US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This is not an authorized publication; it is the continuous build for version 7.0.0-ballot). This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Change Log

Page standards status: Informative

Version = 7.0.0 - ballot

• url: http://hl7.org/fhir/us/core/2024Jan/
• Based on FHIR version : 4.0.1

The January 2024 Ballot

This ballot addresses the following:

• We have updated US Core to include the new U.S. Core Data for Interoperability (USCDI) v4 Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2023:
  • For USCDI Allergies and Intolerances Substance (Non-Medication) data element, no change was needed for the US Core AllergyIntolerance Profile because the existing code element binding to Common substances for allergy and intolerance documentation including refutations already includes “Non-pharmacologic agent”
  • For USCDI Encounter Identifier data element, no changes were needed because the US Core Encounter Profile already supports Encounter.identifier as a Must Support element.
  • For USCDI Facility Information data class and elements, the US Core Location Profile already supports Facility Name and has been updated to support Facility Identifier and Type. The US Core Immunization Profile has been updated to reference the US Core Location resource directly as a Must Support element, and the following US Core Profiles have been updated to indirectly reference the location/facility via US Core Encounter Profile as a Must Support element:
    • US Core DiagnosticReport Profile for Laboratory Results Reporting
    • US Core Immunization Profile
    • US Core MedicationDispense Profile
    • US Core Observation Clinical Result Profile
    • US Core Procedure Profile
    • US Core ServiceRequest Profile
  • For USCDI Time of Procedure data element, no changes were needed because:
    • the US Core Procedure Profile already supports Procedure.performed[x] as a Must Support element.
    • the US Core DiagnosticReport Profile for Report and Note Exchange already supports DiagnosticReport.performed[x] as a Must Support element.
    • the US Core Immunization Profile already supports Immunization.occurrence[x] as a Must Support element.
  • For USCDI Average Blood Pressure data class, the new US Core Average Blood Pressure Profile has been added to US Core. It uses the Vital Signs with Qualifying Elements: Average Blood Pressure Profile as a blueprint.
  • ​For USCDI Medications data class and elements, the US Core MedicationRequest Profile already supports Medication Instructions and has been updated to support Medication Adherence as an Additional USCDI Requirement using the new US Core Medication Adherence Extension.
  • For USCDI Laboratory data class and elements, the US Core Laboratory Result Observation Profile already supports Result Unit of Measure data element for using UCUM for coded quantity units and has been updated to support Result Reference Range and Result Interpretation as a Must Support elements. The US Core Specimen Profile has been updated to support Specimen Identifier as a Must Support element, and Specimen Source Site and Specimen Condition Acceptability as Additional USCDI Requirements.

• Implementers submitted over <N> trackers since the publication of US Core ver 6.0.0 and 6.1.0 We have addressed them and applied over <N’> changes listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Correct invalid invariants us-core-3 and us-core-4 FHIR-41523 See Changes Here and Here and Here
2. Applied: Correct invalid invariants pd-1 and us-core-13 FHIR-41586 See Changes Here
3. Applied: Correct invalid invariant us-core-1 FHIR-41670 See Changes Here and Here
4. Applied: Correct invalid searchparameter expression for USCoreConditionAssertedDate FHIR-41673 See Changes Here
5. Pre-Applied: List all valueset URLs and all VSAC Valuesets FHIR-NNNN See Changes Here
6. Applied: Fix Typo in Tribal Extension FHIR-41739 See Changes Here
7. Applied: Fix Missing Data Example FHIR-42805 See Changes Here
8. ​Triaged: rewrite introduction to USCDI table since it is not relevent. FHIR-42801 See Changes Here
9. Applied: Fix us-core-5 invariant FHIR-42814 See Changes Here
10. Triaged: Differentiate Medicare Parts A, B, C, etc. FHIR-42793
11. Pre-Applied: Fix formatting of example snippet FHIR-42789 See Changes Here
12. Pre-Applied: Clarify note in Search Parameters and Operations page FHIR-42783 See Changes Here
13. ​Submitted: Clarify Coverage status FHIR-42777 See Changes Here
14. ​Triaged: Allow references to other entities for Subject/Patient elements FHIR-42759 See Changes Here
15. ​Submitted: ““Datetime must be at least to day”” regex rejects valid dateTimes with the required precision FHIR-42738 See Changes Here
16. ​Triaged: Add USCDI Version 4 Data Elements to US Core FHIR-42161 See Changes Here
17. ​Triaged: remove option 3 from SNOMED US Edition guidance FHIR-42160 See Changes Here
18. ​Triaged: Reason for Referral support for basedOn(ServiceRequest) FHIR-42136 See Changes Here
19. ​Triaged: USCDI - FHIR US Core Relationship Clarification FHIR-42130 See Changes Here
20. ​Triaged: Add Job Center to US Core Provider Role Value Set FHIR-42092 See Changes Here
21. ​Triaged: Da Vinci DTR Variance Request: QuestionnaireResponse & ServiceRequest not in US Core 3.1.1 FHIR-42071 See Changes Here
22. ​Triaged: Typo in Blood Pressure FHIR-42069 See Changes Here
23. ​Triaged: Clarify the R4 base spec & US Core guidance on DocumentReference FHIR-41902 See Changes Here
24. ​Triaged: limit context for jurisdiction extension FHIR-41867 See Changes Here
25. ​Triaged: Expand ability to capture reason for the procedure FHIR-41761 See Changes Here
26. ​Triaged: Exception for CRD Coverage FHIR-41752 See Changes Here
27. ​Triaged: Exception for CRD ServiceRequest FHIR-41737 See Changes Here
28. ​Triaged: Excel downloads missing header row FHIR-41709 See Changes Here
29. ​Triaged: Add VSAC Value Sets to Terminology Page FHIR-41681 See Changes Here
30. ​Triaged: ‘activity’ category should allow supervision by clinician FHIR-41672 See Changes Here
31. ​Triaged: APGAR should be Apgar FHIR-41666 See Changes Here
32. ​Resolved - change required: Correct invalid invariants pd-1 and us-core-13 FHIR-41586 See Changes Here
33. ​Triaged: Remove USCDI marker for Patient.gender FHIR-41572 See Changes Here
34. ​Triaged: Change ASKU in value set to asked-declined FHIR-41571 See Changes Here
35. ​Triaged: Create a table of VSAC Valueset on the Terminology page FHIR-41506 See Changes Here
36. ​Triaged: Unable to include additional values in Occupation or Industry FHIR-41364 See Changes Here
37. ​Triaged: Patient race should allow more than one FHIR-41359 See Changes Here
38. ​Triaged: update canonical urls in examples and capability statements to include the version FHIR-41256 See Changes Here
39. ​Triaged: Condition profile descriptions are not appearing in IG Detailed Description Snapshot View (other places) FHIR-40813 See Changes Here
40. ​Triaged: Preferred Language vs Communication Language FHIR-40773 See Changes Here
41. ​Triaged: Clarify that support for search by POST is mandatory FHIR-40641 See Changes Here
42. ​Triaged: update UCUM guidance FHIR-40604 See Changes Here
43. ​Triaged: BirthSex in US Core Patient refers to Administrative Gender Code System FHIR-40588 See Changes Here
44. ​Triaged: Patch Request: Patient.us-core-ethnicity does not allow for nullFlavors in value set FHIR-40309 See Changes Here
45. ​Triaged: Abnormal lab examples should carry interpretation FHIR-40297 See Changes Here
46. ​Resolved - change required: RelatedPerson relationshiptype should have binding to FHIR value set RelatedPerson-relationshiptype FHIR-34755 See Changes Here
47. ​Resolved - change required: AllergyIntolerance does not show constraint FHIR-34636 See Changes Here
48. ​Resolved - change required: Several Vital Signs missing from CapabilityStatement US Core Server page FHIR-34478 See Changes Here
49. ​Resolved - change required: Confusing for commercial vendor. Reads very confusing. FHIR-30783 See Changes Here
50. ​Resolved - change required: In most of the data elements – “Binding is from base FHIR and US Core Vital Signs” Need this to be one single combined listing FHIR-30780 See Changes Here
51. ​Resolved - change required: valueset-simple-language.xml QA Error FHIR-30107 See Changes Here
52. ​Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC FHIR-30105 See Changes Here

Version = 6.1.0

• url: http://hl7.org/fhir/us/core/STU6.1/
• Based on FHIR version : 4.0.1

The changes in this STU Update to US Core 6.0.0 have been reviewed by the public through the HL7 STU update process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

What’s new in Version 6.1.0 of US Core:

To meet the U.S. Core Data for Interoperability (USCDI) v3 "sex" data element, US Core added the US Core Sex Extension as a USCDI Requirement. The US Core Birth Sex Extension is no longer a USCDI Requirement.

Updates and Corrected Errata in Version 6.1.0 of US Core:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Add Sex extension necessary to satisfy USCDI v3 FHIR-41301 and FHIR-41352 See Changes Here, Here, and Here
2. Applied: Update link to CDC Race and Ethnicity Code Set FHIR-41277 See Changes Here
3. Applied: Typo change Condition.onsetDate to Condition.onsetDateTime FHIR-41239 See Changes Here
4. Applied: Clarify US Core USCDI Requirement Extension not intended for implementers FHIR-41238 See Changes Here
5. Applied: Correct Provenance Example FHIR-41316 See Changes Here
6. Applied: Update Changes between versions table FHIR-41434 See Changes Here
7. Applied: update us-core-3 and us-core-4 FHIR-41454 See Changes Here

Version = 6.0.0

• url: http://hl7.org/fhir/us/core/STU6/
• Based on FHIR version : 4.0.1

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2023 HL7 balloting process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

What’s new in Version 6.0.0 of US Core:

Each update to a new version of US Core changes the US Core Profiles and conformance expectations. Implementers can find detailed comparisons between the FHIR artifacts in this 6.0.0 version of US Core and each previous major release on Changes Between Versions page. This section provides an overview of the significant changes in Version 6.0.0 of US Core.

