To enable the vision of a provincial immunization system where individuals, health care providers, and public health all have real-time access to the same immunization information, Ontario is taking a coordinated approach to facilitate easier collection of, and access to, complete, accurate, and timely immunization records.
The goal is to improve health outcomes by making comprehensive immunization information accessible in real time to support health care providers in clinical practice and to engage the public as active partners in managing their health. Key to this approach is the provincial digital health immunization repository (DHIR) – a centralized repository of standardized electronic immunization data which forms the foundation of a broader interoperable ecosystem for immunization data in Ontario. The DHIR currently contains approximately 95 million standardized immunization records for over 6.5 million clients.
The DHIR primarily supports data sharing for public health purposes; Ontario’s 36 public health units access the repository through Panorama. However, the public is also able to access and update their immunization records through a web-based tool called Immunization Connect Ontario/Digital Yellow Card (ICON/DYC).
To expand immunization data access options for both health care providers and the public, a new upcoming release of DHIR will make it possible for health care providers to access and update the DHIR through a clinician-oriented version of the ICON web tool. The DHIR specification describes the data store environment and web services for submitting and retrieving immunization data. Intended approaches for expanded clinical access include DHIR integration with regional and provincial clinical viewers, and direct integration with electronic medical record (EMR) systems. Expanded public (consumer) access will be accomplished through DHIR integration with consumer applications and patient portals.
DHIR Release 3 is built on the FHIR (Fast Healthcare Interoperability Resources ®) standard for trial use Release 3. DHIR Release 3 specifies profiles for the following FHIR resources:
This specification ensures all information technology systems that retrieve immunization data from and contribute immunization data to the DHIR can exchange and understand the content through standardized HL7 messages based on FHIR specification and terminologies.
This specification will be available to download for stakeholder review between October 18 and November 16, 2017. Once this review period concludes, the specification then goes through a formal governance committee review and approval process.
FHIR is an evolving trial-for-use standard, so additional changes by HL7 are expected. We will continue to monitor developments and assess whether or not there are impacts, and publish updates as they emerge.