US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 10.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions
| Page standards status: Informative |
US Core is intended to provide an implementable standard for FHIR based interfaces for provider and patient facing systems providing:
The context of US Core within the set of US Realm HL7 FHIR standards is shown in the figure below.
US Core is based on the FHIR R4 specification and relies on these implementation guides:
| Implementation Guide | Version | Reason |
|---|---|---|
| SMART App Launch | 2.2.0 | To support reference in the SMART on FHIR Obligations and Capabilities page. |
| Structured Data Capture | 4.0.0 | US Core QuestionnaireResponse Profile is derived from the Structured Data Capture (SDC) Questionnaire Response Profile. |
Other international and national standards were reviewed and considered during the development process to assess the degree of alignment and to facilitate adoption of this standard. These implementation guides include:
| Implementation Guide | Relationship |
|---|---|
| International Patient Access (IPA) | This IG describes how an application acting on behalf of a patient can access information about the patient from a clinical records system using a FHIR based API. The REST API and profiles in this IG were reviewed and considered during development of US Core. US Core is compatible with IPA, e.g. US Core conformant data can be accessed by an IPA conformant client. |
| International Patient Summary (IPS) | The goal of this Implementation Guide is to specify how to represent in HL7 FHIR the International Patient Summary (IPS). An IPS document is an electronic health record extract containing essential healthcare information about a subject of care. US Core is compatible with IPS, e.g. US Core conformant data can be used to generate a patient summary that is conformant to IPS. |
| United States Patient Care Summary (US-PCS) | This Implementation Guide defines a FHIR patient summary document for care transitions in the US Realm. US Core supplies the resource-level requirements for the content of a US-PCS document, and US-PCS supplies the document structure around that content. US-PCS publishes its own comparison of the US Core profiles it uses against the equivalent IPS profiles in its US Core Profile Variances to IPS Profiles tables. |
The table below summarizes comparisons between the US Core profiles and the International Patient Access and International Patient Summary Implementation Guides profiles. This comparison evaluates US Core conformance requirements against the key implementation guides, identifying where compliance with US Core satisfies the expectations established by the referenced implementation guides. Compliance in the reverse direction is not guaranteed; for example, a resource that is compliant with an IPA profile may not be compliant with US Core.
As part of profile comparison, the requirements, constraints, and standards specified in a particular FHIR profile are evaluated. These requirements can include mandatory elements, Must Support elements, cardinality constraints, data types, terminology bindings, usage rules, extensions, and rules on missing or suppressed data. Detailed comparisons between the FHIR artifacts between US Core and IPA and IPS are provided in the links below:
Legend:
✔ Compliant: A US Core compliant resource meets all requirements of the compared profile.
➕ Additional requirements: A US Core compliant resource is compatible, but additional changes may be needed to meet all requirements of the compared profile. Where additional requirements are identified, more information is provided in the sections below.
✘ Incompatible: A US Core compliant resource is incompatible with the compared profile. A resource cannot be compliant to both. Where incompatible requirements are identified, more information is provided in the sections below.
— No equivalent profile: No equivalent profile in IPA or IPS for comparison. (Note that IPA and IPS profiles with no equivalent profile in US Core are listed in the sections below.)
The following US Core resources are compatible to the IPA profiles, but the IPA profile(s) contain additional requirements which are listed below. Changes may be needed to meet all the IPA profile requirements. Implementers are advised to note that some code changes may be required to support these profiles.
