Da Vinci Health Record Exchange (HRex)
1.2.0-snapshot - STU 1.2 United States of America flag

Da Vinci Health Record Exchange (HRex), published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 1.2.0-snapshot built by the FHIR (HL7® FHIR® Standard) CI Build. 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

1.2.0-snapshot
Official URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-provenance Version:
Standards status: Trial-use Active as of 2026-01-30 Maturity Level: 3 Computable Name: HRexProvenance
Other Identifiers: OID:2.16.840.1.113883.4.642.40.19.42.14

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 might 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.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Provenance 0..* USCoreProvenance(7.0.0) US Core Provenance
This profile also complies with the profile US Core Provenance Profile (6.1.0)
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... target SΣ 1..* Reference(Resource) The Resource this Provenance record supports
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... occurredPeriod Period
.... occurredDateTime dateTime
... recorded SΣ 1..1 instant Timestamp when the activity was recorded / updated
... Slices for agent SC 1..* BackboneElement Actor involved
Slice: Unordered, Open by pattern:type
Constraints: provenance-1
.... agent:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 0..1 CodeableConcept How the agent participated
Binding: USCoreProvenancePaticipantTypeCodes (7.0.0) (extensible)
..... who SΣ 1..1 Reference(US Core Organization Profile(7.0.0) S | US Core Practitioner Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) Who participated
..... onBehalfOf S 0..1 Reference(US Core Organization Profile(7.0.0)) Who the agent is representing
.... agent:ProvenanceAuthor S 0..* BackboneElement Actor involved
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: author
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
.... agent:ProvenanceTransmitter S 0..* BackboneElement Actor involved
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: transmitter
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
... signature S 0..* Signature Signature on target

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Provenance.agent.type Base extensible US Core Provenance Participant Type Codes 📍7.0.0 US Core v7.0
Provenance.agent:ProvenanceAuthor.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceTransmitter.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Provenance If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Provenance If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Provenance If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Provenance If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Provenance A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
provenance-1 error Provenance.agent onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device who.exists((resolve() is Practitioner) or (resolve() is Device)) implies onBehalfOf.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Provenance 0..* USCoreProvenance(7.0.0) US Core Provenance
This profile also complies with the profile US Core Provenance Profile (6.1.0)
... target
.... reference 1..1 string Literal reference, Relative, internal or absolute URL
... occurred[x] S 0..1 Period, dateTime When the activity occurred
... signature S 0..* Signature Signature on target

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Provenance 0..* USCoreProvenance(7.0.0) US Core Provenance
This profile also complies with the profile US Core Provenance Profile (6.1.0)
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... target SΣ 1..* Reference(Resource) The Resource this Provenance record supports
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... occurred[x] S 0..1 When the activity occurred
.... occurredPeriod Period
.... occurredDateTime dateTime
... recorded SΣ 1..1 instant Timestamp when the activity was recorded / updated
... policy 0..* uri Policy or plan the activity was defined by
... location 0..1 Reference(Location) Where the activity occurred, if relevant
... reason 0..* CodeableConcept Reason the activity is occurring
Binding: PurposeOfUse (3.1.0) (extensible): The reason the activity took place.
... activity 0..1 CodeableConcept Activity that occurred
Binding: ProvenanceActivityType (extensible): The activity that took place.
... Slices for agent SC 1..* BackboneElement Actor involved
Slice: Unordered, Open by pattern:type
Constraints: provenance-1
.... agent:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 0..1 CodeableConcept How the agent participated
Binding: USCoreProvenancePaticipantTypeCodes (7.0.0) (extensible)
..... role 0..* CodeableConcept What the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
..... who SΣ 1..1 Reference(US Core Organization Profile(7.0.0) S | US Core Practitioner Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) Who participated
..... onBehalfOf S 0..1 Reference(US Core Organization Profile(7.0.0)) Who the agent is representing
.... agent:ProvenanceAuthor S 0..* BackboneElement Actor involved
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: author
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... role 0..* CodeableConcept What the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
..... onBehalfOf 0..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who the agent is representing
.... agent:ProvenanceTransmitter S 0..* BackboneElement Actor involved
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: transmitter
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... role 0..* CodeableConcept What the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
..... onBehalfOf 0..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who the agent is representing
... entity 0..* BackboneElement An entity used in this activity
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... role Σ 1..1 code derivation | revision | quotation | source | removal
Binding: ProvenanceEntityRole (required): How an entity was used in an activity.
.... what Σ 1..1 Reference(Resource) Identity of entity
.... agent 0..* See agent (Provenance) Entity is attributed to this agent
... signature S 0..* Signature Signature on target

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Provenance.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Provenance.target.type Base extensible ResourceType 📦4.0.1 FHIR Std.
Provenance.reason Base extensible PurposeOfUse 📍3.1.0 THO v7.0
Provenance.activity Base extensible Provenance activity type 📦4.0.1 FHIR Std.
Provenance.agent.type Base extensible US Core Provenance Participant Type Codes 📍7.0.0 US Core v7.0
Provenance.agent.role Base example SecurityRoleType 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceAuthor.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceAuthor.​role Base example SecurityRoleType 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceTransmitter.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceTransmitter.​role Base example SecurityRoleType 📦4.0.1 FHIR Std.
Provenance.entity.role Base required ProvenanceEntityRole 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Provenance If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Provenance If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Provenance If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Provenance If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Provenance A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
provenance-1 error Provenance.agent onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device who.exists((resolve() is Practitioner) or (resolve() is Device)) implies onBehalfOf.exists()

Summary

Mandatory: 1 element
Must-Support: 2 elements

Maturity: 3

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Provenance 0..* USCoreProvenance(7.0.0) US Core Provenance
This profile also complies with the profile US Core Provenance Profile (6.1.0)
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... target SΣ 1..* Reference(Resource) The Resource this Provenance record supports
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... occurredPeriod Period
.... occurredDateTime dateTime
... recorded SΣ 1..1 instant Timestamp when the activity was recorded / updated
... Slices for agent SC 1..* BackboneElement Actor involved
Slice: Unordered, Open by pattern:type
Constraints: provenance-1
.... agent:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 0..1 CodeableConcept How the agent participated
Binding: USCoreProvenancePaticipantTypeCodes (7.0.0) (extensible)
..... who SΣ 1..1 Reference(US Core Organization Profile(7.0.0) S | US Core Practitioner Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) Who participated
..... onBehalfOf S 0..1 Reference(US Core Organization Profile(7.0.0)) Who the agent is representing
.... agent:ProvenanceAuthor S 0..* BackboneElement Actor involved
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: author
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
.... agent:ProvenanceTransmitter S 0..* BackboneElement Actor involved
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: transmitter
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
... signature S 0..* Signature Signature on target

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Provenance.agent.type Base extensible US Core Provenance Participant Type Codes 📍7.0.0 US Core v7.0
Provenance.agent:ProvenanceAuthor.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceTransmitter.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Provenance If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Provenance If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Provenance If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Provenance If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Provenance A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
provenance-1 error Provenance.agent onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device who.exists((resolve() is Practitioner) or (resolve() is Device)) implies onBehalfOf.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Provenance 0..* USCoreProvenance(7.0.0) US Core Provenance
This profile also complies with the profile US Core Provenance Profile (6.1.0)
... target
.... reference 1..1 string Literal reference, Relative, internal or absolute URL
... occurred[x] S 0..1 Period, dateTime When the activity occurred
... signature S 0..* Signature Signature on target

doco Documentation for this format

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Provenance 0..* USCoreProvenance(7.0.0) US Core Provenance
This profile also complies with the profile US Core Provenance Profile (6.1.0)
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... target SΣ 1..* Reference(Resource) The Resource this Provenance record supports
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... occurred[x] S 0..1 When the activity occurred
.... occurredPeriod Period
.... occurredDateTime dateTime
... recorded SΣ 1..1 instant Timestamp when the activity was recorded / updated
... policy 0..* uri Policy or plan the activity was defined by
... location 0..1 Reference(Location) Where the activity occurred, if relevant
... reason 0..* CodeableConcept Reason the activity is occurring
Binding: PurposeOfUse (3.1.0) (extensible): The reason the activity took place.
... activity 0..1 CodeableConcept Activity that occurred
Binding: ProvenanceActivityType (extensible): The activity that took place.
... Slices for agent SC 1..* BackboneElement Actor involved
Slice: Unordered, Open by pattern:type
Constraints: provenance-1
.... agent:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 0..1 CodeableConcept How the agent participated
Binding: USCoreProvenancePaticipantTypeCodes (7.0.0) (extensible)
..... role 0..* CodeableConcept What the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
..... who SΣ 1..1 Reference(US Core Organization Profile(7.0.0) S | US Core Practitioner Profile(7.0.0) | US Core Patient Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) Who participated
..... onBehalfOf S 0..1 Reference(US Core Organization Profile(7.0.0)) Who the agent is representing
.... agent:ProvenanceAuthor S 0..* BackboneElement Actor involved
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: author
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... role 0..* CodeableConcept What the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
..... onBehalfOf 0..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who the agent is representing
.... agent:ProvenanceTransmitter S 0..* BackboneElement Actor involved
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type SΣ 1..1 CodeableConcept How 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
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: transmitter
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... role 0..* CodeableConcept What the agents role was
Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
..... who Σ 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who participated
..... onBehalfOf 0..1 Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization) Who the agent is representing
... entity 0..* BackboneElement An entity used in this activity
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... role Σ 1..1 code derivation | revision | quotation | source | removal
Binding: ProvenanceEntityRole (required): How an entity was used in an activity.
.... what Σ 1..1 Reference(Resource) Identity of entity
.... agent 0..* See agent (Provenance) Entity is attributed to this agent
... signature S 0..* Signature Signature on target

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Provenance.language Base preferred Common Languages 📦4.0.1 FHIR Std.
Provenance.target.type Base extensible ResourceType 📦4.0.1 FHIR Std.
Provenance.reason Base extensible PurposeOfUse 📍3.1.0 THO v7.0
Provenance.activity Base extensible Provenance activity type 📦4.0.1 FHIR Std.
Provenance.agent.type Base extensible US Core Provenance Participant Type Codes 📍7.0.0 US Core v7.0
Provenance.agent.role Base example SecurityRoleType 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceAuthor.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceAuthor.​role Base example SecurityRoleType 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceTransmitter.​type Base extensible Provenance participant type 📦4.0.1 FHIR Std.
Provenance.agent:ProvenanceTransmitter.​role Base example SecurityRoleType 📦4.0.1 FHIR Std.
Provenance.entity.role Base required ProvenanceEntityRole 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Provenance If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Provenance If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Provenance If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Provenance If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Provenance A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
provenance-1 error Provenance.agent onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device who.exists((resolve() is Practitioner) or (resolve() is Device)) implies onBehalfOf.exists()

Summary

Mandatory: 1 element
Must-Support: 2 elements

Maturity: 3

 

Other representations of profile: CSV, Excel, Schematron

Notes:

The following guidance applies to the use of Providence across Da Vinci IGs. IGs can 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 conf§prov-1

| element | Allowed target resources |

| 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 | ——————————————

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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 might be relevant to downstream use of the information.

Populating onBehalfOf

Provenance.agent.onBehalfOf is only relevant in certain circumstances: conf§prov-2

  • 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

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