2026 US Quality Core Implementation Guide
0.5.0 - cibuild US

2026 US Quality Core Implementation Guide, published by Office of the National Coordinator for Health Information Technology (ONC). This guide is not an authorized publication; it is the continuous build for version 0.5.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## USCDI+ Quality

USCDI+ Quality is part of the USCDI+ initiative. The USCDI+ initiative supports the identification and establishment of domain- or program-specific data element lists that operate as extensions to the existing USCDI data element list.

USCDI+ Quality is intended to improve healthcare interoperability across quality programs by establishing a consistent baseline of harmonized data elements for a wide range of quality measurement and reporting use cases. The USCDI+ Quality data element list serves as a baseline dataset to support digital quality measurement and reporting across the healthcare ecosystem.

USCDI+ Quality comprises of two data element lists.

1. Final USCDI+ Quality V1: The USCDI+ Quality V1 data element list focuses on data elements that are standardized, ready for implementation, and directly support electronic clinical quality measures. This list will serve as the basis for developing implementation guidance for health IT systems.

2. Quality Overarching: Like USCDI, the USCDI+ Quality framework includes data classes and elements that are not yet part of USCDI+ Quality V1 but are under consideration for future inclusion. The Quality Overarching data element list tracks all quality-relevant data elements identified across selected programs and captures a wider range of data elements identified through community input that may be included in a future version of USCDI+ Quality.

   Content in the Overarching USCDI+ Quality data element list is outside the scope of this guide. However, implementers and partners are encouraged to review these emerging data elements and provide feedback through the USCDI+ platform to help shape the development of future USCDI+ Quality versions.

### USCDI+ Quality V1 and US Quality Core Implementation Guide

USCDI+ Quality V1 defines high-level data requirements, and the US Quality Core Implementation Guide provides detailed FHIR-based profiles to meet those requirements. This guidance is necessary to achieve interoperability and consistency in quality-related healthcare data exchange in the United States, given the flexibility of the FHIR standard in representing this data.

The US Quality Core Implementation Guide v0.5.0 is derived from the QI-Core 6.0.0, adopting its profiles and annotating them with specific requirements for USCDI+ Quality V1. It also defines specific expectations through CapabilityStatements for accessing the data over a standard FHIR RESTful API.

Note that:

- USCDI+ Quality V1 data class and element names may differ from the US Quality Core profile and element names.
- Not every USCDI+ Quality V1 data class and element maps to a single US Quality Core profile.

Additionally, this implementation guide's conformance requirements with respect to USCDI+ Quality V1 are limited to:

- Data elements that align with existing QI-Core 6.0.0 or US Core 6.1.0 profiles, and
- Data elements used by the 2026 draft CMS eCQMs, which are based on QI-Core 6.0.0.

Data elements that do not clearly fit within these limitations above are out of scope for this version's conformance requirements. The tables included in section 3.1.2 and section 3.1.3 below describe which USCDI+ Quality V1 data elements are in scope and which are out of scope for conformance requirements of this version of the guide.

### In-Scope USCDI+ Quality V1 Data Elements

Only those USCDI+ Quality V1 data classes and elements that are required to be implemented for conformance to this guide are included in this mapping table.

- In scope elements are determined by their support in the current USCDI+ Quality V1 baseline, which includes USCDI v3.1, US Core 6.1.0, and/or QI-Core 6.0.0.
- In scope elements also include data elements that are used by 2026 draft CMS eCQMs, which are based on QI-Core 6.0.0.

The mapping table lists how USCDI+ Quality V1 data classes and elements map to the US Quality Core profiles defined in this guide, where applicable; otherwise, US Core 6.1.0 profiles apply.

