Da Vinci Health Record Exchange (HRex)
1.0.0 - STU R1 United States of America flag

Da Vinci Health Record Exchange (HRex), published by HL7 International - Clinical Interoperability Council. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/davinci-ehrx/ and changes regularly. See the Directory of published versions

Resource Profile: HRex Provenance Profile

Official URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-provenance Version: 1.0.0
Standards status: Trial-use Maturity Level: 2 Computable Name: HRexProvenance

Additional constraints on US Core Provenance to ensure it meets payer needs, including indicating when the event occurred and retaining signatures if present

Provenance is essential when sharing information in the payer space because any given record may have passed through multiple hands before it arrives at a payer. Provenance provides traceability as to where the data originated and helps in the evaluation of the information as well as rationalizing duplicate data acquired through multiple sources. Da Vinci makes a couple of improvements to the US Core Provenance profile that will hopefully be migrated into that profile in the future:

  • Capturing the time of the creation/update, not just the time the Provenance instance was created
  • Ensuring that the Provenance target in fact resolves to a specific resource reference, not allowing only display or an identifier

In addition, in Da Vinci, signatures on Provenances must be retained if present.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from USCoreProvenance

NameFlagsCard.TypeDescription & Constraintsdoco
.. Provenance 0..*USCoreProvenanceUS Core Provenance
... target
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... occurred[x] S0..1Period, dateTimeWhen the activity occurred
... signature S0..*SignatureSignature on target

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Provenance 0..*USCoreProvenanceUS Core Provenance
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... target SΣ1..*Reference(Resource)The Resource this Provenance record supports
.... reference SΣC1..1stringLiteral reference, Relative, internal or absolute URL
.... occurredPeriodPeriod
.... occurredDateTimedateTime
... recorded SΣ1..1instantTimestamp when the activity was recorded / updated
... Slices for agent S1..*BackboneElementActor involved
Slice: Unordered, Open by pattern:type
.... agent:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ0..1CodeableConceptHow the agent participated
Binding: US Core Provenance Participant Type Codes (extensible)
..... who SΣ1..1Reference(US Core Practitioner Profile | US Core Patient Profile | US Core Organization Profile)Who participated
..... onBehalfOf SC0..1Reference(US Core Organization Profile)Who the agent is representing
provenance-1: onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
.... agent:ProvenanceAuthor S0..*BackboneElementActor involved
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: author
..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
.... agent:ProvenanceTransmitter S0..1BackboneElementActor involved
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: transmitter
..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
... signature S0..*SignatureSignature on target

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Provenance.agent.typeextensibleUSCoreProvenancePaticipantTypeCodes
Provenance.agent:ProvenanceAuthor.typeextensiblePattern: author
Provenance.agent:ProvenanceTransmitter.typeextensiblePattern: transmitter

Constraints

IdGradePath(s)DetailsRequirements
provenance-1errorProvenance.agent.onBehalfOfonBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
: (($this.agent.who.resolve() is Practitioner) or ($this.agent.who.resolve() is Device)) implies exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Provenance 0..*USCoreProvenanceUS Core Provenance
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... target SΣ1..*Reference(Resource)The Resource this Provenance record supports
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... occurred[x] S0..1When the activity occurred
.... occurredPeriodPeriod
.... occurredDateTimedateTime
... recorded SΣ1..1instantTimestamp when the activity was recorded / updated
... policy 0..*uriPolicy or plan the activity was defined by
... location 0..1Reference(Location)Where the activity occurred, if relevant
... reason 0..*CodeableConceptReason the activity is occurring
Binding: PurposeOfUse (extensible): The reason the activity took place.


... activity 0..1CodeableConceptActivity that occurred
Binding: ProvenanceActivityType (extensible): The activity that took place.

... Slices for agent S1..*BackboneElementActor involved
Slice: Unordered, Open by pattern:type
.... agent:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ0..1CodeableConceptHow the agent participated
Binding: US Core Provenance Participant Type Codes (extensible)
..... role 0..*CodeableConceptWhat the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.


..... who SΣ1..1Reference(US Core Practitioner Profile | US Core Patient Profile | US Core Organization Profile)Who participated
..... onBehalfOf SC0..1Reference(US Core Organization Profile)Who the agent is representing
provenance-1: onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
.... agent:ProvenanceAuthor S0..*BackboneElementActor involved
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: author
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... role 0..*CodeableConceptWhat the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.


..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
..... onBehalfOf 0..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who the agent is representing
.... agent:ProvenanceTransmitter S0..1BackboneElementActor involved
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: transmitter
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... role 0..*CodeableConceptWhat the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.


