For a full list of available versions, see the Directory of published versions

2. Business Context

This section presents the executive summary and business context for implementing Ontario Health’s digital form strategy using HL7 FHIR® Structured Data Capture (SDC). It describes the goals and key considerations that guide the standardization of FHIR-based Questionnaires across Ontario’s digital health ecosystem.

The Ontario Health eForms platform was created under the Patients Before Paperwork (Pb4P) initiative to reduce administrative burden on clinicians, streamline processes, eliminate redundancy, enhance efficiency, and provide faster service to individuals. eForms leverages HL7 FHIR® SDC, which provides a standard framework for consistently defining, rendering, and processing digital forms in a way that can be implemented in user-friendly interfaces. Form authors can define how forms look, how they behave, and how conformant systems process forms in a consistent way.

To support Ontario Health’s eForms initiative, adopting HL7 FHIR® SDC is essential for ensuring standardized, interoperable, and scalable digital forms. SDC provides a robust framework for defining and processing forms using FHIR resources, enabling integration with EMRs and other health information systems. By leveraging SDC, the eForms ecosystem can support dynamic form behavior, pre-population, structured data capture, and consistent rendering/processing expectations across implementations. .

2.1. Executive Summary

This document outlines the business requirements for implementing the Ontario Questionnaire Requirements using the HL7 FHIR Structured Data Capture (SDC) framework. The goal is to standardize the creation, rendering, and processing of electronic questionnaires across Ontario’s digital health systems, ensuring interoperability, consistency, and alignment with legacy tools.

2.2. Business Objectives

• To standardize and streamline the design, capture, rendering and exchange of structured clinical data using the HL7 FHIR Structured Data Capture (SDC) Questionnaire profile.
• Enable structured, interoperable data capture using FHIR-based questionnaires.
• Align new questionnaire capabilities with legacy Ontario form tools.
• Support e-referral and other digital health workflows through standardized artifacts.
• Improve individual experience across platforms.

2.3. Proposal

Adopt HL7 FHIR® SDC as the foundation for Ontario Health eForms and publish a provincial implementation guide that defines:

• Ontario-specific Questionnaire and QuestionnaireResponse conformance requirements (based on core FHIR and SDC patterns),
• Ontario-specific extensions and terminology needed for consistent rendering and processing, and
• role-based conformance expectations using implementation obligations (by actor/capability).

This approach supports advanced features such as:

• conditional logic and dynamic behavior,
• standardized data types and value sets,
• reusability and modular design of form components, and
• consistent narrative rendering of completed forms (where applicable).

2.4. Partners

• Ontario Health Digital Services
• Clinical and administrative individuals
• IT and development teams
• Standards and interoperability teams

2.5. Functional Requirements

Ontario Health has developed a set of FHIR artifacts to enable consistent design, rendering, and behavior of electronic forms across implementations. These artifacts support dynamic, interoperable forms aligned with HL7 FHIR® SDC and tailored to meet Ontario-specific requirements.

The artifacts include profiles, extensions, terminology bindings, and examples that support key features such as:

• structured and validated data capture using standardized Questionnaire and QuestionnaireResponse profiles,
• consistent rendering behavior and UI-driven rules (styles, item controls, and rich content where applicable),
• conditionality and flow control (e.g., enableWhen and FHIRPath-based logic),
• pre-population capabilities using declared context and expressions,
• definition-based extraction capabilities for downstream structured use, and
• narrative generation of completed forms using Liquid templates where provided.

2.6. Section Contents

• Business Model
• Business Data
• Use Cases