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

## Resource Profile: US Quality Core Communication

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-communication | Version: 0.5.0
Active as of 2026-05-15 | Computable Name: USQualityCoreCommunication

Profile of Communication for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Usage

See the patterns page for implementation and usage patterns.

To create an expression specifically requesting information that a communication intentionally did not occur for a medical, patient or system reason, use the profile USQualityCore-communicationnotdone.

The Communication and CommunicationNotDone profiles represent the positive and negative statements for a communication event. To ensure instances retrieved meet positive intent, applications should check the status as illustrated in this example:

    define Communication:
      [Communication] C
        where C.status in { 'preparation', 'in-progress', 'on-hold', 'completed' }

### Examples

Radiology Report Notification Example

Usages:

- Examples for this Profile: Communication/example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication |  | 0..* | Communication | A record of information transmitted from a sender to a receiver
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown Binding: Non-Negative Event Status (required)
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 0..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred)
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦1.0.1 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | 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 | Communication | 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 | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | 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()`

This structure is derived from Communication

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication |  | 0..* | Communication | A record of information transmitted from a sender to a receiver
status |  | 1..1 | code | preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown Binding: Non-Negative Event Status (required)
subject |  | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 0..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred)
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Communication.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦1.0.1 | THO v7.1

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication |  | 0..* | Communication | A record of information transmitted from a sender to a receiver
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
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
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
identifier | Σ | 0..* | Identifier | Unique identifier
instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(Resource) | Request fulfilled by this communication
partOf | Σ | 0..* | Reference(Resource) | Part of this action
inResponseTo |  | 0..* | Reference(Communication) | Reply to
status | ?!Σ | 1..1 | code | preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown Binding: Non-Negative Event Status (required)
statusReason | Σ | 0..1 | CodeableConcept | Reason for current status Binding: CommunicationNotDoneReason (example): Codes for the reason why a communication did not happen.
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (example): Codes for general categories of communications such as alerts, instructions, etc.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Codes indicating the relative importance of a communication.
medium |  | 0..* | CodeableConcept | A channel of communication Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 0..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred)
about |  | 0..* | Reference(Resource) | Resources that pertain to this communication
encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
reasonCode | Σ | 0..* | CodeableConcept | Indication for message Binding: SNOMEDCTClinicalFindings (example): Codes for describing reasons for the occurrence of a communication.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why was communication done?
payload |  | 0..* | BackboneElement | Message payload
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
content[x] |  | 1..1 |  | Message part content
contentString |  |  | string |
contentAttachment |  |  | Attachment |
contentReference |  |  | Reference(Resource) |
note |  | 0..* | Annotation | Comments made about the communication
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Communication.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Communication.statusReason | Base | example | CommunicationNotDoneReason | 📍4.0.1 | FHIR Std.
Communication.category | Base | example | CommunicationCategory | 📍4.0.1 | FHIR Std.
Communication.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
Communication.medium | Base | example | v3 Code System ParticipationMode | 📦2018-08-12 | FHIR Std.
Communication.topic | Base | preferred | CommunicationTopic | 📦1.0.1 | THO v7.1
Communication.reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | 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 | Communication | 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 | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | 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()`

This structure is derived from Communication

Summary

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Device (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-device)
- US Core Implantable Device Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device|6.1.0)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication |  | 0..* | Communication | A record of information transmitted from a sender to a receiver
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown Binding: Non-Negative Event Status (required)
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 0..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred)
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦1.0.1 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | 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 | Communication | 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 | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | 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()`

Differential View

This structure is derived from Communication

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication |  | 0..* | Communication | A record of information transmitted from a sender to a receiver
status |  | 1..1 | code | preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown Binding: Non-Negative Event Status (required)
subject |  | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 0..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred)
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Communication.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Communication.topic | Base | preferred | CommunicationTopic | 📦1.0.1 | THO v7.1

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Communication |  | 0..* | Communication | A record of information transmitted from a sender to a receiver
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
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
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
identifier | Σ | 0..* | Identifier | Unique identifier
instantiatesCanonical | Σ | 0..* | canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) | Instantiates FHIR protocol or definition
instantiatesUri | Σ | 0..* | uri | Instantiates external protocol or definition
basedOn | Σ | 0..* | Reference(Resource) | Request fulfilled by this communication
partOf | Σ | 0..* | Reference(Resource) | Part of this action
inResponseTo |  | 0..* | Reference(Communication) | Reply to
status | ?!Σ | 1..1 | code | preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown Binding: Non-Negative Event Status (required)
statusReason | Σ | 0..1 | CodeableConcept | Reason for current status Binding: CommunicationNotDoneReason (example): Codes for the reason why a communication did not happen.
category |  | 0..* | CodeableConcept | Message category Binding: CommunicationCategory (example): Codes for general categories of communications such as alerts, instructions, etc.
priority | Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Codes indicating the relative importance of a communication.
medium |  | 0..* | CodeableConcept | A channel of communication Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
subject | Σ | 0..1 | Reference(US Quality Core Patient | Group) | Focus of message
topic |  | 0..1 | CodeableConcept | Description of the purpose/content Binding: CommunicationTopic (preferred)
about |  | 0..* | Reference(Resource) | Resources that pertain to this communication
encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of
sent |  | 0..1 | dateTime | When sent
received |  | 0..1 | dateTime | When received
recipient |  | 0..* | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) | Message recipient
sender |  | 0..1 | Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) | Message sender
reasonCode | Σ | 0..* | CodeableConcept | Indication for message Binding: SNOMEDCTClinicalFindings (example): Codes for describing reasons for the occurrence of a communication.
reasonReference | Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why was communication done?
payload |  | 0..* | BackboneElement | Message payload
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
content[x] |  | 1..1 |  | Message part content
contentString |  |  | string |
contentAttachment |  |  | Attachment |
contentReference |  |  | Reference(Resource) |
note |  | 0..* | Annotation | Comments made about the communication
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Communication.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Communication.status | Base | required | Non-Negative Event Status | 📦0.5.0 | This IG
Communication.statusReason | Base | example | CommunicationNotDoneReason | 📍4.0.1 | FHIR Std.
Communication.category | Base | example | CommunicationCategory | 📍4.0.1 | FHIR Std.
Communication.priority | Base | required | Request priority | 📍4.0.1 | FHIR Std.
Communication.medium | Base | example | v3 Code System ParticipationMode | 📦2018-08-12 | FHIR Std.
Communication.topic | Base | preferred | CommunicationTopic | 📦1.0.1 | THO v7.1
Communication.reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Communication | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Communication | 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 | Communication | 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 | Communication | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Communication | 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()`

This structure is derived from Communication

Summary

Structures

This structure refers to these other structures:

- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core Device (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-device)
- US Core Implantable Device Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device|6.1.0)
- US Quality Core Organization (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-organization)
- US Quality Core Practitioner (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-practitioner)
- US Quality Core RelatedPerson (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-relatedperson)

Other representations of profile: CSV, Excel, Schematron