..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
..... onBehalfOf 0..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who the agent is representing
... entity 0..*BackboneElementAn entity used in this activity
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... role Σ1..1codederivation | revision | quotation | source | removal
Binding: ProvenanceEntityRole (required): How an entity was used in an activity.

.... what Σ1..1Reference(Resource)Identity of entity
.... agent 0..*See agent (Provenance)Entity is attributed to this agent
... signature S0..*SignatureSignature on target

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Provenance.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Provenance.target.typeextensibleResourceType
Provenance.reasonextensiblePurposeOfUse
Provenance.activityextensibleProvenanceActivityType
Provenance.agent.typeextensibleUSCoreProvenancePaticipantTypeCodes
Provenance.agent.roleexampleSecurityRoleType
Provenance.agent:ProvenanceAuthor.typeextensiblePattern: author
Provenance.agent:ProvenanceAuthor.roleexampleSecurityRoleType
Provenance.agent:ProvenanceTransmitter.typeextensiblePattern: transmitter
Provenance.agent:ProvenanceTransmitter.roleexampleSecurityRoleType
Provenance.entity.rolerequiredProvenanceEntityRole

Constraints

IdGradePath(s)DetailsRequirements
provenance-1errorProvenance.agent.onBehalfOfonBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
: (($this.agent.who.resolve() is Practitioner) or ($this.agent.who.resolve() is Device)) implies exists()

This structure is derived from USCoreProvenance

Summary

Mandatory: 1 element
Must-Support: 3 elements

Maturity: 2

Differential View

This structure is derived from USCoreProvenance

NameFlagsCard.TypeDescription & Constraintsdoco
.. Provenance 0..*USCoreProvenanceUS Core Provenance
... target
.... reference S1..1stringLiteral reference, Relative, internal or absolute URL
... occurred[x] S0..1Period, dateTimeWhen the activity occurred
... signature S0..*SignatureSignature on target

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Provenance 0..*USCoreProvenanceUS Core Provenance
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... target SΣ1..*Reference(Resource)The Resource this Provenance record supports
.... reference SΣC1..1stringLiteral reference, Relative, internal or absolute URL
.... occurredPeriodPeriod
.... occurredDateTimedateTime
... recorded SΣ1..1instantTimestamp when the activity was recorded / updated
... Slices for agent S1..*BackboneElementActor involved
Slice: Unordered, Open by pattern:type
.... agent:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ0..1CodeableConceptHow the agent participated
Binding: US Core Provenance Participant Type Codes (extensible)
..... who SΣ1..1Reference(US Core Practitioner Profile | US Core Patient Profile | US Core Organization Profile)Who participated
..... onBehalfOf SC0..1Reference(US Core Organization Profile)Who the agent is representing
provenance-1: onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
.... agent:ProvenanceAuthor S0..*BackboneElementActor involved
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: author
..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
.... agent:ProvenanceTransmitter S0..1BackboneElementActor involved
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: transmitter
..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
... signature S0..*SignatureSignature on target

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Provenance.agent.typeextensibleUSCoreProvenancePaticipantTypeCodes
Provenance.agent:ProvenanceAuthor.typeextensiblePattern: author
Provenance.agent:ProvenanceTransmitter.typeextensiblePattern: transmitter

Constraints

IdGradePath(s)DetailsRequirements
provenance-1errorProvenance.agent.onBehalfOfonBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
: (($this.agent.who.resolve() is Practitioner) or ($this.agent.who.resolve() is Device)) implies exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Provenance 0..*USCoreProvenanceUS Core Provenance
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... target SΣ1..*Reference(Resource)The Resource this Provenance record supports
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... occurred[x] S0..1When the activity occurred
.... occurredPeriodPeriod
.... occurredDateTimedateTime
... recorded SΣ1..1instantTimestamp when the activity was recorded / updated
... policy 0..*uriPolicy or plan the activity was defined by
... location 0..1Reference(Location)Where the activity occurred, if relevant
... reason 0..*CodeableConceptReason the activity is occurring
Binding: PurposeOfUse (extensible): The reason the activity took place.


... activity 0..1CodeableConceptActivity that occurred
Binding: ProvenanceActivityType (extensible): The activity that took place.

... Slices for agent S1..*BackboneElementActor involved
Slice: Unordered, Open by pattern:type
.... agent:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ0..1CodeableConceptHow the agent participated
Binding: US Core Provenance Participant Type Codes (extensible)
..... role 0..*CodeableConceptWhat the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.


..... who SΣ1..1Reference(US Core Practitioner Profile | US Core Patient Profile | US Core Organization Profile)Who participated
..... onBehalfOf SC0..1Reference(US Core Organization Profile)Who the agent is representing
provenance-1: onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
.... agent:ProvenanceAuthor S0..*BackboneElementActor involved
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: author
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... role 0..*CodeableConceptWhat the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.


