a baseline for SMART on FHIR, CDS Hooks and lots of other interoperability initiatives that rely on a base level of consistency to essential healthcare data. As much as possible, we should aim to align the Canadian baseline with the U.S. baseline to minimize (and sometimes eliminate) the need for rework in using apps created for the US market in Canada. In terms of changes, we'd be looking at changes to the drug value sets, using a different edition of SNOMED, perhaps adding an extension for healthcard version and one or two other things, but it's not going to be a significant difference.

Agree that there'll need to be a governance and review process and that it'll need to be maintained - primarily to deal with changes in the underlying resources and the U.S. Core profiles as they evolve, though there may be a few changes that originate based on evolving Canadian requirements and Canadian-specific implementer feedback. That process needs to reflect jurisdiction and EHR and other implementer perspectives.

I think that waiting for resources to be normative is a mistake. FHIR has significant penetration in many countries even though nothing goes normative until the end of this year and the key clinical resources won't go normative until 2021 or even 2023. The Canadian market is starting to use FHIR now and the more we can encourage and ensure consistency with base level concepts, the better positioned we'll be for things like integrating with Apple, using SMART, CDS Hooks and similar technologies.

Note that the baseline doesn't need to reflect all of the nuanced variation of jurisdictions. Instead, it reflects a core set of capabilities that we agree are reasonable for human-patient primary care purposes regardless of jurisdiction, inpatient vs. outpatient, etc.