Prep Work for Friday's Canadian FHIR Baseline Profiling Workstream Meeting (2-3pm EST)

Derek - I wouldn't expect any implementer to target their product at just the consensus baseline unless you are trying to be as accommodating as possible. SMART on FHIR is able to be that accommodating and thus targets this baseline. I rather expect that jurisdictions and vendors would use this Canadian Baseline as the starting point for their implementation guides. I know that I am doing just that in Saskatchewan for the PIP Pharmacy Guide I'm producing.

As an example, if the baseline Canadian Patient profile says that everyone must support Communication.language and makes it mandatory because we want all implementers to be forced to support this, we would be basically telling people not to use our profiles since that constraint does not make sense as a baseline constraint.

A constraint that makes total sense in the Canadian baseline is that you use the Canada Health CCDD code system for Medication codes. Or that the Preferred binding for address states is the Canadian Province value set.

Lloyd -- this is REALLY important point, and deserves (please) a bit more elaboration. There is definitely an attractiveness to this approach for those who are well-served by this simplification. We should expect that a lowest-common-denominator will be easier to develop a consensus around. This consensus-building is helped by the expectation that each implementation that requires something more/different can add in their requirements as FHIR extensions.

What will be the implications for digital health software product developers? It does not sound like they will be able to target their products to the consensus baseline. As you know... I have worries about a proliferation of extensions... and the apparent ease of spec'ing extensions seems to me to obfuscate the tall burden on commercial software vendors of developing, implementing and maintaining solutions that support FHIR-based specs that are deployed different-every-time.

A key thing to keep in mind is that FHIR's methodology is not "design by constraint". There's no expectation that these profiles will contain every piece of information that might be relevant to the clinical or business context of a particular implementer. Instead, they're intended to be a "lowest common denominator". I.e. "What do we think, based on our knowledge of existing application capabilities, is reasonable to expect *all* EHR systems to support in the Canadian space regardless of jurisdiction or context?" We're not trying to push implementers to add support for new data elements or to improve alignment with "good/desired practice". That comes later

That lowest common denominator is what allows a firm foundation for technologies like CDS Hooks, SMART on FHIR, etc. It's totally fine for jurisdictions or projects to then add additional expectations around support for additional data elements, resources and extensions.

Attendees

Michael Savage
Sheridan Cook
Russ Buchanan
Finnie Flores
Sisira De Silva
Jean Duteau
Jorge Pichardo
Ken Sinn
Natalya Pogrebetsky
Alex Goel
Christopher Kundra
Fang Cao
Francis Lau
Harsh Sharma
Igor Sirkovich
Joel Francis
Laura Bright
Mike Cordeiro
Rita Pyle
Scott Prior
Shamil Nizamov
Thomas Zhou
Craig Anderson
Fariba Behzadi
Marc L'Arrivee
Vu Vuong

• Walkthrough of Canadian Core Project Tools
• Sheridan provided walkthrough of Simplifier.net project where full canvas of Canadian Core draft Profiles are available

• Viewing Profiles
o All links to these projects are available on the forum
o Simplifier Project link: simplifier.net/canadianfhirbaselineprofilesca-core
o IGPublisher link: build.fhir.org/ig/scratch-fhir-profiles/CA-Core/index.html
o GitHub link: github.com/scratch-fhir-profiles/CA-Core
o Simplifier
 All files in project are linked to those in GitHub repository
 All Canadian Core draft profiles are available for consumption and review
 Profiles are in ‘canvas’ form; all in one place for people to react to and review
 Still hashing out the best ways / tools for getting everyone’s voices on the profiles
o GitHub
 Showed scratch FHIR profiles
 More of the master source of truth
 Allows us to run validation
 An ‘amped up’ version of functionality from what you can view on simplifier
• Profile Authoring – Forge – can be looked at more thoroughly upon individual’s requests

• Question/Comments
o In Simplifier – how to reference other resources
 For manual authoring – forge is the way to manually edit the profiles
o Issues directly entered in Simplifier?
 To be looked at in future
o For a clinical perspective – where do you draw the boundary?
 i.e. there could be any number of things you could need data for a patient
 One recommendation for the template is to have a ‘parking lot’ for considerations for other resources for future considerations; ‘emerging Canadian issues’

• Walkthrough of Patient Profile
• Sheridan provided the walkthrough of the existing draft of the Canadian Core Patient Profile
o Patient profile has the minimum viable elements
o From a clinician standpoint – what if you see that the profile is missing information that you know you need about a patient
 Look at the base resource to see if it can be included
o ‘S’ next to an element = must support = an element that you must support; even if you don’t have data on this, you need to be ready to recognize it if it’s incoming; need to be able to work with it; ex: “I understand you requested telecom”
o Cardinality = does the patient NEED to have one of these
o Mostly inherited value sets for the US Core
o Use of Bindings, ex: birthsex value set
 If you have data on this, you MUST use the bound value set
o Jurisdictional health number designation
 In Canada we support a specific way of doing HCNs
 Positive response to how the Canadian Core can say to new implementations ‘this is how we will do these things’
 CC has the jurisdictional HCNs
o Gap analysis between profile and existing pan-can standards?
 Can be a good approach; comparing CC profile of patient to CIHI standard CRDM, etc
 People can bring their input to their review of profiles
o Determining how we leverage terminology sets for the profiles
 Take a look at the value sets that are already part of the US Core; is there a more appropriate value set to use in the Canadian context?

• Action items
o Mike to upload template for submitting proposed changes to profiles to InfoCentral (done) - infocentral.infoway-inforoute.ca/en/resources/docs/fhir (email address to submit completed form is located in the instructions tab of the document)
o Mike to update posted template with some guiding questions for reviewers; draft Profile Review Process (based on discussion during meeting, and people’s feedback post-meeting); draft sequence of deadlines for reviews of each profile; aim is for all items to be posted in advance of governance-focused meeting (Jun 5th 2019)

Hi all!

Thanks to everyone for a great meeting, great discussion, and great guidance for action items in the short term.

I will be able to provide more fulsome notes and takeaways early next week, but for the moment I want to call your attention to the draft profile review form on InfoCentral for your downloading and for your submission to me with proposed changes, located here infocentral.infoway-inforoute.ca/en/resources/docs/fhir

Thank you again!

Thanks to Sheridan and Russ for getting this underway.

For those reviewing:
- The Simplifier Project link is simplifier.net/canadianfhirbaselineprofilesca-core (Simplifier Project link above is broken)
- The IGPublisher page link is build.fhir.org/ig/scratch-fhir-profiles/CA-Core/index.html

(both links are correct/available via the GitHub instruction site)