..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
..... onBehalfOf 0..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who the agent is representing
.... agent:ProvenanceTransmitter S0..1BackboneElementActor involved
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... type SΣ1..1CodeableConceptHow the agent participated
Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.


Required Pattern: At least the following
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... version0..1stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: transmitter
....... display0..1stringRepresentation defined by the system
....... userSelected0..1booleanIf this coding was chosen directly by the user
...... text0..1stringPlain text representation of the concept
..... role 0..*CodeableConceptWhat the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.


..... who Σ1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who participated
..... onBehalfOf 0..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)Who the agent is representing
... entity 0..*BackboneElementAn entity used in this activity
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... role Σ1..1codederivation | revision | quotation | source | removal
Binding: ProvenanceEntityRole (required): How an entity was used in an activity.

.... what Σ1..1Reference(Resource)Identity of entity
.... agent 0..*See agent (Provenance)Entity is attributed to this agent
... signature S0..*SignatureSignature on target

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Provenance.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Provenance.target.typeextensibleResourceType
Provenance.reasonextensiblePurposeOfUse
Provenance.activityextensibleProvenanceActivityType
Provenance.agent.typeextensibleUSCoreProvenancePaticipantTypeCodes
Provenance.agent.roleexampleSecurityRoleType
Provenance.agent:ProvenanceAuthor.typeextensiblePattern: author
Provenance.agent:ProvenanceAuthor.roleexampleSecurityRoleType
Provenance.agent:ProvenanceTransmitter.typeextensiblePattern: transmitter
Provenance.agent:ProvenanceTransmitter.roleexampleSecurityRoleType
Provenance.entity.rolerequiredProvenanceEntityRole

Constraints

IdGradePath(s)DetailsRequirements
provenance-1errorProvenance.agent.onBehalfOfonBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
: (($this.agent.who.resolve() is Practitioner) or ($this.agent.who.resolve() is Device)) implies exists()

This structure is derived from USCoreProvenance

Summary

Mandatory: 1 element
Must-Support: 3 elements

Maturity: 2

 

Other representations of profile: CSV, Excel, Schematron

Notes:

The following guidance applies to the use of Providence across Da Vinci IGs. IGs may impose additional expectations with respect to the use of Provenance either across their whole use-case or in the context of specific events.

Searching

There is no expectation for support for querying Provenance except using _revinclude using the ‘target’ parameter (to return Provenance instances associated with a returned resource).

Aligning Provenance and Resource elements

Provenance should align with information present in the record. Where a Provenance deals with the creation of an instance, the author, performer and (if present) informer should align with the equivalent elements on the record. Similarly, Provenance.occurred should align with the creation date for the record.

Populating Provenance.agent

The following table lists the various agent codes and what resource types are appropriate. These recommendations SHOULD be followed

| transmitter | This could be Patient, RelatedPerson, Practitioner or PractitionerRole or Organization. A second transmitter could capture the specific Device used | | enterer | Patient, RelatedPerson, Practitioner or PractitionerRole | | performer | could be anything | | author | could be anything | | verifier | generally only Practitioner or PractitionerRole | | legal | Only Practitioner or PractitionerRole | | attester | Patient, RelatedPerson, Practitioner or PractitionerRole | | informant | Patient, RelatedPerson, Practitioner or PractitionerRole | | custodian | usually Organization, could also be Device, Practitioner or PractitionerRole | | assembler | usually a Device, could be Practitioner or PractitionerRole | ——————————————

Handling agents with multiple roles

In general, the most important role to capture is “author”. If they are the only role present, the presumption is that they are also the enterer, performer, verifier, legal, attester, informant, etc. Specifying other roles is only necessary if they differ from the author. Not all systems will necessarily track all participants. Roles other than author only need to be shared if the system captures them and feels they may be relevant to downstream use of the information.

Populating onBehalfOf

Provenance.agent.onBehalfOf is only relevant in certain circumstances:

  • onBehalfOf SHOULD NOT be populated if RelatedPerson is acting on behalf of the Patient. (Because that is the assumption and there is already a link to the Patient on that resource)
  • onBehalfOf SHOULD NOT be populated with an Organization if the agent is Practitioner - use PractitionerRole instead (even if it is a contained PractitionerRole)
  • onBehalfOf SHOULD NOT be populated with an Organization if the agent is PractitionerRole unless PractitionerRole is pointing to an organization and the onBehalfOf is different (i.e. Dr. Smith for Clinic A did something on behalf of clinic B)
  • It is unusual for onBehalfOf to be populated if the agent is Patient or RelatedPerson
  • onBehalfOf SHOULD NOT be populated with an Organization if it is the same as Device.owner