US Core Implementation Guide
5.0.1 - STU5 Release US

This page is part of the US Core (v5.0.1: STU5) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Change Log

Version = 5.0.1

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.

Correct 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:
  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

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:

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:
  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:
  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:
  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:
  24. Applied: Clarify that SDOH data elements does not include work information (see ODH) FHIR-34701 See Change:
  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:
  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:
  30. Applied: Lab Result and Specimen Information for RBC Observation is Missing FHIR-34910 See Change
  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:
  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:
  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:
  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:
  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:
  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

Changes:

The January 2022 Ballot

This Ballot addresses the following issues:

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:
  2. Applied: FIX imm-1.json NDC/CVX codes QA Error FHIR-30104 See Change:
  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:
  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:
  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
  24. Applied: Clarify MustSupport for Observation.component.value[x] vs dataAbsentReason FHIR-34061 See Change:
  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:
  30. Applied: Resolution of http://hl7.org/fhir/us/core/OperationDefinition/docref FHIR-34044 See 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 Application Status

  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

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:
  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:
  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 grammar. All codes SHALL have an system value. Correction “a value system”. (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:
  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:
  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:
  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

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)
  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:
  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:
  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
  57. Clarify search by reference conformance expectations (FHIR-27905) See Changes Here:
  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:
  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

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

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

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

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

Changes:

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


Version = 2.0.0

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

Changes:

STU2 Ballot


Version = 1.0.1

Changes:

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


Version = 1.0.0

Changes:

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


Version = 0.0.0

Changes:

STU1 Ballot