US Core ADI DocumentReference Profile
Additional requirements in IPA DocumentReference (IPA vs US Core):
DocumentReference.content.attachment.contentType Element minimum cardinalities differ: '1' vs '0'DocumentReference.context Elements differ in definition for mustSupport: 'true' vs 'false'DocumentReference.context.encounter Elements differ in definition for mustSupport: 'true' vs 'false'DocumentReference.context.encounter Element maximum cardinalities differ: '1' vs '*'DocumentReference.context.period Elements differ in definition for mustSupport: 'true' vs 'false'US Core DocumentReference Profile
Additional requirements in IPA DocumentReference (IPA vs US Core):
DocumentReference.content.attachment.contentType Element minimum cardinalities differ: '1' vs '0'US Core Average Blood Pressure Profile
Additional requirements in IPA Observation (IPA vs US Core):
Observation.value[x] Elements differ in definition for mustSupport: 'true' vs 'false'Observation.value[x] Element maximum cardinalities differ: '1' vs '0'Observation.dataAbsentReason Elements differ in definition for mustSupport: 'true' vs 'false'US Core Care Experience Preference Profile, US Core Patient Accommodation Profile, US Core Simple Observation Profile, US Core Tobacco And Nicotine Use Observation Profile, US Core Treatment Intervention Preference Profile
Additional requirements in IPA Observation (IPA vs US Core):
Observation.dataAbsentReason Elements differ in definition for mustSupport: 'true' vs 'false'US Core Observation ADI Documentation Profile, US Core Observation Occupation Profile
Additional requirements in IPA Observation (IPA vs US Core):
Observation.value[x] Elements differ in definition for mustSupport: 'true' vs 'false'Observation.dataAbsentReason Elements differ in definition for mustSupport: 'true' vs 'false'Additional requirements in IPA Patient (IPA vs US Core):
Patient.active Element minimum cardinalities differ: '1' vs '0'Patient.active Elements differ in definition for mustSupport: 'true' vs 'false'Patient.gender Elements differ in definition for mustSupport: 'true' vs 'false'Patient.link Element maximum cardinalities differ: '1' vs '*' (:thinking_face: a technical error in IPA profile)Patient.link Elements differ in definition for mustSupport: 'true' vs 'false'US Core compliant resources are compliant with IPA requirements for Missing Data.
IPA does not include requirements for Suppressed Data.
This version of US Core has no equivalent profile for the following IPA profiles:
The following US Core resources are compatible to the IPS profiles, but the IPS profile(s) contain additional requirements which are listed below. Changes may be needed to meet all the IPS profile requirements. Implementers are advised to note that some code changes may be required to support these profiles.
The US Core Patient Accommodation Profile is the one profile marked incompatible with IPS. IPS represents this information with Flag - Alert (IPS) rather than with an Observation, so a single resource cannot conform to both. US Core has no Flag profile, and IPS Flag - Alert is listed under Additional profiles in IPS below.
US Core AllergyIntolerance Profile
Additional requirements in IPS AllergyIntolerance (IPS vs US Core):
AllergyIntolerance.patient.reference Element minimum cardinalities differ: '1' vs '0'AllergyIntolerance.type Element differ in definition for mustSupport/Obligations: 'true' vs 'false'AllergyIntolerance.onset[x] Element differ in definition for mustSupport/Obligations: 'true' vs 'false'AllergyIntolerance.reaction.severity Element differ in definition for mustSupport/Obligations: 'true' vs 'false'AllergyIntolerance.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'AllergyIntolerance.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'AllergyIntolerance.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'AllergyIntolerance.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'US Core Condition Problems and Health Concerns Profile
Additional requirements in IPS Condition (IPS vs US Core):
Condition.subject.reference Element minimum cardinalities differ: '1' vs '0'Condition.clinicalStatus.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.clinicalStatus.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.clinicalStatus.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.clinicalStatus.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.category.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.category.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.category.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.category.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.severity Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.severity.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.severity.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.severity.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.severity.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Condition.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Additional requirements in IPS Device (IPS vs US Core):
Device.type.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Device.type.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Device.type.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Device.type.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'US Core DiagnosticReport Profile for Report and Note Exchange and US Core DiagnosticReport Profile for Laboratory Results Reporting
Additional requirements in IPS DiagnosticReport (IPS vs US Core):
DiagnosticReport.subject.reference Element minimum cardinalities differ: '1' vs '0'DiagnosticReport.effective[x] Element minimum cardinalities differ: '1' vs '0'DiagnosticReport.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'DiagnosticReport.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'DiagnosticReport.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'DiagnosticReport.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Additional requirements in IPS ImagingStudy (IPS vs US Core):
ImagingStudy.subject.reference Element minimum cardinalities differ: '1' vs '0'ImagingStudy.started Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.procedureCode Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.reasonCode Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.series Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.series.uid Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.series.modality Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.series.instance Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.series.instance.uid Element differ in definition for mustSupport/Obligations: 'true' vs 'false'ImagingStudy.series.instance.sopClass Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Additional requirements in IPS Immunization (IPS vs US Core):