USCDI+ Quality Data Class / Element | Implement with US Quality Core Profile(s) | Implement with US Core Profile(s)
--- | --- | ---
Adverse Events |  |
•Adverse Event | US Quality Core AdverseEvent |
•Adverse Event Category | US Quality Core AdverseEvent |
•Adverse Event Recorded Time | US Quality Core AdverseEvent |
•Adverse Event Suspect Entity | US Quality Core AdverseEvent |
Allergies and Intolerances |  |
•Allergy Intolerance Onset Time | US Quality Core AllergyIntolerance |
•Allergy Intolerance Recorded Date | US Quality Core AllergyIntolerance |
•Drug Class Allergy Intolerance | US Quality Core AllergyIntolerance |
•Medication Allergy Intolerance | US Quality Core AllergyIntolerance |
•Reaction | US Quality Core AllergyIntolerance |
•Reaction Date | US Quality Core AllergyIntolerance |
Care Team Members |  |
•Care Team Member Identifier | US Quality Core CareTeam US Quality Core Practitioner US Quality Core PractitionerRole |
•Care Team Member Location | US Quality Core Practitioner US Quality Core PractitionerRole US Quality Core RelatedPerson |
•Care Team Member Name | US Quality Core Practitioner US Quality Core PractitionerRole US Quality Core RelatedPerson |
•Care Team Member Role | US Quality Core RelatedPerson US Quality Core PractitionerRole US Quality Core CareTeam |
•Care Team Member Telecom | US Quality Core Practitioner US Quality Core PractitionerRole US Quality Core RelatedPerson |
Clinical Notes |  |
•Consultation Note |  | US Core DocumentReference Profile (6.1.0)
•Discharge Summary Note |  | US Core DocumentReference Profile (6.1.0)
•History & Physical |  | US Core DocumentReference Profile (6.1.0)
•Procedure Note | US Quality Core DiagnosticReport Profile for Report and Note Exchange |
•Progress Note |  | US Core DocumentReference Profile (6.1.0)
Clinical Tests |  |
•Clinical Test | US Quality Core Observation Clinical Result US Quality Core DiagnosticReport Profile for Report and Note Exchange |
•Clinical Test Result/Report | US Quality Core Observation Clinical Result US Quality Core DiagnosticReport Profile for Report and Note Exchange |
•Clinical Test Status | US Quality Core Observation Clinical Result US Quality Core DiagnosticReport Profile for Report and Note Exchange |
Diagnostic Imaging |  |
•Diagnostic Imaging Report | US Quality Core DiagnosticReport Profile for Laboratory Results Reporting US Quality Core Observation Clinical Result |
•Diagnostic Imaging Test | US Quality Core DiagnosticReport Profile for Laboratory Results Reporting US Quality Core Observation Clinical Result |
Encounter Information |  |
•Diagnosis Rank | US Quality Core Claim |
•Encounter Diagnosis | US Quality Core Condition Encounter Diagnosis US Quality Core Encounter |
•Encounter Diagnosis Role | US Quality Core Condition Encounter Diagnosis |
•Encounter Disposition | US Quality Core Encounter |
•Encounter Identifier | US Quality Core Encounter |
•Encounter Location | US Quality Core Encounter |
•Encounter Status | US Quality Core Encounter |
•Encounter Time | US Quality Core Encounter |
•Encounter Type | US Quality Core Encounter |
•Present on Admission | US Quality Core Claim |
Facility Information |  |
•Facility Address | US Quality Core Location |
•Facility Name | US Quality Core Location |
•Facility Type | US Quality Core Location |
Family Health History |  |
•Family Health History | US Quality Core FamilyMemberHistory |
Goals and Preferences |  |
•Patient Goals | US Quality Core Goal |
•SDOH Goals | US Quality Core Goal |
Health Insurance Information |  |
•Coverage Period | US Quality Core Coverage |
•Coverage Status | US Quality Core Coverage |
•Coverage Type | US Quality Core Coverage |
•Group Identifier | US Quality Core Coverage |
•Health Insurance Beneficiary | US Quality Core Coverage |
•Insurance Plan Name | US Quality Core Coverage |
•Member Identifier | US Quality Core Coverage |
•Payer Identifier | US Quality Core Coverage US Quality Core Organization |
•Plan Identifier | US Quality Core Coverage |
•Relationship to Subscriber | US Quality Core Coverage |
•Subscriber Identifier | US Quality Core Coverage |
Health Status Assessments |  |
•Disability Status | US Quality Core Simple Observation US Quality Core Observation Screening Assessment US Quality Core Observation Cancelled US Quality Core Condition Problems Health Concerns |