• New and updated resources to meet the U.S. Core Data for Interoperability (USCDI) v3 new Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2022. This table summarizes the USCDI Data Classes and Data Elements and the corresponding US Core Profile(s).
  • The new US Core Coverage Profile represent and access data related to an individual’s health insurance coverage for health care.
  • The profiles from version 5.0.1 have been renamed and re-scoped in this version to accommodate the USCDI Health Status/Assessments Data Classes.
    • The US Core Observation Screening Assessment Profile replaces the US Core Observation Survey Profile and US Core Observation SDOH Assessment Profile, and the US Core Simple Observation Profile replaces the US Core Observation Social History Profile. See the Cross Version Comparisons Table on the Changes Between Versions page for a summary of profile revisions between versions.
    • The SDOH Assessments documentation has been rewritten and renamed to Screening and Assessments, reflecting its expanded coverage of Health Status/Assessments Data Elements including: Functional Status, Disability Status, and Mental/Cognitive Status in addition to SDOH Assessments.
  • The new US Core Observation Pregnancy Status Profile and US Core Observation Pregnancy Intent Profile have been added to communicate pregnancy status.
  • The US Core Laboratory Result Observation Profile supports the result status and terminology requirements for coded and numeric results.
  • The new US Core Specimen Profile has been added to support Specimen Type.
  • The US Core MedicationRequest Profile was updated to support Dose, Dose Unit of Measure, Indication,.
  • The new US Core MedicationDispense Profile has been added to support Fill Status.
  • Updated Patient Demographics/Information:
    • To support Date of Death US Core Patient Profile was updated
    • The new US Core Tribal Affiliation Extension has been added to support Tribal Affiliation
    • The US Core Birth Sex Extension meets the patient sex requirement (NOTE: US Core 6.1.0 added the US Core Sex Extension as a USCDI Requirement. The US Core Birth Sex Extension is no longer a USCDI Requirement.)
    • To support Related Person’s Name and Related Person’s Relationship US Core RelatedPerson Profile was updated
    • The new US Core Observation Occupation Profile supports a patient’s Occupation and Occupation Industry
  • Reason for Referral is supported by an updated US Core ServiceRequest Profile and US Core Procedure Profile

• The US Core Observation Clinical Result Profile supersedes version 5.0.1 US Core Observation Clinical Test Result Profile and US Core Observation Imaging Result Profile. In addition, it is the base for the US Core Laboratory Result Observation Profile. The Cross Version Comparisons Table on the Changes Between Versions page summarized these significant revisions.

• Document the USCDI Requirement conformance category: Besides Mandatory and Must Support elements, the US Core Profile elements consist of USCDI Requirements elements for ONC Health IT Certification. This version clarifies the meaning and documents how it is communicated in the StructureDefinitions and on the profile pages

• Expanded CapabilityStatement Narrative: Each US Core Profile contains references to other resources that it depends on or is related to. The CapabilityStatements narrative provides a table summarizing the Must Support references for US Core Profiles to help implementers understand their required capabilities.

• Expanded documentation on the Terminology page: In addition to detailing the Code Systems unique to this guide, links all the Code Systems used in US Core are listed.

• Introduce US Core SMART Scopes as a candidate requirements under consideration, and provide example for each Profile.

• We continue our efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) where applicable and, as a result, align terminology between US Core and HL7 C-CDA.

Changes:

These changes are a result of over 150 January 2023 Ballot related trackers which are listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Remove html entities from examples FHIR-37474
2. Applied: Change Condition patient + category search to SHALL support FHIR-37918 See Changes Here
3. Applied: Diagnostic Report Laboratory Codes LOINC CLASSTYPE value should be ““1”” FHIR-37933 See Changes Here
4. Applied: Additional guidance for accessing imaging studies FHIR-38808 See Changes Here
5. Applied: Allow multiple NPIs for Organizations and Practitioners FHIR-39382 See Changes Here
6. Applied: Keep QuestionnaireResponse and Update Screening and Assessments page FHIR-39495 See Changes:
   • Here
   • Here
   • Here
   • Here
   • Here
   • Here
   • Here
7. Applied: Fix slicing in Observation.component:industryFHIR-39608 See Changes Here
8. Applied: Add support for Condition search that include patient + category + status FHIR-39610 See Changes Here
9. Applied: Reference only reason for using MedicationDispense FHIR-39611 See Changes Here
10. Applied: Revert to simplegenderIdentify extension FHIR-39615 See Changes Here
11. Applied: Duplicated words FHIR-39637 See Changes Here
12. Applied: Missing comma FHIR-39638 See Changes Here
13. Applied: Clarify that Observation.specimen is a MustSupport FHIR-39639 See Changes Here
14. Applied: Clarify and updates examples to use SNOMED CT US Edition FHIR-39640 See Changes Here and Here
15. Applied: Add NDC codes to the Medication Guidance FHIR-39641 See Changes Here
16. Applied: Extra trailing parenthesis FHIR-39643 See Changes Here
17. Applied: Clinical Judgement Profile does not exist FHIR-39650 See Changes Here
18. Applied: Clarify the difference between Simple Observation and Screening Assessment FHIR-39652 See Changes Here and Here
19. Applied: uscore or us-core FHIR-39653
20. Applied: Fix $docref examples FHIR-39658 See Changes Here
21. Applied: Resolve conflicting guidance in Observation Blood Pressure FHIR-39659 See Changes Here
22. Applied: Clarify how profiles are defined FHIR-39703 See Changes Here and Here and Here
23. Applied: Clarify where the US Core Profile FHIR Restful transactions are defined? FHIR-39704 See Changes Here
24. Applied: Use ValueSet and not value set when a FHIR ValueSet is intended FHIR-39705 See Changes Here
25. Applied: Use uppercase “Must Support” and not lowercase “must suppor”t FHIR-39706
26. Applied: Document Must Support and Modifier Elements FHIR-39707 See Changes Here
27. Applied: Common format for Resources and Resource fields FHIR-39708
28. Applied: Use of mandatory text FHIR-39709
29. Applied: Add reference to FHIR section on language support FHIR-39710 See Changes Here
30. Applied: Refer to FHIR specification as base definition for RESTful operations FHIR-39711 See Changes Here
31. Applied: POST based searches FHIR-39712 See Changes Here
32. Applied: Clarify compartment based search FHIR-39713 See Changes Here
33. Applied: Updated CapabilityStatement to list un-profiled required resources FHIR-39714 See Changes Here
34. Applied: Change “Systems” to “Servers” FHIR-39716 See Changes Here
35. Applied: Update “Clinical Note Server” to “FHIR Server” FHIR-39717 See Changes Here and Here
36. Applied: DocumentReference, DiagnosticReport and embedded documents FHIR-39718 See Changes Here
37. Applied: Correction and clarify use of $expand FHIR-39719 See Changes Here and Here
38. Applied: Clarify MedicationAdministration and MedicationStatement support. FHIR-39720 See Changes Here
39. Applied: The use of Observations where QuestionnaireReponse is more applicable FHIR-39722 See Changes Here
40. Applied: Updated CapabilityStatement to list required referenced profiles and resources FHIR-39723 See Changes Here
41. Applied: External link is missing FHIR-39725 See Changes Here
42. Applied: Change whenHandedOver from min =1 to min =0 FHIR-39732 See Changes Here
43. Applied: Wrong resource referenced FHIR-39733 See Changes Here
44. Applied: plural/singular mismatch FHIR-39734 See Changes Here
45. Applied: Screening and Assessment typo FHIR-39735 See Changes Here
46. Applied: Missing Hyperlinks FHIR-39736 See Changes Here
47. Applied: Clarify period of pregnancy intent FHIR-39737 See Changes Here
48. Applied: Missing Hyperlinks FHIR-39738 See Changes Here and See Changes Here
49. Applied: Add a “memberId” slice to Coverage.identifier and add guidanceFHIR-39743 See Changes Here
50. Applied: Change RelatedPerson search to combination of Patient + Name FHIR-39791 See Changes Here
51. Applied: RelatedPerson uses text from Observation Laboratory profile FHIR-39792 See Changes Here
52. Applied: Reference only reason for using MedicationDispense FHIR-39856 See Changes Here
53. Applied: Adjust USCDI Mapping references to MedicationRequest Profile FHIR-39857 See Changes Here
54. Applied: Adjust USCDI Mapping references to DiagnosticReport Profile FHIR-39858 See Changes Here
55. Applied: Add USCDI Mapping references for Disability Status and Mental/Cognitive Status FHIR-39859 See Changes Here
56. Applied: Adjust USCDI Mapping references to Patient Profile FHIR-39860 See Changes Here
57. Applied: Fix Value set expansion FHIR-39861 See Changes Here
58. Applied: Extensions - context of use FHIR-39863 See Changes Here
59. Applied: Add more Lab Result examples FHIR-39868 See Changes Here
60. Applied: MedicationRequest - Change prescriber to 0..1 this information is not known for patient reported medications. FHIR-39869 See Changes Here
61. Applied: Update Profile Formal Views labels FHIR-39873
62. Applied: Provide guidance for Prescriptions Sent by Mail FHIR-39878 See Changes Here
63. Applied: Change CarePlan.text from Mandatory min = 1 to Must Support min = 0 FHIR-39902 See Changes Here
64. Applied: Using SNOMED CT United States Edition Typo FHIR-39903 See Changes Here
65. Applied: Update the Change log FHIR-39923 See Changes Here
66. Applied: Define the term Screening and Assessment FHIR-39938 See Changes Here](http://hl7.org/fhir/us/core/STU6/screening-and-assessments.html#introduction)
67. Applied: Clarify that Simple Observation Profile captures any sort of “simple” observations FHIR-39940 See Changes Here
68. Applied: Correct the description of the Simple Observation Profile FHIR-39942 See Changes Here
69. Applied: Provide further guidance on use of US Core vs other domain specific IGs FHIR-39943 See Changes Here
70. Applied: Reframe Screening and Assessments Page FHIR-39944 See Changes Here
71. Applied: Update the Screening and Assessment Activities diagram FHIR-39945 See Changes Here
72. Applied: Update the “Screening and Assessment Activities” diagram with proper profile name FHIR-39946 See Changes Here
73. Applied: Update Screening and Assessments” title and content FHIR-39947 See Changes Here
74. Applied: Correct titleFHIR-39948 See Changes Here
75. Aoplied: Update description of Screening Assessments Profile FHIR-39949 See Changes Here
76. Applied: Change Header FHIR-39950 See Changes Here
77. Applied: Correct title of section 3.6.2.2 US Core Observation Simple Observation Profile FHIR-39951 See Changes Here
78. Applied: Require US Core Server to support the Simple Observation profile for simple assessments FHIR-39953 See Changes Here
79. Applied: Correct the link and sentence for assessment category codes FHIR-39954 See Changes Here
80. Applied: Describe the purpose and intent of “Grouping” and update the diagram FHIR-39955 See Changes Here
81. Applied: Remove US Core Common SDOH Assessments ValueSet FHIR-39956
82. Applied: Fix link text FHIR-39958 See Changes Here
83. Applied: Remove MS from Observation Screening Assessment Observation.performer Practitioner Reference FHIR-39964 See Changes Here
84. Applied: Revert references the US Core QuestionnaireResponse Profile FHIR-39965 See Changes Here
85. Applied: Correct link issue in “Profile specific implementation guidance section” of the ServiceRequest Profile FHIR-39966 See Changes Here
86. Applied: Coverage.type binding clarification FHIR-39982 See Changes Here
87. Applied: Rename US Core Observation Category Value Set FHIR-40034 See Changes Here
88. Applied: Extra ) in Screening and Assessments FHIR-40041 See Changes Here
89. Applied: Fix the link. FHIR-40043 See Changes Here
90. Applied: Fix Pregnancy status codes FHIR-40045 See Changes Here
91. Applied: RelatedPerson profile text contains Observation content FHIR-40048 See Changes Here
92. Applied: 2 typos in history page FHIR-40069 See Changes Here
93. Applied: Reword a Quick Start example FHIR-40072 See Changes Here
94. Applied: Consider alternative answer choices for pregnancy intect codes FHIR-40084 See Changes Here
95. Applied: Improve Screening Assessment Observation.hasMember short description FHIR-40085 See Changes Here
96. Applied Update the “bindings when slicing by value sets” figure FHIR-40086 See Changes Here
97. Applied: Update Condition category slices to align with Observation/ServiceRequestFHIR-40087 See Changes Here
98. Applied: Add guidance to the Procedure profile to express sdoh category FHIR-40088 See Changes Here and
99. Applied: Improve language as to the expectations of clinicalStatus when category is problem list FHIR-40089 See Changes Here
100. Applied: Align with FHIR DS4P IG FHIR-40090 See Changes Here
101. Applied: Remove AHC HRSN screening tool examples FHIR-40091
102. Applied: Add guidance show collection method and performer can be captured using Provenance FHIR-40092 See Changes Here and Here
103. Applied: Remove MustSupport from DocumentReference.category requiring clinical-note FHIR-40102 See Changes Here
104. Applied: Add Goal.startDate as 0..1 MS with choice of supporting this or Goal.target.dueDate FHIR-40103 See Changes Here
105. Applied: Clarify that other category codes are permitted and Remove MS from Observation.performer Practitioner Reference FHIR-40104 See Changes Here
106. Applied: Add to the code systems chart FHIR-40124 See Changes Here
107. Applied: Make Specimen.subject must support FHIR-40136 See Changes Here
108. Applied: Clarify use of unknown for occupation. FHIR-40137 See Changes Here, Here and Here
109. Applied: Clarify applicability of DiagnosticReport in USCDI Mapping FHIR-40138 See Changes Here
110. Applied: Remove the word ““status”” from introductory text FHIR-40149 See Changes Here
111. Applied: Incorrect link for ““record or update”” and additional examples FHIR-40151 See Changes Here
112. Applied: Incorrect Resource noted in the introductory paragraph FHIR-40155 See Changes Here
113. Applied: Define JobFHIR-40158 See Changes Here
114. Applied: Member or subscriber id is must have but the element cardinality is 0..* FHIR-40160 See Changes Here
115. Applied: Modify comment regarding Screening and Assessments FHIR-40161 See Changes Here
116. Applied: Modify Examples/ValueSet for Language Codes FHIR-40165 See Changes Here
117. Applied: Add Guidance for more advanced Occupation detail.FHIR-40166 See Changes Here
118. Applied: Add implementer guidance FHIR-40170 See Changes Here
119. Applied: Add guidance for current job FHIR-40172 See Changes Here
120. Applied: Add guidance to clarify multiple codings can be used FHIR-40178 See Changes Here
121. Applied: Add _include guidance for Specimen FHIR-40180 See Changes Here
122. Applied: Update Industry NAICS Detail (ODH) to extensible. FHIR-40181 See Changes Here
123. Applied: Remove duplicate of Notes: Quick Start intro bullets FHIR-40182 See Changes Here
124. Applied: Add search guidance FHIR-40183 See Changes Here
125. Applied: Update profile description to state the profile represents a patient’s ‘Past or Present Job’ FHIR-40187 See Changes Here
126. Applied: Give guidance on SMART v2 scopes FHIR-40192 See Changes Here and Here
127. Applied: Remove the SFCU extension, and retain the birth-sex extension to meet USCDI Patient Sex. FHIR-40197 See Changes Here
128. Applied: Clarify guidance FHIR-40199 See Changes Here
129. Applied: Document expectations for Additional USCDI Requirements FHIR-40200 See Changes Here and Here
130. Applied: ServiceRequest Profile Implementation Specific Guidance - incorrect reference to ServiceRequest.reasonCode FHIR-40202 See Changes Here
131. Applied: Tribal Affiliation Extension - add guidance to that extension:isEnrolled is an optional extension FHIR-40203 See Changes Here
132. Applied: Change Observation Occupation binding strength extensible FHIR-40204 See Changes Here
133. Applied: Change whenHandedOver cardinality 0..1 FHIR-40205 See Changes Here
134. Applied: MedicationRequest.reasonCodeableConcept does not exist FHIR-40235 See Changes Here
135. Applied: Clarify patient previous name and previous address FHIR-40299 See Changes Here
136. Applied: Update PractitionerRole.role binding FHIR-40372 See Changes Here
137. Applied: Remove MS from Patient on CareTeam.participant.member FHIR-40415 See Changes Here
138. Applied: Update laboratory results example FHIR-40427 See Changes Here
139. Applied: Update laboratory results example FHIR-40428 See Changes Here
140. Applied: Add Specimen to BUN example FHIR-40429 See Changes Here
141. Applied: Additional guidance for accessing imaging studies FHIR-40514 See Changes Here
142. Applied: Update example to follow 58410-2 CBC panel FHIR-40521 See Changes Here
143. Applied: Flag additional USCDI requirements in a computable way FHIR-40553 See Changes Here
144. Applied: Corrected expression in Condition asserted-date search parameter FHIR-40573 See Changes Here
145. Applied: List only base profiles for reasonReference. FHIR-40656 See Changes Here and Here
146. Applied: Remove US Core QuestionnaireResponse Tag Element FHIR-40742 See Changes Here and Here
147. Applied: Clarify Direct address options FHIR-40583 See Changes Here

