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

## Must Support

US Quality Core derives from US Core, and therefore the requirements on "MustSupport" defined in US Core must be respected.

US Quality Core adopts the QI-Core approach to flag USCDI+ Quality elements with a US Quality Core USCDI+ Quality Extension to indicate significance for implementers, instead of applying additional "MustSupport" flags above the inherited US Core "MustSupport" flags. This is consistent with US Core's use of the USCDI Requirement Extension to indicate those requirements specifically applicable to USCDI conformance.

Implementers are expected to implement all profiles and FHIR elements that contain the USCDI+ Quality flag, shown as (USCDI+ Quality).

Each of the US Quality Core profiles that are in scope for the conformance requirements of this guide includes a summary of the elements flagged as USCDI+ Quality elements. This summary is presented in the Examples section, located above the Formal View of Profile Content. See Figure 1 as an example.

Figure 1. Summary of USCDI+ Quality Elements in a US Quality Core Profile

Figure 2 below illustrates how the USCDI+ Quality flag is presented in Formal View of Profile Content, the "Key Elements Table" tab, on the US Quality Core profile pages.

Figure 2. USCDI+ Quality Flag in Formal View of Profile Content