•Functional Status | US Quality Core Simple Observation US Quality Core Observation Screening Assessment US Quality Core Observation Cancelled US Quality Core Condition Problems Health Concerns |
•Health Concerns | US Quality Core Condition Problems Health Concerns |
•Mental/Cognitive Status | US Quality Core Simple Observation US Quality Core Observation Screening Assessment US Quality Core Observation Cancelled US Quality Core Condition Problems Health Concerns |
•Nutrition Assessment | US Quality Core Simple Observation US Quality Core Observation Screening Assessment US Quality Core Observation Cancelled US Quality Core Condition Problems Health Concerns |
•Pregnancy Status |  | US Core Observation Pregnancy Intent Profile (6.1.0) US Core Observation Pregnancy Status Profile (6.1.0)
•SDOH Assessment | US Quality Core Simple Observation US Quality Core Observation Screening Assessment US Quality Core Observation Cancelled US Quality Core Condition Problems Health Concerns |
•Smoking Status |  | US Core Smoking Status Observation Profile (6.1.0)
Immunizations |  |
•Immunization Record Source | US Quality Core Immunization |
•Immunization Status | US Quality Core Immunization |
•Immunizations | US Quality Core Immunization |
•Reason Not Performed | US Quality Core Immunization US Quality Core Immunization Not Done |
•Vaccination Administration Date | US Quality Core Immunization |
Laboratory |  |
•Laboratory Result Report Date Time | US Quality Core Laboratory Result Observation US Quality Core DiagnosticReport Profile for Laboratory Results Reporting |
•Result Interpretation | US Quality Core Laboratory Result Observation |
•Result Status | US Quality Core Laboratory Result Observation US Quality Core DiagnosticReport Profile for Laboratory Results Reporting |
•Result Unit of Measure | US Quality Core Laboratory Result Observation US Quality Core DiagnosticReport Profile for Laboratory Results Reporting |
•Specimen Type |  | US Core Specimen Profile (6.1.0)
•Tests | US Quality Core Laboratory Result Observation US Quality Core DiagnosticReport Profile for Laboratory Results Reporting |
•Values/Results | US Quality Core Laboratory Result Observation US Quality Core DiagnosticReport Profile for Laboratory Results Reporting |
Medical Devices |  |
•Device Type | US Quality Core DeviceRequest US Quality Core ServiceRequest US Quality Core Device Not Requested US Quality Core Service Not Requested |
Medications |  |
•Date Medication Administered | US Quality Core MedicationAdministration |
•Date Medication Prescribed | US Quality Core MedicationRequest |
•Days Supply | US Quality Core MedicationDispense US Quality Core MedicationRequest |
•Dispense Status | US Quality Core MedicationDispense US Quality Core MedicationDispense Declined |
•Dose | US Quality Core MedicationDispense US Quality Core MedicationRequest US Quality Core MedicationAdministration |
•Dose unit of measure | US Quality Core MedicationDispense US Quality Core MedicationRequest US Quality Core MedicationAdministration |
•Indication | US Quality Core MedicationRequest |
•Medication Administration Status | US Quality Core MedicationAdministration US Quality Core MedicationAdministration Not Done |
•Medication Instructions | US Quality Core MedicationDispense US Quality Core MedicationRequest US Quality Core MedicationAdministration |
•Medication Order | US Quality Core MedicationRequest |
•Medication Quantity | US Quality Core MedicationDispense US Quality Core MedicationRequest |
•Medications | US Quality Core MedicationDispense US Quality Core MedicationRequest US Quality Core MedicationAdministration US Quality Core Medication |
•Reason Not Performed | US Quality Core MedicationAdministration Not Done US Quality Core Medication Not Requested US Quality Core MedicationDispense Declined |
Newborn's Delivery Information |  |
•Birth Outcome | US Quality Core Simple Observation |
•Birth Time | US Quality Core Simple Observation |
•Birth Weight | US Quality Core Simple Observation |
•Gestational Age at Delivery | US Quality Core Simple Observation |
Orders |  |
•Medication Order | US Quality Core MedicationRequest |
Patient Demographics/Information |  |
•Current Address | US Quality Core Patient |
•Date of Birth | US Quality Core Patient |
•Date of Death | US Quality Core Patient |
•Email Address | US Quality Core Patient |
•Ethnicity | US Quality Core Patient |
•First Name | US Quality Core Patient |
•Last Name | US Quality Core Patient |
•Middle Name (Including middle initial) | US Quality Core Patient |
•Name Suffix | US Quality Core Patient |
•Occupation |  | US Core Observation Occupation Profile (6.1.0)
•Occupation Industry |  | US Core Observation Occupation Profile (6.1.0)
•Patient Identifier | US Quality Core Patient |
•Phone Number | US Quality Core Patient |
•Phone Number Type | US Quality Core Patient |
•Preferred Language | US Quality Core Patient |
•Previous Address | US Quality Core Patient |
•Previous Name | US Quality Core Patient |
•Race | US Quality Core Patient |
•Related Person's Name | US Quality Core RelatedPerson |
•Relationship Type | US Quality Core RelatedPerson |
•Tribal Affiliation | US Quality Core Patient |
Patient Summary and Plan |  |
•Assessment and Plan of Treatment | US Quality Core CarePlan |
Pregnancy Information |  |
•Delivery Procedures | US Quality Core Procedure US Quality Core Procedure Not Done |
•Delivery Time | US Quality Core Simple Observation |
•Estimated Date of Delivery | US Quality Core Simple Observation |
•Fetal Presentation | US Quality Core Simple Observation |
•Gestational Age | US Quality Core Simple Observation |
•Gravidity | US Quality Core Simple Observation |
•Parity | US Quality Core Simple Observation |
•Pregnancy Outcomes | US Quality Core Simple Observation |
•Preterm Births | US Quality Core Simple Observation |
•Term Births | US Quality Core Simple Observation |
Problems |  |
•Clinical Status | US Quality Core Condition Problems Health Concerns |
•Condition Verification Status | US Quality Core Condition Problems Health Concerns |
•Date of Diagnosis | US Quality Core Condition Problems Health Concerns US Quality Core Condition Encounter Diagnosis |
•Date of Onset |  |
•Date of Resolution | US Quality Core Condition Problems Health Concerns |
•Problems | US Quality Core Condition Problems Health Concerns |
•SDOH Problems/Health Concerns | US Quality Core Condition Problems Health Concerns |
Procedures |  |
•Performance Time | US Quality Core Procedure US Quality Core Immunization US Quality Core DiagnosticReport Profile for Report and Note Exchange US Quality Core Procedure Not Done US Quality Core Immunization Not Done |
•Procedure Reason Code | US Quality Core Procedure US Quality Core ServiceRequest US Quality Core Procedure Not Done US Quality Core Service Not Requested US Quality Core Task US Quality Core Task Rejected |
•Procedure Status | US Quality Core Procedure US Quality Core Procedure Not Done |
•Procedures | US Quality Core Procedure US Quality Core Procedure Not Done US Quality Core Task US Quality Core Task Rejected |
•Reason for Referral | US Quality Core Procedure US Quality Core ServiceRequest US Quality Core Procedure Not Done US Quality Core Service Not Requested |
•SDOH Interventions | US Quality Core Procedure US Quality Core ServiceRequest US Quality Core Procedure Not Done US Quality Core Service Not Requested |
Provenance |  |
•Author Organization |  | US Core Provenance Profile (6.1.0)
•Author Time Stamp |  | US Core Provenance Profile (6.1.0)
Referrals |  |
•Reason for Referral | US Quality Core ServiceRequest |
•Referral Status | US Quality Core ServiceRequest US Quality Core Service Not Requested |
•Referral Time | US Quality Core ServiceRequest US Quality Core Service Not Requested |
Vital Signs |  |
•Average Blood Pressure |  | US Core Blood Pressure Profile (6.1.0)
•BMI |  | US Core BMI Profile (6.1.0)
•BMI Percentile (2 - 20 years) |  | US Core Pediatric BMI for Age Observation Profile (6.1.0)
•Body Height |  | US Core Body Height Profile (6.1.0)
•Body Temperature |  | US Core Body Temperature Profile (6.1.0)
•Body Weight |  | US Core Body Weight Profile (6.1.0)
•Diastolic Blood Pressure |  | US Core Blood Pressure Profile (6.1.0)
•Head Occipital-frontal Circumference Percentile (Birth - 36 Months) |  | US Core Pediatric Head Occipital Frontal Circumference Percentile Profile (6.1.0)
•Heart Rate |  | US Core Heart Rate Profile (6.1.0)
•Inhaled Oxygen Concentration |  | US Core Pulse Oximetry Profile (6.1.0)
•Pain Severity | US Quality Core Observation Screening Assessment |
•Pulse Oximetry |  | US Core Pulse Oximetry Profile (6.1.0)
•Respiratory Rate |  | US Core Respiratory Rate Profile (6.1.0)
•Systolic Blood Pressure |  | US Core Blood Pressure Profile (6.1.0)
•Weight-for-length Percentile (Birth - 24 Months) |  | US Core Pediatric Weight for Height Observation Profile (6.1.0)