Version = 6.0.0 - ballot

• url: http://hl7.org/fhir/us/core/2023Jan/
• Based on FHIR version : 4.0.1

The January 2023 Ballot

This ballot addresses the following:

• We have updated US Core to include the U.S. Core Data for Interoperability (USCDI) v3 Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2022:

  • Applied: Health Insurance Information Using US Core to represent and access data related to an individual’s insurance coverage for health care.
  • Applied: The SDOH Assessments documentation has been rewritten and renamed to Screening and Assessments, reflecting its expanded coverage of Health Status/Assessments Data Elements. It documents how to use US Core Observation Screening Assessment Profile and the US Core Simple Observation Profile to represent and access health status and assessments, including: Functional Status, Disability Status, and Mental/Cognitive Status in addition to SDOH Assessments.
  • Applied: US Core Observation Pregnancy Status Profile and US Core Observation Pregnancy Intent Profile have been added to specifically address pregnancy status.
  • Applied: Laboratory: The US Core Laboratory Observation Profile already supports the result status and terminology requirements for coded and numeric results. The US Core Specimen Profile has been added to support Specimen Type.
  • Applied: Medications: Updates to the US Core MedicationRequest Profile to support Dose, Dose Unit of Measure, Indication and the US Core MedicationDispense Profile has been added to support Fill Status.
  • Applied: Patient Demographics/Information
    • Date of Death See Change Here
    • Tribal Affiliation See Change Here
    • Sex (for clinical use)See Change Here
      • Note that the US Core BirthSex Extension will not be deprecated.
    • Related Person’s Name and Related Person’s Relationship See
    • Occupation and Occupation Industry See Change Here
  • Applied: Procedures: Reason for Referral See Change Here and See Change Here
• Several profiles from version 5.0.1 have been retired or renamed and rescoped in this version to accommodate the USCDI Health Status/Assessments Data Classes and as a result of implementer feedback. The Cross Version Comparisions Table summarized these significant revisions.
• We continue our efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable and, as a result, align terminology between US Core and HL7 C-CDA.
• Implementers submitted over 70 trackers since the publication of US Core ver 5.0.0 and 5.0.1. We have addressed them and applied over 50 changes listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: US Core: Require Provenance Resource for Create/Update/Delete Events, AuditEvent for Read FHIR-14388 See Changes Here and See Changes Here
2. Applied: Add recommended search combination of patient + status FHIR-19803 See Changes Here
3. Applied: Consider adding years since quite smoking FHIR-20131 See Changes Here
4. Applied: Create a US Core extension to communicate the state jurisdiction for an element FHIR-26943 See Changes Here
5. Applied: Update missing data for coded data examples FHIR-31381 See Changes Here
6. Applied: Clarify the purpose of Clinical Test Observation Profile FHIR-35114 See Changes Here
7. Applied: Clarify how to read Profile Page FHIR-36083 See Changes Here
8. Applied: Clarify organization responsible for the DocumentReference FHIR-36654 See Changes Here
9. Applied: Clarify Device UDI-PI requirements FHIR-36657 See Changes Here
10. Applied: Add ‘problem-list-item’ condition example FHIR-36759 See Changes Here
11. Applied: Fix LOINC LP code links FHIR-36763 See Changes Here
12. Applied: Fix Link to “Direct Secure Messaging” FHIR-36764 See Changes Here
13. Applied: Update US Core Practitioner to clarify work related contact information FHIR-36765 See Changes Here
14. Applied: CLD for US Core Non Laboratory Codes value set is not computable FHIR-36789 See Changes Here
15. Applied: US Core Organization slice for CLIA does not list an HTA/THO approved external identifier system FHIR-36926 See Changes Here
16. Applied: Remove effectiveDateTime invariant from Sexual Orientation and Simple Observation (aka Social History) Profiles FHIR-36932 See Changes Here and See Changes Here
17. Applied: Correct code system URI for HCPCS FHIR-37336 See Changes Here
18. Applied change ‘resources’ to ‘profiles’ FHIR-37343 See Changes Here
19. Applied: Clarify Expectations for Observation.value[x] in blood pressure and pulse oximetry profiles FHIR-37358 See Changes Here and See Changes Here
20. Applied: Clarify vaccineCode code system URI FHIR-37400 See Changes Here
21. Applied: Typos on SDOH Guidance Page FHIR-37469 See Changes Here
22. Applied Add Constraint to validate NPI FHIR-37498 See Changes Here and See Changes Here
23. Applied: Remove extra instance or the word “resource” in Lab observation narrative profile FHIR-37507 See Changes Here
24. Applied: Allow multiple Gender Identities and associated dates. FHIR-37509 See Changes Here
25. Applied: Typos on Patient and Practitioner “Name” SearchParameter pages FHIR-37541 See Changes Here and See Changes Here
26. Applied: Add Guidance on DocumentReference.category FHIR-37592 See Changes Here
27. Applied: Correct us-core-6 invariant expression FHIR-37704 See Changes Here
28. Applied: Change Immunization.primarySource to must support and update definition FHIR-37723 See Changes Here
29. Applied: Added supportedProfiles to US Core CapabilityStatementsFHIR-37766 See Changes Here
30. Applied: Clarify how to use categories vis a vis codes in US Core Diagnostic Report Category element FHIR-37770 See Changes Here
31. Applied: Clarify that US Core requires any version of SMART? FHIR-37813 See Changes Here
32. Applied: Typo of “DiagnostisReport” in Clinical Notes Guidance FHIR-37819 See Changes Here
33. Applied: Update $docref type input to multiple Codings FHIR-37894 See Changes Here and See Changes Here
34. Applied: Add Conformance expectation of SHOULD to resolve for server Capability FHIR-37901 See Changes Here
35. Applied: Change Condition patient + category search to SHALL support FHIR-37918 See Changes Here
36. Applied: Typo in Observation SDOH p7764rofile FHIR-37928 See Changes Here
37. Applied: Typo in Condition Problems and Health Concerns search example FHIR-37929 See Changes Here
38. Applied: Update Laboratory Loinc Valueset description FHIR-37933 See Changes Here
39. Applied: Clarify that guide uses US Edition of SNOMED and update links to it FHIR-38190 See Changes Here
40. Applied: Update QuickStart to include all the search requirements by type. FHIR-38629 See Changes Here
41. Applied: Specify $docref’s operates on DocumentReference endpoint FHIR-38658 See Changes Here
42. Applied: Remove comment in $docref FHIR-38686 See Changes Here
43. Applied: Add USCDI V3 Requirements FHIR-38702 See Changes Listed in introduction above.
44. Applied: Correct documentation on Procedure.performed attribute FHIR-38737 See Changes Here
45. Applied: Improve docref documentation FHIR-38746 See Changes Here
46. Applied: Fix title for US Core Pediatric Head Occipital Frontal Circumference Observation Profile FHIR-38794 See Changes Here
47. Applied: Add Refill and Quantity to MedRequest FHIR-39343 See Changes Here
48. Applied: Fix Quick Start Rendering FHIR-39367 See Changes Here
49. Applied: Remove Bulk Dependency FHIR-39377 See Changes Here
50. Applied: Fix Cross Version Comparisons section FHIR-39417 See Changes Here
51. Applied: Add Ballot Comment to CarePlan for community feedback FHIR-32949 See Changes Here
52. Applied: Change ServiceRequest.category to min=0 FHIR-39493 See Changes Here
53. Applied: Fix provenance-1 FHIR-39518 See Changes Here

Version = 5.0.1

• url: http://hl7.org/fhir/us/core/STU5.0.1/
• Based on FHIR version : 4.0.1

The changes in this errata to version 5.0.0 of US Core have been reviewed by the public through the HL7 errata process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

Corrected Errata in Version 5.0.1 of US Core:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Typos in Condition Profile URls FHIR-37585 See Changes:
   • Here
   • Here
2. Applied: Update VSAC dependency package version and remove STU Notes where expansion now supported by publisher FHIR-37586
3. Applied: Correct misapplied tracker - for agent.who remove MS from reference Practitioner and add to Organization FHIR-28517 See Change Here

Version = 5.0.0

• url: http://hl7.org/fhir/us/core/STU5/
• Based on FHIR version : 4.0.1

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2022 HL7 balloting process. The resolution of the community comments has been agreed to and voted on by the members of the HL7 International Cross-Group Projects work group.

What’s new in Version 5.0.0 of US Core:

• New and updated resources to meet the U.S. Core Data for Interoperability (USCDI) v2 new Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2021:
  • A Social Determinants Of Health (SDOH) guidance page on using US Core to represent and access SDOH Assessments, Goals, Interventions, and Problems/Health Concerns.
  • US Core Observation Survey Profile, US Core Observation SDOH Assessment Profile, and US Core QuestionnaireResponse Profile to represent SDOH Assessments
  • US Core ServiceRequest Profile to represent SDOH Interventions
  • US Core Observation Clinical Result Profile to represent Clinical Test Results
  • US Core Observation Clinical Result Profile to represent Imaging Results
  • US Core Gender Identity Extension for patient demographics
  • US Core Observation Sexual Orientation Profile for patient demographics
  • US Core RelatedPerson Profile to represent care member such as a caretaker.
  • Updates to US Core CareTeam Profile
  • Updates to US Core Encounter Profile
  • US Core Condition has been split into:
    • US Core Condition Encounter Diagnosis Profile to represent encounter diagnosis
    • US Core Condition Problems and Health Concerns Profile to represent problems and health concerns included SDOH health concerns.
• New pages and headers:
  • Change Log new header and page. content migrated from the Directory of published versions page to create this page
  • Conformance new Header that contains these pages:
    • General Requirements content migrated from version 4.0.0 General Requirements and Conformance Expectation pages
    • Must Support renamed and edited from version 4.0.0 Conformance Expectation pages
  • USCDI content migrated from version 4.0.0 General Requirements Page
  • Changes Between Versions rewritten and renamed from version 4.0.0 DSTU2 to R4 Conversion page
• Link more terminology directly to the FHIR Terminology Service for VSAC Resources and align terminology between US Core and HL7 C-CDA.

Changes:

These changes are a result of over 100 January 2022 Ballot related trackers which are listed below:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Remove requirement for component SDOH Assessment’s Observations FHIR-34384 See Change Here
2. Applied: Clarify clinicalStatus invariant FHIR-34468 See Change Here
3. Applied: Fix Ethnicity ValueSet description FHIR-34488 See Change Here
4. Applied: Remove MS from ServiceRequest.occurrenceDateTime add MS to ServiceRequest.occurrencePeriod FHIR-34493 See Change Here
5. Applied: Change Goal.description search requirement from SHALL to SHOULD FHIR-34546 See Change Here
6. Applied: Warn client that categorization is fuzzy for SDOH FHIR-34550 See Change Here
7. Applied: Split US Core Condition into two profile: Encounter Diagnosis and Problems/Health Concerns FHIR-34553 See Change:
   • Here
   • Here
8. Applied: Update narrative on abatement date FHIR-34554 See Change Here
9. Applied: Change Clinical Tests Observations category to “clinical-test” and add guidance FHIR-34555 See Changes:
   • Here
   • Here
   • Here
   • Here
10. Applied: Update all occurrences of U.S. Core Data for Interoperability (USCDI) v1 to v2 or removed specific references to version. FHIR-34613 For Example, See Change Here
11. Applied: Referencing US Core Profiles FHIR-34623 See Change Here
12. Applied: Correct code system in example snippetFHIR-34624 See Change Here
13. Applied: Add further clarification between slicing a binding (4.1.0) vs using extensible binding (4.0.0) FHIR-34626 See Change Here
14. Applied: Fix typo FHIR-34627
15. Applied: Clarify reported guidance on how secondary sourced MedicationRequest information can be represented. FHIR-34628 See Change Here
16. Applied: Fix contextDirection in Example 1FHIR-34629 See Change Here
17. Applied: Fix Medication List Examples FHIR-34630 See Change Here
18. Applied: Correct Careteam Narrative errors (remove reference to Organization) FHIR-34637 See Change Here
19. Applied: Fix typo FHIR-34638
20. Applied: Added missing search query parameter values FHIR-34642 See Change Here
21. Applied: Inconsistent on conditional required element FHIR-34643 See Change:
    • Here
    • Here
22. Applied: ServiceRequest.category:us-core should be required? FHIR-34645 See Change Here
23. Applied: Remove Condition.category “us-core-1” (due to FHIR-34553) and change Immunization.vaccineCode “us-core-1” to “us-core-5”, Patient.name.family “us-core-8” to “us-core-6 “ to remove duplicate invariant id, is now [‘us-core-1’, ‘us-core-2’, ‘us-core-3’, ‘us-core-4’, ‘us-core-5’, ‘us-core-6’, ‘us-core-7’, ‘us-core-8’, ‘us-core-9’,’us-core-10’,’us-core-13’, ‘us-core-14’,] FHIR-34646 [See Change:
    • Here
    • Here
24. Applied: Clarify that SDOH data elements does not include work information (see ODH) FHIR-34701 See Change:
    • Here
    • Here
25. Applied: Add 386053000 “Evaluation procedure” ,410606002 “Social service procedure” to the ServiceRequest Category Code FHIR-34747 See Change Here
26. Applied: Broaden Common SDOH assessment concepts and clarify is a starter set FHIR-34752 See Change:
    • Here
    • Here
    • Here
27. Applied: Clinical Test Result Observation Profile Must Have needs to address the 3 slices for procedure, exam, and activity in the explanatory text FHIR-34753 See Change Here
28. Applied: Clarify guidance for use of Patient.genderIdentity, Patient.birthsex, and pre-existing Patient.gender FHIR-34754 See Change Here
29. Resolved - change required: List profiles by type and create table comparing Observation Profiles FHIR-34890 See Changes:
    • Here
    • Here
    • Here
30. Applied: Lab Result and Specimen Information for RBC Observation is Missing FHIR-34910 See Change
    • Here
    • Here
    • Here
31. Applied: Added guidance on Observation.category limitations FHIR-34949 See Change Here
32. Applied: Add guidance on Imaging DiagnosticReport ontology FHIR-34958 See Change Here
33. Applied: Clarify that the profile guidance is not limited to profiled elements FHIR-34971 See Change Here
34. Applied: Fix asterisk notation in profiles FHIR-34972 See Change Here
35. Applied: Clarify “time” elements used in the DiagnosticReport profiles FHIR-34973 See Change:
    • Here
    • Here
36. Applied: Change the query parameter value to be consistent with previous statement FHIR-35047 See Change Here
37. Applied: Re-ordered sections in Downloads page and provide a zip file of schematrons FHIR-35064 See Change Here
38. Applied: Split General Guidance page into 1) USCDI 3)General Guidance. Split Conformance Expectations into General Requirements and Must Support. Move General Guidance to General Requirements FHIR-35065 See Changes:
    • Here
    • Here
    • Here
    • Here
39. Applied: Clarify expectations for supporting multiple versions of US Core.FHIR-35067 See Change Here
40. Applied: Clarify that Changes Between Versions (né DSTU2 to R4 Conversion) page documents a set of best practices FHIR-35068 See Change Here
41. Applied: Typo in Category Codes section FHIR-35072 See Change Here
42. Applied: Typo FHIR-35115
43. Applied: Provide guidance when specific code systems are to be used in ServiceRequest FHIR-35122 See Change Here
44. Applied: Clarify description for effective time. FHIR-35125 See Change Here
45. Applied: Fix CareTeam example’s participant.role value FHIR-35152 See Change Here
46. Applied: US Core Condition profile “status” is ambiguous; clarify to be clinicalStatus FHIR-35280 See Change Here
47. Applied: Align Observation category for SDOH assessments FHIR-35282 See Change Here
48. Applied: Add effective[x] 0..1 MS to US Core Observation Social History Profile FHIR-35283 See Change Here
49. Applied: Clarify Condition.clinicalStatus requirements and searching using clinical-status FHIR-35318 See Change Here
50. Applied: Fix link FHIR-35362
51. Applied: Modify example usage text in all profile pages FHIR-35363 See Change Here
52. Applied: Clarify modeling of SDOH screening using Observations, Add QuestionnaireResponse profile as alternative screening instrument FHIR-35364 See Changes:
    • Here
    • Here
    • Here
    • Here
53. Applied: Clarify $docref operation expectations FHIR-35380 See Change Here
54. Applied: Typo FHIR-35388
55. Applied: Duplicate sections in US Core RelatedPerson Profile profile FHIR-35452
56. Applied: Updated guidance on changes between versions FHIR-35576 See Change Here
57. Applied: Split section on “deleted” from “entered in error” FHIR-35622 See Change Here
58. Applied: Use “sdoh” instead of “LG41762-2” for SDOH Categories and Tags FHIR-35644 See Changes:
    • Here
    • Here
    • Here
59. Applied: Update Gender Identity Value setFHIR-35677 See Change Here
60. Applied: Remove “OTH” from OMB Race Category valueSet FHIR-35694 See Change Here
61. Applied:Add basic introduction to the FHIR RESTful Search interaction in the home page FHIR-35755 See Change Here
62. Applied: Remove MS from DiagnosticReport.imagingStudy FHIR-35759 See Change Here
63. Applied: Media example data value fails regex FHIR-35790 See Change Here
64. Applied: Typo FHIR-35844
65. Applied: Typo FHIR-35851
66. Applied: Change fixed category slice to max=1 FHIR-35854 See Change Here
67. Applied: Clarify narrative of status “active” element. FHIR-35870 See Change Here
68. Applied: allow ethnicity extension in FamilyMemberHistory FHIR-35997 See Change Here
69. Applied: allow race extension in FamilyMemberHistory FHIR-35998 See Change Here
70. Applied: Update Condition Implementation Guidance to reflect current USCDI terminology standards FHIR-36056 See Change Here
71. Applied: Clarify expectations for reader FHIR-36057 See Changes:
    • Here
    • Here
72. Applied: Update US Core Yearly Updates FHIR-36058 See Change Here
73. Applied: Remove “Cause of death” from Condition.category and remove US Core Condition Category Codes ValueSet FHIR-36104
74. Applied: Add OTH to sexual orientation ValueSet FHIR-36166 See Change Here
75. Applied: Updated coding system in Missing Data documentation FHIR-36177 See Change Here
76. Applied: Add “Other Race” to OMB Race Categories FHIR-36247 See Change Here
77. Applied: Add MS to Device.distinctIdentifier to correct editorial error FHIR-36303 See Change Here
78. Applied: Fix provenance-1 invariant FHIR-36328 See Change Here
79. Applied: Correct _targetProfile element in Provenance StructureDefinition FHIR-36344 See Change Here
80. Applied: Correct guidance on accessing VSAC Valuesets FHIR-36639 See Change Here
81. Applied: Move change log from version history to new change log page in IG FHIR-36703 See Change Here
82. Applied: Remove redundant example sections FHIR-36728
83. Applied: Realign ids names and titles for all new profiles for consistency FHIR-36766 See Change Here
84. Applied: Move profile page introduction into structuredefinition description FHIR-36824 See Change Here
85. Applied: Fixed profile, Added STU Note, Updated FHIR Core Vitals Profile binding in FHIR R4B. FHIR-27845 See Change Here
86. Applied: Change Encounter.reasonReference from 0..1 to 0..* FHIR-36862 See Change Here
87. Applied: Change URL for CDT from http://ada.org/cdt to http://www.ada.org/cdt. FHIR-36861 See Change Here

The Following Trackers Will be Applied in Future Version

Due external dependencies and publication tooling limitations, the application of these resolutions have been deferred.

Working with HL7 publishing to resolve these publishing issues:

Tracker Status: Summary Jira Issue Application Status

1. Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC FHIR-30105 Manual code expansion and STU Note Present. Working with HL7 publishing to fix integration with VSAC.
2. Resolved - change required: valueset-simple-language.xml QA Error FHIR-30107 Working with HL7 publishing to fix.
3. Resolved - change required: Extensions used that are not defined in the scope FHIR-35775

Working with HL7 IG Authoring project to address these issues on IG readability:

Tracker Status: Summary Jira Issue Application Status

1. Resolved - change required: In most of the data elements – “Binding is from base FHIR and US Core Vital Signs” Need this to be one single combined listing FHIR-30780
2. Resolved - change required: AllergyIntolerance does not show constraint FHIR-34636
3. Resolved - change required: RelatedPerson relationshiptype should have binding to FHIR value set RelatedPerson-relationshiptype FHIR-34755

---

Version = 4.1.0

• Publication Date: 2021-11-30
• url: http://hl7.org/fhir/us/core/2022Jan
• Based on FHIR version : 4.0.1

Changes:

The January 2022 Ballot

This Ballot addresses the following issues:

• Adds United States Core Data for Interoperability (USCDI) V2 updates that the Office of the National Coordinator (ONC) published in July of 2021 with these new Data Elements and Classes:
  • Applied: A Social Determinants Of Health (SDOH) Guidance page to document and provide guidance on using US Core to represent and access SDOH Assessments and Here, Goals, Interventions represented by ServiceRequest + Procedure, and Problems/Health Concerns
  • Applied: Clinical Tests and Diagnostic Imaging also see Changes Here
  • Applied: Patient Gender Identity and Sexual Identity
  • Applied: Care Team Member: Name, Identifier, Location, Telecom and Role See Change Here and Here and Here
  • Applied: Encounter: Diagnosis, Disposition, Location, Time, Type See Change Here
  • Applied: Problems: Date of Diagnosis and Date of Resolution See Change Here
• Continued efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable and as a result align terminology between US Core and HL7 C-CDA.
• Updated uscdii table for easier browsing.
• Addition of consolidated CSV and Excel File representations of Profiles to enable testers and analysts to review elements properties across profiles in a single table
• Addressed and applied over 30 trackers submitted by implementers since the previous STU2 ballot for US Core ver 4.0.0:

Tracker Status: Summary Jira Issue Link to Updated Content

1. Applied: Make values in direct and birth sex extensions min=1 FHIR-26459 See Change:
   • Here
   • Here
2. Applied: FIX imm-1.json NDC/CVX codes QA Error FHIR-30104 See Change:
   • Here
   • Here
3. Applied: Fix patient search parameter definitions to only target Patient FHIR-32305 See Change Here
4. Applied: Provide a caution to the user that a query of MedicationRequest does not provide complete information. FHIR-32720 See Change Here
5. Applied: Make Condition.encounter 0..1 MS FHIR-32844 See Change Here
6. Applied: Correction on USCoreCarePlanProfile Binding FHIR-32846 See Change Here
7. Applied: Fix title for BMI Profile FHIR-32847 See Change Here
8. Applied: Remove unchanged elements from Differentials FHIR-32848 For example change see
9. Applied: Create US Core slices for category elements FHIR-32857 See Change:
   • Here
   • Here
   • Here
   • Here
10. Applied: Change drug class value set for allergens to align with C-CDA FHIR-32953 See Change Here
11. Applied: Referencing incorrect figure FHIR-32961 See Change Here
12. Applied: Clarify Guidance for missing data for Coding data type element FHIR-33048 See Change Here
13. Applied: Fix us-core-1 Invariant for Observation FHIR-33052 See Change Here
14. Applied: Remove requirement to use only 401 from capabiltystatement FHIR-33069 See Change Here
15. Applied: US Core to USCDI guidance page – add patient email FHIR-33079 See Change Here
16. Applied: Utilize “use” field for patient previous name and previous address FHIR-33080 See Change Here
17. Applied: Fix search parameter list FHIR-33123 See Change Here
18. Applied: Clarify requirement on date searches without prefix FHIR-33156 See Change Here
19. Applied: Clarify distinction between repeated search params and “composite” params FHIR-33159 See Change Here
20. Applied: Add content as mandatory element in narrative for documentreference FHIR-33160 See Change Here
21. Applied: Fix invalid elements in extensions FHIR-33233 See Change:
    • Here
    • Here
    • Here
22. Applied: Make Procedure.performed conditionally mandatory FHIR-33243 See Change Here
23. Applied: add same Null options to Race and Ethnicity FHIR-34036 See Change
    • Here
    • Here
    • Here
    • Here
24. Applied: Clarify MustSupport for Observation.component.value[x] vs dataAbsentReason FHIR-34061 See Change:
    • Here
    • Here
25. Applied: Add Null options to US Core Birth Sex Extension FHIR-34133 See Change Here
26. Applied: USCDI v2 update FHIR-34231 SEE SECTION ABOVE
27. Applied: Fix Observation Examples using appliesTo FHIR-34286 See Change Here
28. Applied: Correct CapabilityStatement SMART IG reference FHIR-34281 See Change Here
29. Applied: Make DiagnosticReport.effective and DiagnosticReport.issued conditionally mandatory FHIR-34330 See Change:
    • Here
    • Here
30. Applied: fix URLSee Change Here
31. Applied: US Core search page is not working FHIR-34028 See Change Here - Coordination with HL7 IG publishing team to Correct

The Following Trackers Will be Applied Following this Ballot

Due external dependencies and publication tooling limitations, the application of these resolutions have been deferred.

Tracker Status: Summary Jira Issue Link to Updated Content

1. Resolved - change required: US Core Pulse Oximetry Profile noncomformant UCUM Unit for Oxygen Concentration FHIR-27845 - Awaiting FHIR-4b updates to update base FHIR Vitals Profile, STU Note Present
2. Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC FHIR-30105 See Change Here - Coordination with VSAC and IG publishing team to Correct and align Code System OIDS between FHIR, CCDA, and VSAC, Note To Balloters Present
3. Resolved - change required: valueset-simple-language.xml QA Error FHIR-30107 See Change Here - Coordination with IG publishing team to Correct - Note To Balloters present
4. Resolved - change required: Display only differential invariants and terminology tables in Differential View FHIR-30780 See Change Here - Coordination with HL7 IG publishing team to Correct
5. Resolved - change required: Confusing to reads invariants and terminology tables in Differential View FHIR-30783 See Change Here - Coordination with HL7 IG publishing team to Correct
6. Resolved - change required: Wrong link to IG homepage from package manifest FHIR-33132 See Change Here - Coordination with HL7 IG publishing team to Correct

---

Version = 4.0.0

• Publication Date: 2021-06-28
• url: http://hl7.org/fhir/us/core/STU4
• Based on FHIR version : 4.0.1

Changes:

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2021 HL7 balloting process. The resolution of the community comments has been agreed to and voted on by the members of the sponsoring work group HL7 International Cross-Group Projects.

The key changes are summarized below:

1. New Conformance Expectations page
   • Defining different ways to implement and conform to US Core.
   • Clarification of the Must Support definitions as it relates to various FHIR elements such a choice datatype and references.
2. Publishing a set US Core Vital Signs independent of the FHIR core profile upon which it is based
   • US Core Vital Signs Profile
   • US Core Blood Pressure Profile
   • US Core BMI Profile
   • US Core Head Circumference Profile
   • US Core Body Height Profile
   • US Core Body Weight Profile
   • US Core Body Temperature Profile
   • US Core Heart Rate Profile
   • US Core Respiratory Rate Profile
3. Linking terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable: US Core Value Set, VSAC Value Set, VSAC OID, extensional? 1. Detailed ethnicity, Detailed Ethnicity, 2.16.840.1.114222.4.11.877, No 1. OMB Ethnicity Categories, Ethnicity, 2.16.840.1.114222.4.11.837, Yes 1. US Core CareTeam Provider Roles, Care Team Member Function, 2.16.840.1.113762.1.4.1099.30, Yes 1. US Core Medication Codes (RxNorm), Medication Clinical Drug, 2.16.840.1.113762.1.4.1010.4, Yes 1. US Core Provider Specialty (NUCC), Healthcare Provider Taxonomy, 2.16.840.1.114222.4.11.1066, No 1. US Core Smoking Status, Smoking Status, 2.16.840.1.113883.11.20.9.38, Yes 1. US Core Vaccine Administered Value Set (CVX), CVX Vaccines Administered Vaccine Set, 2.16.840.1.113762.1.4.1010.6, Yes 1. US Core Common substances for allergy and intolerance documentation including refutations, Common substances for allergy and intolerance documentation including refutations, 2.16.840.1.113762.1.4.1186.8, No
4. Migrating to the standard set of HL7 FHIR IG templates for publishing. Although we strove to minimize the differences between this version and the previous versions of US Core, these changes are notable:
   • Additional Features include:
     • Addition of vocabulary and constraint tables to the profile pages
     • Addition of a summary table and to the profile page introduction
     • Addition of “Snapshot Table (Must Support)” Tab to profile views
   • Due to restrictions on customizable content, the full narrative text summaries of profiles is no longer available.
5. Addressing over 90 January 2021 Ballot related trackers resulting in the followed detailed changes.

Listed below are the resolved trackers for this version:

Status: Summary:(Jira Issue) Link to Change

1. Applied:Update PractitionerRole.practitioner to )..1 MS (FHIR-29681) See Change Here
2. Applied:Change CareTeam status search parameter compositeOR expectation to SHOULD (FHIR-29768) See Change Here
3. Applied:Provide guidance on the population of narrative (FHIR-29777) See Change Here
4. Applied: Change $docref start and end input parameter types from date to dateTime (FHIR-29825) See Change Here
5. Applied: The history file markdown rendering of the table (FHIR-30100) See Change Here
6. Applied:footnote rendering - pre-applied (FHIR-30101) See Change Here
7. Applied:Random Section Numbering (Reminder for tooling issue) (FHIR-30102) See Change Here
8. Applied:Move section 1.5 US Core Conformance Requirements (FHIR-30103) See Change Here
9. Applied:Make custodian optional on document reference (FHIR-30108) See Change Here
10. Applied:Remove required binding on procedure and condition (FHIR-30109) See Changes:
    • Here
    • Here
    • Here
11. Applied:Update DocumentReference CCD operation (FHIR-30110) See Change Here
12. Applied:Update DocumentReference MustSupport to choice of data or url (FHIR-30111) See Change Here
13. Applied:Reference to 3 new document types - addressing corresponding metadat (FHIR-30112) See Change Here AND See Change Here
14. Applied:Typo (FHIR-30113)
15. Applied:Clarify Must Support of Complex elements (FHIR-30321) See Change Here
16. Applied:Clarify that VSAC FHIR API only retrieves a definition (FHIR-30344) See Change Here
17. Applied:Allergy Intolerance example for UNKNOWN allergy status does not use unknown (FHIR-30345) See Change Here
18. Applied:Corrected allergy intolerance example SNOMED CT code (FHIR-30346) See Change Here
19. Applied:Allergy codes updated to snomed product hierarchy in VSAC(FHIR-30347) See Change Here
20. Applied:Clarify plans to align with Gender Harmony(FHIR-30350) See Change Here
21. Applied:Typos on Conformance Expectations Page (FHIR-30353) See Change Here
22. Applied:clarify use of additional codings (FHIR-30354) See Change Here
23. Applied:Clarify server requirements for Choice of Profile Elements scenario (FHIR-30355) See Change Here
24. Applied:Add all options to Procedure.performed[x] (FHIR-30391) See Change Here
25. Applied:Updated MedicationRequest.authoredOn from mandatory to must support(FHIR-30430) See Change Here
26. Applied:Typo (FHIR-30460) See Change Here
27. Applied: Update Encounter Type CPT Description (FHIR-30470) See Change Here
28. Applied: Clarify Missing Data language for coded data elements with required binding strength (FHIR-30630) See Change Here
29. Applied:Note re language codes(FHIR-30654) See Change Here
30. Applied:Change URL for Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes(FHIR-30655) See Changes Here and Here
31. Applied:Typo (FHIR-30656)
32. Applied: Explain the relationship between US CORE and an evolving USCDI. (FHIR-30657) See Change Here
33. Applied:Correct 2 bullet points in section 1.2. (FHIR-30658) See Change Here
34. Applied:Clarify actors (FHIR-30659) See Change Here
35. Applied:Edit basic provenance (FHIR-30660) See Change Here
36. Applied:Clarify the duplication requirement for scanned documents in DocumentReference and DiagnosticReport. (FHIR-30662) See Change Here
37. Applied:Clarify that clients should retain data visualization between DSTU2 to R4 upgrades. (FHIR-30665) See Change Here
38. Applied:Add provenance to writing/updating guidance? (FHIR-30666) See Change Here
39. Applied:Clarify Code System section and update codesystem table (FHIR-30667) See Change Here
40. Applied: Clarify guidance on implantable medical devices. (FHIR-30669) [See Change Here
41. Applied: Make udi_HRF a Must Support element. (FHIR-30670) See Change Here
42. Applied: Clarify UDI information. (FHIR-30672) See Changes:
    • Here
    • Here
43. Applied:Clarify text (FHIR-30673) See Change Here
44. Applied:Typos (FHIR-30674)
45. Applied:Clarify prohibition on using contained resources. (FHIR-30677) See Change Here
46. Applied:Add guidance on suppressed data. (FHIR-30678) See Change Here
47. Applied:Clarify what is meant by “support the other elements.” (FHIR-30680) See Change Here
48. Applied:Typo(FHIR-30681)
49. Applied:Fix typos (FHIR-30683) Various Changes
50. Applied:Update on Guidance on DataAbsentReason for Observations (FHIR-30685) See Change Here
51. Applied:Clarify use of qualifier LOINCs (FHIR-30690) See Change Here
52. Applied: Fix Typo (FHIR-30695) See Change Here
53. Applied: Update on Guidance on DataAbsentReason for Observations (FHIR-30699) See Change Here
54. Applied: Clarify what is intended with “additional observations”(FHIR-30772) See Change Here
55. Applied: Add statement about clinical safety to the security page (FHIR-30776) See Change Here
56. Applied: Added clarification to vitals profile regarding use of additional codings and component observations. (FHIR-30778) See Change Here
57. Applied: Typo (FHIR-30782) See Change Here
58. Applied: Clarify resource search requirements CapabilityStatements and provide guidance on search for multiple patients using Bulk data (FHIR-30787) See Changes:
    • Here
    • Here
59. Applied: Add MedicationAdministration to the Future Page. (FHIR-30788) See Change Here
60. Applied: Fix text in $docref description (FHIR-30810) See Change Here
61. Applied: Mandate that CapabilityStatement.instantiates refer to US Core (FHIR-30889) See Change Here
62. Applied: Add binding so Vitals will render it in differential view (FHIR-31391) See Change Here
63. Applied: Update to URI from OID for CDT in Procedure Code ValueSet (FHIR-31556) See Change Here
64. Applied: Add DocumentReference.content is under “must have” list (FHIR-31364) See Change Here
65. Applied: Update Must Support Bullet regarding missing data (FHIR-31507) See Change Here
66. Applied: Update use context for Race and Ethnicity extensions (FHIR-31008) See Change Here
67. Applied: Add guidance on “POST based search” (FHIR-31585) See Changes:
    • Here
    • Here
68. Applied: Add reference to Mapping from LOINC scale type to FHIR data type (FHIR-31084) See Change Here
69. Applied: Update Observation.value[x] definition (FHIR-31083) See Change Here
70. Applied: Add LOINC to procedure codes (FHIR-31514) See Change Here
71. Applied: Make PractitionerRole.organization must support and add invariant (FHIR-29680) See Change Here
72. Applied: Fix FHIRPath constraint for provenance-1(FHIR-31020) See Change Here
73. Applied: Add guidance to BMI Profile(FHIR-32658) See Change Here
74. Applied: Write usage note for non-vaccination CVX codes(FHIR-31899) See Change Here
75. Applied: Clarify that Extensible binding can always provide a mapped code(FHIR-32010) See Change Here
76. Applied: Clarify RESTFul requirements(FHIR-31490) See Changes:
    • Here
    • Here
    • Here
    • Here
77. Applied: fix Procedure Example error (FHIR-30106) See Change Here

Known issues:

We are working to fix these issues that may come up when using US CORE. We will correct them in a future version of the guide

Publishing

• Resolved - change required:Confusing for commercial vendor. Reads very confusing. (FHIR-30783) proposal is to make the differential tab the default view, see publishing plans here timeline unknown.
• Resolved - change required:In most of the data elements – “Binding is from base FHIR and US Core Vital Signs” Need this to be one single combined listing (FHIR-30780) proposal is to limit the terminology and invariants to view shown. see Zulip chat timeline unknown.
• Resolved - change required:Why are there separate codes for USCoreVitalSigns and the Systolic.value and the diastolic value? (FHIR-30779) proposal is to work with publishing to “clean up” terminology and invariants to view shown. see: see Zulip chat timeline unknown.

Terminology

• Resolved - change required: valueset-simple-language.xml QA error “Error from server: Language valuesets cannot be expanded as they are based on a grammar” (FHIR-30107) this error is still extant from prior version of US Core and has yet to be resolved. Work with publishing to fix and created STU note. see Zulip chat
• Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC Patient (FHIR-30105) CDCREC codes and code system value not aligned with VSAC. Workaround is to publish the CDCREC code system and valuesets in USCore until this content is moved to HL7 Terminology Add an STU Note. Zulip chat1 and Zulip chat2 and Zulip chat3
• Resolved - change required:imm-1.json NDC/CVX codes QA Error (FHIR-30104) Work with terminology server team to correct. see Zulip chat
• Resolved - change required:Pulse Ox Example: observation-satO2-fiO2 (FHIR-27845) Proposed Jira ticket to resolve in base made an STU note that is technically not conformant with the base FHIR vital profile. See Zulip chat

---

Version = 3.2.0

• Publication Date: 2021-1-30
• url: http://hl7.org/fhir/us/core/2021Jan
• Based on FHIR version : 4.0.1

Changes:

The changes in this version have been voted on by the members of the sponsoring work group HL7 International Cross-Group Projects. This version addresses the following key issues:

1. Clarification of the Must Support definitions as it relates to:
   • Polymorphic datatypes, which of the possible types must be supported
   • Reference datatype (Reference, canonical) which of the target types must be supported
   • The vital signs profile in the Core Specification which profiles must be supported
   • New [Conformance Expectations] page (see individual trackers below for details)
2. Publishing a set US Core Vital Signs independent of the FHIR core profile upon which it is based (see individual trackers below for details)
   • US Core Vital Signs Profile
   • US Core Blood Pressure Profile
   • US Core BMI Profile
   • US Core Head Circumference Profile
   • US Core Body Height Profile
   • US Core Body Weight Profile
   • US Core Body Temperature Profile
   • US Core Heart Rate Profile
   • US Core Respiratory Rate Profile
3. Linking terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable

• We are seeking to resolve several technical and policy glitches when using VSAC directly prior to publishing which include the requirement to log in using your own UMLS API Key requiring a current UMLS account to view the value sets. VSAC UMLS Licensing information.
• To view the VSAC value set, use the link https://vsac.nlm.nih.gov/valueset/{OID}/expansion in your browser replacing the {OID} with the OID from the table below.
• Enumerated (extensional) value sets can also be downloaded as a FHIR ValueSet resource. To do this, use the link https://cts.nlm.nih.gov/fhir/ValueSet/{OID} in your browser replacing the {OID} with the OID from the table below.

• NOTE that the Code System value used in FHIR® Terminology Service for VSAC Resources for Race and Ethnicity (CDCREC) concepts does not align with historical and current usage of OIDs in C-CDA and US Core. This issue has not been resolved in time for publication of the ballot version of this guide. As a result validation errors may occur when validating against this version of the US Core Patient Profile. Feedback on which code system value to use is welcome.

  1. US Core Value Set, VSAC Value Set, VSAC OID, extensional?
  2. Detailed ethnicity, Detailed Ethnicity, 2.16.840.1.114222.4.11.877, No
  3. Detailed Race, Race, 2.16.840.1.113883.1.11.14914, No
  4. OMB Ethnicity Categories, Ethnicity, 2.16.840.1.114222.4.11.837, Yes
  5. US Core CareTeam Provider Roles, Care Team Member Function, 2.16.840.1.113762.1.4.1099.30, Yes
  6. US Core Medication Codes (RxNorm), Medication Clinical Drug, 2.16.840.1.113762.1.4.1010.4, Yes
  7. US Core Provider Specialty (NUCC), Healthcare Provider Taxonomy, 2.16.840.1.114222.4.11.1066, No
  8. US Core Smoking Status, Smoking Status, 2.16.840.1.113883.11.20.9.38, Yes
  9. US Core Vaccine Administered Value Set (CVX), CVX Vaccines Administered Vaccine Set, 2.16.840.1.113762.1.4.1010.6, Yes
  10. US Core Common substances for allergy and intolerance documentation including refutations, Common substances for allergy and intolerance documentation including refutations, 2.16.840.1.113762.1.4.1186.8, No

1. Migrating to the standard set of HL7 FHIR IG templates for publishing. Although we strove to minimize the differences between this version and the previous versions of US Core, these changes are notable:
   • Additional Features include:
     • Addition of vocabulary and constraint tables to the profile pages
     • Addition of a summary table and to the profile page introduction
     • Addition of “Snapshot Table (Must Support)” Tab to profile views
   • Due to restrictions on customizable content, the following features of prior versions are no longer available:
     • Full narrative text summaries of profiles NOTE: We are seeking feedback on whether to retain these full narrative text summaries for this guide (an example can be seen here by clicking on the “Text Summary” tab)*
2. Addressing over 95 outstanding trackers.

Trackers items and links to the updated content listed below are the resolved trackers for this version:

1. Must Support Over Interpreted (FHIR-28375) Changes throughout the profiles – added conformance page See Change Here

2. Replace the US Core Update Allergy substances value set with VSAC reference (FHIR-29322) See Change Here

3. Update Organization Quick Start Example Search. (FHIR-29269) See Change Here

4. birthsex binding applied to the wrong element in US Core Patient StructuredDefinition/differential (FHIR-29262) See Change Here

5. us-core-12 invariant interpretation (FHIR-28942) See Changes Here

6. Incorrect Description Observation.component (Pulse Ox) (FHIR-28934) See Change Here

7. References should be constrained to use reference not identifier (FHIR-28573) See Change Here

8. Update USCorePatientName search description for consistency (FHIR-28540) See Change Here

9. Make Provenance.author optional (FHIR-28517) See Change Here

10. Add must support type choices for US Core Goal.target.due[x]. (FHIR-28477) See Change Here

11. Immunization Profile Mandatory and Must Support Intro is missing attributes (FHIR-28452) See Change Here

12. DiagnosticReport-cardiology-report JSON and XML samples contain invalid hashes (FHIR-28408) See Change Here

13. MedicationRequest.medication[x] (FHIR-28395) See Change Here

14. Fix MedicationRequest.encounter reference (FHIR-28258) See Change Here

15. Fix typo: “an another” -> “another” (FHIR-28227) See Change Here

16. Declare mustSupport on Organization telecom children (FHIR-28216) See Change Here

17. Resolve remaining discrepancies with FHIR R4 Search Parameters (FHIR-28181) See Changes Here:
    • 1 SearchParameter-us-core-condition-onset-date
    • 2 SearchParameter-us-core-organization-name
    • 3 SearchParameter-us-core-location-name

18. Provenance without activity is not very useful (FHIR-28179) See Change Here

19. Make Provenance.target.reference mandatory (FHIR-28165) See Change Here

20. Missing narrative Element (FHIR-28159) See Change Here

21. “Updated guidance regarding gender and sex.” (FHIR-28138) See Change Here

22. Replace the US Core Smoking Status with VSAC reference (FHIR-28123,FHIR-26059) See Change Here

23. Timing association for smoking status changed from issued to effectiveDateTime (FHIR-28090) See Change Here

24. Remove Must Support from Patient.telecom (FHIR-27731) See Change Here

25. Remove Must Support from Patient.communication.language (FHIR-27730) See Change Here

26. Remove Must Support from us-core-birthsex extension (FHIR-27729) See Change Here

27. Remove Must Support from us-core-ethnicity extension (FHIR-27728) See Change Here

28. Remove Must Support from us-core-race extension (FHIR-27727) See Change Here

29. Expand US Core state value set to include US Military codes (FHIR-26833) See Change Here

30. Fixed Value Set Expansion Operation examples (FHIR-26625) See Change Here

31. Add must support reference type choices for US Core laboratory DiagnosticReport.performer (FHIR-25120) See Change Here

32. Fix US-Core-1 constraint on Observation.effectivePeriod (FHIR-29658) See Change Here

33. Change bindings from extensible to required for Condition.code value set: US Core Condition Category Codes Procedure.code value set: US Core Procedure Codes (FHIR-29563) See Changes Here:
    • 1 StructureDefinition-us-core-condition-definitions
    • 2 StructureDefinition-us-core-procedure-definitions

34. Remove text “an author responsible for the update”. Keep author organization (FHIR-28516) See Change Here

35. “Clarify expectations when accessing “other endpoint” for DocumentReference.content.attachment.url” (FHIR-28472) See Change Here

36. Add a required category to smoking status (FHIR-28436) See Change Here

37. Use of US Core Profile when not explicitly referenced when using Contained resources (FHIR-28396) See Change Here

38. DocumentReference.custodian to be Optional (FHIR-28393) See Proposed Change Here

39. Encounter.serviceProvider Must Support and Encounter.location.location Optional (FHIR-28392) See Change Here

40. Observation.hasMember Vital Signs Panel Profile Reference Choice (FHIR-28391) See Change Here

41. Add must support type choices for Observation.value[x] for Lab Observation Profile (FHIR-28390) See Change Here

42. Add must support type choices for Observation.effective[x] for Lab Observation Profile (FHIR-28389) See Change Here

43. Add must support type choices for Immunization.occurrence[x] (FHIR-28388) See Change Here

44. Add must support type choices for DiagnosticReport.effective[x] for Note Data (FHIR-28387) See Change Here

45. Add must support type choices for DiagnosticReport.effective[x] for Lab Data Type (FHIR-28385) See Change Here

46. Add must support reference type choices for Provenance.agent.who Reference (FHIR-28383) See Change Here

47. Add must support reference type choices for MedicationRequest.requester Reference (FHIR-28382) See Change Here

48. Add must support reference type choices for MedicationRequest.reported Choice (FHIR-28381) See Change Here

49. Add must support reference type choices for DocumentReference.author Reference (FHIR-28380) See Change Here

50. Add must support reference type choices for DiagnosticReport.performer for Note (FHIR-28379) See Change Here

51. Add must support reference type choices for DiagnosticReport.performer for Lab (FHIR-28378) See Change Here

52. Add must support reference type choices for CareTeam.participant.member Reference (FHIR-28376) See Change Here

53. Add choice for and type choices for Encounter.reasonReference (FHIR-27951) See Change Here

54. Add choice for Procedure.performed[x] (FHIR-29695) See Change Here

55. Clarify deleted resources requirements and guidance (FHIR-28091) See Change Here

56. Clarify search by date precision conformance expectations (FHIR-27906) See Change Here
    • General Guidance
    • Example in QuickStart
    • Example in CapabilityStatement
57. Clarify search by reference conformance expectations (FHIR-27905) See Changes Here:
    • General Guidance
    • Example in QuickStart
    • Example in CapabilityStatement

58. Add “Cause of Death” to category codes to meet the Public Health Use Case for VRDR (FHIR-27904) See Change Here

59. Address non-implantable device and how to document usage (FHIR-27896, FHIR-23715, FHIR-23715) See Change Here

60. Resource constraints based on Jurisdiction which are not well documented (FHIR-27810) See Change Here

61. Updated CPT copyright to current year (FHIR-27770) See Change Here

62. Change binding for CareTeam.participant.role from NUCC to Care Team Member Function, replace the US Core Careteam Provider Roles Value Set with VSAC reference (FHIR-27769) See Change Here