Immunization.patient.reference Element minimum cardinalities differ: '1' vs '0'Immunization.vaccineCode.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Immunization.vaccineCode.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Immunization.vaccineCode.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Immunization.vaccineCode.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Additional requirements in IPS Medication (IPS vs US Core):
Medication.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.form Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.form.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.form.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.form.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.form.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.ingredient Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.ingredient.item[x] Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.ingredient.item[x].coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.ingredient.item[x].coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.ingredient.item[x].coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.ingredient.item[x].text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Medication.ingredient.strength Element differ in definition for mustSupport/Obligations: 'true' vs 'false'US Core MedicationRequest Profile
Additional requirements in IPS MedicationRequest (IPS vs US Core):
MedicationRequest.medication[x].coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'MedicationRequest.medication[x].coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'MedicationRequest.medication[x].coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'MedicationRequest.medication[x].text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'MedicationRequest.subject.reference Element minimum cardinalities differ: '1' vs '0'US Core Observation Pregnancy Status Profile
Additional requirements in IPS Observation Pregnancy Status (IPS vs US Core):
Observation.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.subject.reference Element minimum cardinalities differ: '1' vs '0'Observation.bodySite Element maximum cardinalities differ: '0' vs '*'Observation.specimen Element maximum cardinalities differ: '0' vs '*'Observation.device Element maximum cardinalities differ: '0' vs '*'Observation.referenceRange Element maximum cardinalities differ: '0' vs '*'Observation.hasMember Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.hasMember.reference Element minimum cardinalities differ: '1' vs '0'Observation.hasMember.reference Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.component Element maximum cardinalities differ: '0' vs '*'US Core Observation Clinical Result Profile and US Core Laboratory Result Observation Profile
Additional requirements in IPS Observation Results - Laboratory/Pathology (IPS vs US Core):
Observation.status Element differ in valueset: 'http://hl7.org/fhir/uv/ips/ValueSet/results-status-uv-ips (required)' vs 'http://hl7.org/fhir/ValueSet/observation-status (required)'Observation.category.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.category.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.category.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.category.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.subject.reference Element minimum cardinalities differ: '1' vs '0'Observation.effective[x] Element minimum cardinalities differ: '1' vs '0'Observation.performer Element minimum cardinalities differ: '1' vs '0'Observation.valueCodeableConcept.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.valueCodeableConcept.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.valueCodeableConcept.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.valueCodeableConcept.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.component Element differ in definition for mustSupport/Obligations: 'true' vs 'false'US Core Observation Clinical Result Profile
Additional requirements in IPS Observation Results - Radiology (IPS vs US Core):
Observation.category:radiology Element minimum cardinalities differ: '1' vs '0'Observation.category:radiology Element maximum cardinalities differ: '1' vs '*'Observation.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.subject.reference Element minimum cardinalities differ: '1' vs '0'Observation.effective[x] Element minimum cardinalities differ: '1' vs '0'Observation.performer Element minimum cardinalities differ: '1' vs '0'Observation.component Element differ in definition for mustSupport/Obligations: 'true' vs 'false'US Core Simple Observation Profile
Additional requirements in IPS Observation Alcohol Use (IPS vs US Core):
Observation.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.subject.reference Element minimum cardinalities differ: '1' vs '0'Observation.effective[x] Element minimum cardinalities differ: '1' vs '0'Observation.component Element maximum cardinalities differ: '0' vs '*'US Core Tobacco And Nicotine Use Observation Profile
Additional requirements in IPS Observation Tobacco Use (IPS vs US Core):
Observation.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Observation.subject.reference Element minimum cardinalities differ: '1' vs '0'Observation.component Element maximum cardinalities differ: '0' vs '*'Additional requirements in IPS Patient (IPS vs US Core):
Patient.name.use Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Patient.name.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Patient.telecom Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Patient.gender Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Patient.birthDate Element minimum cardinalities differ: '1' vs '0'Patient.generalPractitioner Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Additional requirements in IPS Practitioner (IPS vs US Core):
Practitioner.name.given Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Additional requirements in IPS Procedure (IPS vs US Core):
Procedure.code.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Procedure.code.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Procedure.code.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Procedure.code.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Procedure.subject.reference Element minimum cardinalities differ: '1' vs '0'Procedure.performed[x] Element minimum cardinalities differ: '1' vs '0'Additional requirements in IPS Specimen (IPS vs US Core):
Specimen.type.coding Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Specimen.type.coding.system Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Specimen.type.coding.code Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Specimen.type.text Element differ in definition for mustSupport/Obligations: 'true' vs 'false'Specimen.subject.reference Element minimum cardinalities differ: '1' vs '0'US Core compliant resources are compliant with IPS requirements for Missing Data.
IPS does not include requirements for Suppressed Data.
This version of US Core has no equivalent profile for the following IPS profiles: