US Core Implementation Guide
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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 9.0.0-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

Relationship With Other IGs

Page standards status: Informative

Scope and Context of US Core

US Core is intended to provide an implementable standard for FHIR based interfaces for provider and patient facing systems​ providing:

  • An exchange Standard for U.S. Core Data for Interoperability (USCDI) and comments and requests from the US Realm FHIR community.
  • A set of conformance requirements that enforce a set of 'minimum requirements' on FHIR resources to create the US Core Profiles specifying rules for the elements, extensions, vocabularies, and value sets, and the RESTful API interactions.
  • For use by US stakeholders when implementing FHIR to provide a common implementation and to be built upon when creating further US Realm specific profiles and implementation guides for specific use cases.

The context of US Core within the set of US Realm HL7 FHIR standards is shown in the figure below.

Figure 1: Figure 1: Context of US Core within the set of HL7 US FHIR standards
relationships.svg

Relationship to US Core and Other IGs

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) This IG describes specify how to represent in HL7 FHIR the 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.

Comparison With International IGs

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 in this current 9.0.0-ballot version of 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 for comparison.

US Core 9.0.0-ballot International Patient Access 1.1.0 International Patient Summary 2.0.0
US Core ADI DocumentReference Profile ➕ —
US Core AllergyIntolerance Profile ✔ ➕
US Core Average Blood Pressure Profile ➕ —
US Core BMI Profile ✔ —
US Core Blood Pressure Profile ✔ —
US Core Body Height Profile ✔ —
US Core Body Temperature Profile ✔ —
US Core Body Weight Profile ✔ —
US Core Care Experience Preference Profile ➕ —
US Core CarePlan Profile — —
US Core CareTeam Profile — —
US Core Condition Encounter Diagnosis Profile ✔ —
US Core Condition Problems and Health Concerns Profile ✔ ➕
US Core Coverage Profile — —
US Core Device Profile — ✔
US Core DiagnosticReport Profile for Laboratory Results Reporting — ➕
US Core DiagnosticReport Profile for Report and Note Exchange — ➕
US Core DocumentReference Profile ➕ —
US Core Encounter Profile — —
US Core Goal Profile — —
[US Core FamilyMedicalHistory Profile] — —
US Core Head Circumference Profile ✔ —
US Core Heart Rate Profile ✔ —
US Core Immunization Profile ✔ ➕
US Core Laboratory Result Observation Profile ✔ ➕
US Core Location Profile — —
US Core Medication Profile ✔ ➕
US Core MedicationDispense Profile — —
US Core MedicationRequest Profile ✔ ➕
US Core Observation ADI Documentation Profile ➕ —
US Core Observation Clinical Result Profile ✔ ➕
US Core Observation Occupation Profile ➕ —
US Core Observation Pregnancy Intent Profile ✔ —
US Core Observation Pregnancy Status Profile ✔ ➕
US Core Observation Screening Assessment Profile ✔ —
US Core Observation Sexual Orientation Profile ✔ —
US Core Organization Profile — ✔
US Core Patient Profile ➕ ➕
US Core Pediatric BMI for Age Observation Profile ✔ —
US Core Pediatric Head Occipital Frontal Circumference Percentile Profile ✔ —
US Core Pediatric Weight for Height Observation Profile ✔ —
US Core Practitioner Profile ✔ ➕
US Core PractitionerRole Profile ✔ ✔
US Core Procedure Profile — ➕
US Core Provenance Profile — —
US Core Pulse Oximetry Profile ✔ —
US Core QuestionnaireResponse Profile — —
US Core RelatedPerson Profile — —
US Core Respiratory Rate Profile ✔ —
US Core ServiceRequest Profile — —
[US Core PMO ServiceRequest Profile] — —
US Core Simple Observation Profile ➕ ➕
US Core Smoking Status Observation Profile ➕ ➕
US Core Specimen Profile — ➕
US Core Treatment Intervention Preference Profile ➕ —
US Core Vital Signs Profile ✔ —
Additional IPA requirements

The following US Core resource 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.

  1. US Core ADI DocumentReference Profile

    Additional requirements for IPA DocumentReference:

    • 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'

  2. US Core DocumentReference Profile

    Additional requirements for IPA DocumentReference:

    • DocumentReference.content.attachment.contentType Element minimum cardinalities differ: '1' vs '0'

  3. US Core Average Blood Pressure Profile

    Additional requirements for IPA Observation

    • 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'

  4. US Core Care Experience Preference Profile, US Core Simple Observation Profile, US Core Smoking Status Observation Profile, US Core Treatment Intervention Preference Profile

    Additional requirements for IPA Observation:

    • Observation.dataAbsentReason Elements differ in definition for mustSupport: 'true' vs 'false'

  5. US Core Observation ADI Documentation Profile, US Core Observation Occupation Profile

    Additional requirements for IPA Observation:

    • Observation.value[x] Elements differ in definition for mustSupport: 'true' vs 'false'
    • Observation.dataAbsentReason Elements differ in definition for mustSupport: 'true' vs 'false'

  6. US Core Patient Profile

    Additional requirements for IPA Patient:

    • 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'
Missing Data

US Core compliant resources are compliant with IPA requirements for Missing Data.

Suppressed Data

IPA does not include requirements for Suppressed Data.

Additional profiles

This version of US Core has no equivalent profile for the following IPA profiles:

Additional IPS requirements

The following US Core resource 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 IPA profile requirements. Implementers are advised to note that some code changes may be required to support these profiles.

  1. US Core AllergyIntolerance Profile

    Additional requirements for IPS AllergyIntolerance:

    • 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'

  2. US Core Condition Problems and Health Concerns Profile

    Additional requirements for IPS Condition:

    • 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'

  3. US Core Device Profile

    Additional requirements for IPS Device:

    • 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'

  4. US Core DiagnosticReport Profile for Report and Note Exchange and US Core DiagnosticReport Profile for Laboratory Results Reporting

    Additional requirements for IPS DiagnosticReport:

    • 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'

  5. US Core Immunization Profile

    Additional requirements for IPS Immunization:

    • 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'

  6. US Core Medication Profile

    Additional requirements for IPS Medication:

    • 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'

  7. US Core MedicationRequest Profile

    Additional requirements for IPS MedicationRequest:

    • 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'

  8. US Core Observation Pregnancy Status Profile

    Additional requirements for IPS Observation Pregnancy Status:

    • 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 '*'

  9. US Core Observation Clinical Result Profile and US Core Laboratory Result Observation Profile

    Additional requirements for IPS Observation Results - Laboratory/Pathology:

    • 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'

  10. US Core Observation Clinical Result Profile

    Additional requirements for IPS Observation Results - Radiology:

    • 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'

  11. US Core Simple Observation Profile

    Additional requirements for IPS Observation Alcohol Use:

    • 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 '*'

  12. US Core Smoking Status Observation Profile

    Additional requirements for IPS Observation Tobacco Use:

    • 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 '*'

  13. US Core Patient Profile

    Additional requirements for IPS Patient:

    • 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'

  14. US Core Practitioner Profile

    Additional requirements for IPS Practitioner:

    • Practitioner.name.given Element differ in definition for mustSupport/Obligations: 'true' vs 'false'

  15. US Core Procedure Profile

    Additional requirements for IPS Procedure:

    • 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'

  16. US Core Specimen Profile

    Additional requirements for IPS Specimen:

    • 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'
Missing Data

US Core compliant resources are compliant with IPA requirements for Missing Data.

Suppressed Data

IPA does not include requirements for Suppressed Data.

Additional profiles

This version of US Core has no equivalent profile for the following IPS profiles: