HL7 FHIR® US Core Implementation Guide (Release 3.0.1 STU3 Update for Comment)

This page is part of the US Core (v3.0.1: STU3 Ballot 3) based on FHIR R4. The current version which supercedes this version is 5.0.1. For a full list of available versions, see the Directory of published versions

DSTU2 to R4 Conversion

Introduction

There are several consideration for the user and developer experience when transitioning from DSTU2 to R4. To ensure a smoother upgrade path the following the guidance is provided.

Endpoint Discoverability

FHIR Version - a client should know which version they are dealing with without having inspect metadata on each endpoint

  • A server SHOULD make explicit which version of Argo/US Core on their FHIR endpoint
    • e.g., “DSTU2” or “R4” path component or separate files based on version

    A single best practice may be defined in a future version of this guide through continued engagement with the implementer community.

No Guarantee that Resource IDs are Preserved

In some FHIR servers the identifier of the underlying clinical data is not maintained across FHIR versions. Client applications must plan on deduplication methods that don’t rely on a common identifier across FHIR versions.publication.

  • Servers SHOULD maintain a stable common identifier for a resource across versions.

Expectation that DSTU2 Data is Preserved in R4

In an upgraded R4 endpoint, at a minimum the resources support available in the DSTU2 implementation must be available in R4.

  • Resource types present in DSTU2 endpoint SHALL be present in the R4 endpoint.
    • Exceptions
      • MedicationStatement MAY be deprecated and the data SHALL be mapped to MedicationRequest.
      • care teams as represented by CarePlan in DSTU2 SHALL be replaced by and the data mapped to CareTeam in R4
  • Servers SHALL make available the same data in DSTU2 and R4. ( e.g patient Rhonda Jones is available on both)
    • Exceptions
      • MedicationStatement data mapped to MedicationRequest
      • care teams as represented by CarePlan SHALL be mapped to CareTeam in R4
  • Data SHALL not be degraded between versions.

Authorization Across Versions

  • Separate authorization is required
    • There is no expectation that DSTU2 authorizations will work on R4 endpoints and reauthorization is required when migrating between versions.
      • Maintaining the same auth server for both endpoints so that the refresh token is valid for both DSTU2 the R4 endpoint as well may be possible but not in scope.
  • The new endpoint will bring additional/changed resource types and added scopes

    The table below summarizes the different profiles and resource types between DSTU2 and R4:

DSTU2 Profile Equivalent R4 Profile Notes
Argonaut AllergyIntolerance Profile US Core AllergyIntolerance Profile  
Argonaut CarePlan Profile US Core CarePlan Profile Resource type changed from CarePlan in DSTU2 to CareTeam in R4
Argonaut CareTeam Profile US Core CareTeam Profile  
Argonaut Condition Profile US Core Condition Profile  
Argonaut Device Profile US Core Implantable Device Profile  
Argonaut DiagnosticReport Profile US Core DiagnosticReport Profile for Laboratory Results Reporting  
Argonaut DocumentReference Profile US Core DocumentReference Profile  
Argonaut Goal Profile US Core Goal Profile  
Argonaut Immunization Profile US Core Immunization Profile  
Argonaut Medication Profile US Core Medication Profile  
Argonaut MedicationOrder Profile US Core MedicationRequest Profile  
Argonaut MedicationStatement Profile   US Core MedicationStatement Profile not defined in R4, Map DSTU2 data to MedicationRequest
Argonaut Observation Results Profile US Core Laboratory Result Observation Profile  
Argonaut Patient Profile US Core Patient Profile  
Argonaut Procedure Profile US Core Procedure Profile  
Argonaut Smoking Status Observation Profile US Core Smoking Status Observation Profile  
Argonaut Vital Signs Observation Profile FHIR Vital Signs Profile The FHIR Vital Signs Profile is published in the FHIR specification
- US Core DiagnosticReport Profile for Report and Note exchange New Profile in R4
- US Core Encounter Profile New Profile in R4
- US Core Location Profile New Profile in R4
- US Core Organization Profile New Profile in R4
- US Core Pediatric BMI for Age Observation Profile New Profile in R4 based on the FHIR Vital Signs Profile
- US Core Pediatric Weight for Height Observation Profile New Profile in R4 based on the FHIR Vital Signs Profile
- US Core Practitioner Profile New Profile in R4
- US Core PractitionerRole Profile New Profile in R4
- US Core Provenance Profile New Profile in R4
- US Core Pulse Oximetry Profile New Profile in R4 based on the FHIR Vital Signs Profile