CA Baseline Practitioner Profile for Registries

This Practitioner profile sets minimum expectations for the Practitioner resource to record, search and fetch demographics and other administrative information about a person who is directly or indirectly involved in the provisioning of healthcare.

This profile further constrains the general purpose Practitioner profile and is intended to be used by Provider or Healthcare Directory systems.

Differences from US Core

Note: This profile was generated from HL7 StructureDefinition on 2020-02-19 and constrained during a review of US Core against Canadian sources.

Mandatory Data Elements

All elements or attributes defined in FHIR have cardinality as part of their definition - a minimum number of required appearances and a maximum number.

Most elements in FHIR specification have a minimum cardinality of 0, which means that they may be missing from a resource when it is exchanged between systems.

Required elements:

• a identifier
• a practitioner name

In addition to that, some optional elements (e.g., Practitioner.qualification) have required components that MUST be present if that optional element is provided.

Data Absent Reason

In situations where the minimum cardinality of an element or attribute is 1 and information is missing and the Responder knows the precise reason for the absence of data, Responders SHALL send the reason for the missing information using values (such as NullFlavor) from the value set where they exist or using the DataAbsentReason extension.

Must Support Data Elements

Some elements are labeled as MustSupport meaning that implementations that produce or consume resources SHALL provide "support" for the element in some meaningful way (see Must Support definition).

Following elements are marked as Must Support in the Practitioner profile to aid record matching in databases with many pediatric records.

Must Support elements:

• an identifier
• a practitioner name
• contact detail (e.g. a telephone number or an email address)
• a birth date

Extensions

Deceased Extension

This Practitioner profile contains optional deceased extension to indicate if a practitioner is deceased or not.

This extension was previously labeled as a modifier extension (because of its potential impacts on clinical processes if the practitioner is marked deceased), but was removed after further discussion on the nuances of making something a modifierExtension vs regular extension if it was expected to be picked up by registry implementation guides that collect deceased practitioner information but may or may not use it in ways that would align to HL7 FHIR R4 definition and expectations for modifierExtension.

Implementers should recognize that the determination of whether this should be considered a modifierExtension is ongoing. Since Modifier Extensions should have extreme caution in their application and are further nuanced by the use cases in the implementing registry systems, this extension has been shifted back to a regular extension to align to use in existing implementations. Implementers who are considering using this extension in their guidance might consider applying a Must Support flag on the extension, but those treating wanting to re-create it as a modifier extension are required to review the [FHIR Guidance on Modifier Extensions])(https://www.hl7.org/fhir/R4/extensibility.html#modifierExtension) before including this extension in their profile. Implementers should also be aware of the Practitioner.deceased[x] R5 concept and that the CA Baseline is monitoring changes in the element to determine if the approach to this extension requires a shift.

Usage Note

This Practitioner profile is intended to provide a foundation for a central or distributed Provider or Healthcare Directory. Additional work flow components and elements may be required for a particular implementation.

Identifiers

Multiple types of provider identifiers may be used in Practitioner.identifier element in the Canadian context:

• Provincial health plan provider/ Billing number
• Licence Number
• Medical Doctor Number

Implementers may use other identifiers to capture in a more specific way such as internal provider number, jurisdictions providing credentials. The full list of possible identifier types is in Canadian URI Registry

In some cases, the same license number can be used as the provider identifier and provider's qualification identifier.

Telecom

A provider may have multiple ways to be contacted with different uses or applicable periods. This Practitioner profile allows multiple contact points (e.g. a telephone number or an email address) by which the individual may be contacted.

To indicate the preferred way to contact use Practitioner.telecom.rank attribute (i.e., the ContactPoint.rank component) that specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.

Address

The Practitioner profile is provided for use in a Canadian context where some constraint on content is desirable to guarantee the quality of the Canadian address whilst still supporting other type of address (e.g., other countries or UNstructured addresses).

Canadian postal code

If an address in the Practitioner resource instance represents Canadian address, it SHOULD follow Canadian postal code format.

The Canadian Postal Code SHOULD be a six-character uniformly structured uppercase alphanumeric code in the form of "ANA NAN", where "A" represents an alphabetic character and "N" represents a numeric character, with one space between the first three and the last three characters.

A hyphen SHOULD NOT be used (example of UNacceptable format: T0L-1K0).

Preferred

The Practitioner.address MAY have a Preferred extension. This is the FHIR standard defined extension used as a flag denoting whether parent address item is preferred.

Qualifications & Credentials

In Canadian context qualifications and credentials are not synonymous. This difference is defined by slices applied to Practitioner.qualification.code.coding element.

Qualification defines a code for the degree or educational rank that the credential specifies and may also apply to an expertise type. This profile recommends to use Canadian QualifiedRoleType value set as the coded representation of the provider's qualification.

Credential defines a role type that is used to categorize an entity that delivers health care in an expected and professional manner to an entity in need of health care services. It uses Canadian HealthcareProviderRoleType value set as the coded representation of the provider's credentials.

The binding strength for the Practitioner.qualification.code element is Preferred meaning that implementers are encouraged to draw codes from the specified code system for interoperability purposes but are not required to do so to be considered conformant.

Example:

"code": {
  "coding": [
    {
      "system": "https://fhir.infoway-inforoute.ca/CodeSystem/scpqual",
      "code": "BSC",
      "display": "Bachelor of Science Degree"
    }
  ],
  "text": "Bachelor of Science Degree"
}