63. Remove US Core Server Capability Statement requires support for HTTP status 410-deleted (FHIR-26597) See Change Here

64. Change US Core Condition Codes Value Set Logical Definition (FHIR-26060) See Change Here

65. Recommend against using SSN for Patient.identifier (FHIR-24903) See Change Here

66. Remove identifier (OID) from ValueSet: US Core Encounter Type (FHIR-29691) See Change Here

67. Review vocabulary to align with CCDA and use VSAC valueset where possible (FHIR-22488) [See Changes Here:
    • Detailed ethnicity –> Detailed Ethnicity
    • Detailed Race –> Race
    • OMB Ethnicity –> Categories|Ethnicity
    • US Core Medication Codes (RxNorm) –> Medication Clinical Drug and here
    • US Core Provider Specialty (NUCC) –> Healthcare Provider Taxonomy
    • US Core Vaccine Administered Value Set (CVX) –> CVX Vaccines Administered Vaccine Set

68. Remove CVX-NDC mapping table (FHIR-29745) See Change Here

69. Since CarePlan.text.div is min== 1 add must support == true element to be consistent with US Core design (FHIR-29765) See Change Here

70. Remove unused US Core ICD-10-PCS Procedure Codes valueset (FHIR-29822)

71. Remove Clinical Notes Guidance References to ONC 2019 NPRM and move requirements to main body (FHIR-29824) See Change Here

---

Version = 3.1.1

• Publication Date: 2020-6-30
• url: http://hl7.org/fhir/us/core/STU3.1.1
• Based on FHIR version : 4.0.1

Changes:

This update addresses several technical corrections and errata and clarifications. They have been reviewed and voted on by the members of the HL7 International Cross-Group Projects WorkGroup who is sponsoring this errata release and reconciliation of the comments.:

1. Add guidance for representing patient name suffix and previous patient name to the US Core Patient Profile (FHIR-28129)
2. Correct copy/paste error in Goal Profile (FHIR-28109)
3. Correct US Core Provider Specialty (NUCC) ValueSet to hide abstract grouping codes (FHIR-27975)
4. Added example of US Core Direct Extension to Practitioner-2 Example (FHIR-27947)
5. Corrected technical errors in pediatric profiles StructureDefinitions (FHIR-27946)
6. Corrected errors in DiagnosticReport Cardiology Example (FHIR-27913)
7. Update Federal Register link for OMB race and ethnicity category classifications. (FHIR-27907)
8. Clarified token search syntax (FHIR-27897).
9. Corrected US Core DocumentReference Profile to support multiple attachments (FHIR-25778).
10. Fix FHIRPath Expression in USCoreGoalTargetDate (FHIR-27892).
11. Fix FHIRPath Expression in USCoreProcedureDate(FHIR-27887).
12. Add omitted “ge” comparators to SearchParameters (FHIR-27893).
13. Remove Must Support References to non US Core Profiles (FHIR-27876)
14. Add missing reaction to the US Core AllergyIntolerance Profile (FHIR-27867).
15. Clarify reference to US Core Patient in Vitals Signs Profiles (FHIR-27857).
16. Corrected US Core Pulse Oximetry Profile component.valueQuantity.code and component.valueQuantity.unit min from 0 to 1 to be consistent with the valueQuantity constraints within US Core (FHIR-27846)
17. Correct UCUM Unit in US Core Pulse Oximetry Profile Text Summary (FHIR-27845)
18. Update Procedure Codes Value Set to include ICD-10 PCS codes (FHIR-27836)
19. Update Procedure Codes Value Set to include CDT codes (FHIR-27737)
20. Clarify that pediatric vital sign percentile Observations should reference growth chart (FHIR-27549),
21. Added Missing US core Head Occipital-frontal Circumference Percentile Profile (FHIR-27542).
22. Correct requirements for supporting CLIA identifiers (FHIR-27158)
23. Change Description of ICD-10-PCS Value Set (FHIR-27116)
24. Correct AllergyIntolerance guidance for verificationStatus (FHIR-27096)
25. Fix example US Core heart-rate example (FHIR-27086)
26. review period comments Update smoking status codes to align with USCDI (FHIR-27082).
27. Fix invariant provenance-1 (FHIR-27065)
28. Fix invalid json snippet (FHIR-27001)
29. review period comments Remove Provenance requirement from Medication, Location, Practitioner, PractitionerRole, and Organization and correct copy and paste error to Medication and Provenance searchType support in CapabilityStatement (FHIR-26840, FHIR-28161).
30. Correction on USCDI Table change “MedicationStatement” to “MedicationRequest” and remove references to MedicationStatement in the Medication Profile and CapabilityStatements (FHIR-26840).
31. Clarify that US Core Location/PractitionerRole are not being referenced by other resources (FHIR-26840).
32. Correct editing error restoring Write and Operation capability guidance into DocumentReference QuickStart (FHIR-26840).
33. Clarify guidance that servers SHALL support search with status if status required (FHIR-26840).
34. Correct canonical url for ImplementationGuide (FHIR-26686).
35. Correct system URI for ICD-10 procedure codes (FHIR-26679).
36. Fix invariant us-core-1 (FHIR-26605).
37. Change valueCode min from 0 to 1 for US Core Birth Sex Extension and valueBoolean min from 0 to 1 forUS Core Direct email Extension (FHIR-26459).
38. Change valueQuantity min from 1 to 0 for US Core Pediatric BMI for Age Observation Profile and US Core Pediatric Weight for Height Observation Profile (FHIR-26363).
39. Add page contents to Clinical Notes Guidance and Basic Provenance pages (FHIR-25785).
40. Fix duplicate URL causing validation failure. (FHIR-25536).
41. Fix Invariant us-core-8 (FHIR-25459).
42. Corrected the wording “should support” to “shall support” in Clinical Notes Guidance (FHIR-25455).
43. Fix Invariant us-core-8 to allow for Data Absent Reason Extension on Patient name.(FHIR-25249).
44. Fix Link to LOINC LP29708-2 (FHIR-25213).
45. Corrected guidance for conveying “Patient-Reported medications” (FHIR-25035)

---

Version = 3.1.0

• Publication Date: 2019-10-31
• url: http://hl7.org/fhir/us/core/STU3.1
• Based on FHIR version : 4.0.1

Changes:

In order meet the proposed *ONC U.S. Core Data for Interoperability** (USCDI) regulatory requirements for access to patient data, this STU Update of the US Core Implementation Guide has added new content. Structured Documents and the Argonaut Project Team have spent the last several months reviewing, testing and providing invaluable feedback on these and other topics including most notably: 1) A US Core Provenance Profile and Basic Provenance guidance on fetching Provenance for patient data. 2) Medication List Guidance for fetching a patient medications 3) Recasting the US Core Device profile into a US Core Implantable Device Profile 4) A US Core spO2 by US Core Pulse Oximetry Profile 5) Updated search to support requiring search by multiple statuses 6) Guidance when the source has no data 7) General guidelines and considerations for DSTU2 to R4 Conversion 8) Guidance for language support 9) Considerations for fetching data for multiple patients] 10) Future considerations for times offset and timezone guidelines 11) Future Considerations for writing and updating data 12) Update security pageto reflect current testing. 13) Clarify definition of MustSupport to reflect the intent that the server must be able to populate a MustSupport element in order to claim conformance to the profile. 14) Expanding bindings for Procedure and Condition codes for quality measures and other purposes. These sections as well as several other clarifications, corrections and technical changes that are listed in the sections below have been reviewed and voted on by the members of the HL7 International Structured Documents WorkGroup who is sponsoring this STU Update comment period and reconciliation of the comments.

---

Version = 3.0.1

• Publication Date: 2019-09-01
• url: http://hl7.org/fhir/us/core/2019Sep
• Based on FHIR version : 4.0.0

Changes:

In order meet the proposed ONC U.S. Core Data for Interoperability (USCDI) regulatory requirements for access to patient data, this STU Update for Comment Version of the US Core Implementation Guide has added new content. The Argonaut Project Team has spent the last several months reviewing, testing and providing invaluable feedback on these and other topics including most notably: 1) A US Core Provenance Profile and guidance on fetching Provenance for patient data. 2) Guidance on fetching a patient’s medications 3) A US Core spO2 by Pulse Oximetry profile 4) Recasting the US Core Device profile into a US Core Implantable Device profile 5) Making server search requirements less opaque and requiring search by multiple statuses. 6) Guidance when the source has no data 7) General guidelines and considerations for DSTU2 to R4 Conversion 8) Guidance for language support 9) Considerations for Fetching data for multiple patients 10) Future considerations for times offset and timezone guidelines These sections as well as several other clarifications, corrections and technical changes that are listed in the sections below have been reviewed and voted on by the members of the HL7 International Structured Documents WorkGroup who is sponsoring this STU Update comment period and reconciliation of the comments.

---

Version = 3.0.0

• Publication Date: 2019-06-15
• url: http://hl7.org/fhir/us/core/STU3
• Based on FHIR version : 4.0.0

Changes:

FHIR R4 version of US Core which added profiles for exchanging Clinical Notes, expanded search expectations, and updated guidance as a results of comments from balloters.

---

Version = 2.1.0

• Publication Date: 2018-12-04
• url: http://hl7.org/fhir/us/core/2019Jan
• Based on FHIR version : 4.0.0

Changes:

STU 3 Ballot #1. First ballot on FHIR R4.

---

Version = 2.0.0

• Publication Date: 2018-12-04
• url: http://hl7.org/fhir/us/core/STU2
• Based on FHIR version : 3.0.1

Changes:

Publication added the following profiles: 1)US Core DocumentReference Profile 2)US Core Encounter Profile 3)US Core PractitionerRole Profile

---

Version = 1.1.0

• Publication Date: 2017-12-20
• url: http://hl7.org/fhir/us/core/2108Jan
• Based on FHIR version : 3.0.1

Changes:

STU2 Ballot

---

Version = 1.0.1

• Publication Date: 2017-11-02
• url: http://hl7.org/fhir/us/core/1.0.1
• Based on FHIR version : 3.0.1

Changes:

This version corrects technical errata from the original publication and for FHIR R3.

---

Version = 1.0.0

• Publication Date: 2017-03-21
• url: http://hl7.org/fhir/us/core/STU1
• Based on FHIR version : 3.0.1

Changes:

The first official published version of this IG published immediately following the release of FHIR STU3

---

Version = 0.0.0

• Publication Date: 2017-12-06
• url: http://hl7.org/fhir/us/core/2017Jan
• Based on FHIR version : 1.8.0

Changes:

STU1 Ballot

---