### Out-of-Scope USCDI+ Quality V1 Data Elements

The following data elements in USCDI+ Quality V1 are out of scope for the conformance expectations of this guide. Data elements listed here may map to newer published versions of QI-Core or US Core, and the applicable versions are indicated in parenthesis next to the profile.

USCDI+ Quality V1 elements that do not have a mapping in the table below indicate those elements are not identified as mandatory or Must Support, or tagged (QI), (QI-Core), or "Additional USCDI" in any of the newer versions of QI-Core or US Core, including QI-Core 7.0.1 and 8.0.0-ballot, US Core 7.0.0, 8.0.1, and 9.0.0-ballot.

USCDI+ Quality Data Class / Element | Relevant QI-Core Profile(s) | Relevant US Core Profile(s)
--- | --- | ---
Advance Directives |  |
•Advance Directive Observation |  | US Core Observation ADI Documentation Profile (8.0.1) US Core ADI DocumentReference Profile (8.0.1)
Adverse Events |  |
•Adverse Event Degree of Harm | QICore AdverseEvent (7.0.2) |
Allergies and Intolerances |  |
•Non-Medication Allergy Intolerance | QICore AllergyIntolerance (7.0.2) |
Diagnostic Imaging |  |
•Diagnostic Imaging Reference |  |
Facility Information |  |
•Facility Identifier | QICore Location (7.0.2) |
Goals and Preferences |  |
•Care Experience Preference |  | US Core Care Experience Preference Profile (7.0.0)
•Treatment Intent |  | US Core Treatment Intervention Preference Profile (7.0.0)
•Treatment Intervention Preference |  | US Core Treatment Intervention Preference Profile (7.0.0)
Health Status Assessments |  |
•Alcohol Use | QICore Simple Observation (7.0.2) QICore Observation Screening Assessment (7.0.2) QICore Condition Problems Health Concerns (7.0.2) |
•Physical Activity | QICore Simple Observation (7.0.2) QICore Observation Screening Assessment (7.0.2) QICore Condition Problems Health Concerns (7.0.2) |
•Substance Use | QICore Simple Observation (7.0.2) QICore Observation Screening Assessment (7.0.2) QICore Condition Problems Health Concerns (7.0.2) |
Laboratory |  |
•Specimen Collection Date Time |  |
Medical Devices |  |
•Unique Device Identifier (UDI) |  | US Core Device Profile (9.0.0)
Observations |  |
•Advance Directive Observation |  | US Core Observation ADI Documentation Profile (8.0.1) US Core ADI DocumentReference Profile (8.0.1)
Provenance |  |
•Author |  | US Core Provenance Profile (8.0.1)
•Author Role |  | US Core Provenance Profile (8.0.1)
Nutrition and Diet |  |
•Nutritional Reason |  |
Orders |  |
•Nutrition Order |  |
Procedures |  |
•Procedure Type |  |

### Summary List of In-Scope Profiles for Conformance

US Quality Core is derived from QI-Core v6.0.0 and includes inherited copies of all QI-Core profiles, regardless of whether they are applicable to USCDI+ Quality V1. Per the conformance expectations and the capability statements in this guide, only US Quality Core profiles that include at least one USCDI+ Quality–flagged element (as defined in Must Support) are in scope for conformance and SHALL be supported.

The following profiles include at least one USCDI+ Quality–flagged element and SHALL be supported:

- US Quality Core AdverseEvent
- US Quality Core AllergyIntolerance
- US Quality Core CarePlan
- US Quality Core CareTeam
- US Quality Core Claim
- US Quality Core Condition Encounter Diagnosis
- US Quality Core Condition Problems Health Concerns
- US Quality Core Coverage
- US Quality Core Device Not Requested
- US Quality Core DeviceRequest
- US Quality Core DiagnosticReport Profile for Laboratory Results Reporting
- US Quality Core DiagnosticReport Profile for Report and Note Exchange
- US Quality Core Encounter
- US Quality Core FamilyMemberHistory
- US Quality Core Goal
- US Quality Core ImagingStudy
- US Quality Core Immunization
- US Quality Core Immunization Not Done
- US Quality Core Laboratory Result Observation
- US Quality Core Location
- US Quality Core Medication
- US Quality Core Medication Not Requested
- US Quality Core MedicationAdministration
- US Quality Core MedicationAdministration Not Done
- US Quality Core MedicationDispense
- US Quality Core MedicationDispense Declined
- US Quality Core MedicationRequest
- US Quality Core Observation Cancelled
- US Quality Core Observation Clinical Result
- US Quality Core Observation Screening Assessment
- US Quality Core Organization
- US Quality Core Patient
- US Quality Core Practitioner
- US Quality Core PractitionerRole
- US Quality Core Procedure
- US Quality Core Procedure Not Done
- US Quality Core RelatedPerson
- US Quality Core Service Not Requested
- US Quality Core ServiceRequest
- US Quality Core Simple Observation
- US Quality Core Task
- US Quality Core Task Rejected

### Summary List of Out-of-Scope Profiles for Conformance

Some profiles in this guide are inherited from QI-Core v6.0.0 but do not include any USCDI+ Quality–flagged elements (as defined in Must Support). These profiles are out-of-scope for USCDI+ Quality V1 conformance but are included to ease adoption for systems that currently support QI-Core v6.0.0.

The following profiles do not include any USCDI+ Quality–flagged elements and MAY be supported:

- US Quality Core BodyStructure
- US Quality Core ClaimResponse
- US Quality Core Communication
- US Quality Core Communication Not Done
- US Quality Core CommunicationRequest
- US Quality Core Device
- US Quality Core DeviceUseStatement
- US Quality Core Flag
- US Quality Core ImmunizationEvaluation
- US Quality Core ImmunizationRecommendation
- US Quality Core MedicationStatement
- US Quality Core NonPatient Observation
- US Quality Core NutritionOrder
- US Quality Core QuestionnaireResponse
- US Quality Core Substance