This page is part of the US Core (v4.1.0: STU5 Ballot 1) 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 
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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
- Applied: Make values in direct and birth sex extensions min=1 FHIR-26459 See Change:
- Applied: FIX imm-1.json NDC/CVX codes QA Error FHIR-30104 See Change:
- Applied: Fix patient search parameter definitions to only target Patient FHIR-32305 See Change Here
- Applied: Provide a caution to the user that a query of MedicationRequest does not provide complete information. FHIR-32720 See Change Here
- Applied: Make Condition.encounter 0..1 MS FHIR-32844 See Change Here
- Applied: Correction on USCoreCarePlanProfile Binding FHIR-32846 See Change Here
- Applied: Fix title for BMI Profile FHIR-32847 See Change Here
- Applied: Remove unchanged elements from Differentials FHIR-32848 For example change see
- Applied: Create US Core slices for category elements FHIR-32857 See Change:
- Applied: Change drug class value set for allergens to align with C-CDA FHIR-32953 See Change Here
- Applied: Referencing incorrect figure FHIR-32961 See Change Here
- Applied: Clarify Guidance for missing data for Coding data type element FHIR-33048 See Change Here
- Applied: Fix us-core-1 Invariant for Observation FHIR-33052 See Change Here
- Applied: Remove requirement to use only 401 from capabiltystatement FHIR-33069 See Change Here
- Applied: US Core to USCDI guidance page – add patient email FHIR-33079 See Change Here
- Applied: Utilize “use” field for patient previous name and previous address FHIR-33080 See Change Here
- Applied: Fix search parameter list FHIR-33123 See Change Here
- Applied: Clarify requirement on date searches without prefix FHIR-33156 See Change Here
- Applied: Clarify distinction between repeated search params and ““composite”” params FHIR-33159 See Change Here
- Applied: Add content as mandatory element in narrative for documentreference FHIR-33160 See Change Here
- Applied: Fix invalid elements in extensions FHIR-33233 See Change:
- Applied: Make Procedure.performed conditionally mandatory FHIR-33243 See Change Here
- Applied: add same Null options to Race and Ethnicity FHIR-34036 See Change
- Applied: Clarify MustSupport for Observation.component.value[x] vs dataAbsentReason FHIR-34061 See Change:
- Applied: Add Null options to US Core Birth Sex Extension FHIR-34133 See Change Here
- Applied: USCDI v2 update FHIR-34231 SEE SECTION ABOVE
- Applied: Fix Observation Examples using
appliesTo FHIR-34286 See Change Here
- Applied: Correct CapabilityStatement SMART IG reference FHIR-34281 See Change Here
- Applied: Make DiagnosticReport.effective and DiagnosticReport.issued conditionally mandatory FHIR-34330 See Change:
- Applied: Resolution of http://hl7.org/fhir/us/core/OperationDefinition/docref FHIR-34044 See Change Here
- 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
- 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
- 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
- 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
- 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
- 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
- Resolved - change required: Wrong link to IG homepage from package manifest FHIR-33132 See Change Here - Coordination with HL7 IG publishing team to Correct
Key updates and detailed changes between this and prior versions are available in the US Core change notes
Introduction
The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum set of constraints on the FHIR resources to create the US Core Profiles. It also defines the minimum set of FHIR RESTful interactions for each of the US Core Profiles to access patient data. There are two different ways to implement US Core:
- Profile Only Support: Systems may support only the US Core Profiles to represent clinical information.
- Profile Support + Interaction Support: Systems may support both the US Core Profile content structure and the RESTful interactions defined for a resource.
For a detailed description between these different usages of US Core, see the Conformance Expectations page.
US Core has benefitted from testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. This guide and the US Core profiles have become the foundation for US Realm FHIR implementation guides. This release is the first of yearly US Core updates to reflect changes to U.S. Core Data for Interoperability (USCDI) v1 and requests from the US Realm FHIR community. This Approach is outlined in the Future of US Core page. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm.
Background
The US Core requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. The Argonaut Data Query Implementation Guide superseded DAF and documented security and authorization and the querying of the 2015 Edition Common Clinical Data Set (CCDS) and static documents. US Core descended directly from the Argonaut guide to support FHIR Version STU3 and eventually FHIR R4 and The ONC U.S. Core Data for Interoperability (USCDI) v1.
How to read this Guide
This Guide is divided into several pages which are listed at the top of each page in the menu bar.
- Home: The home page provides the introduction and background for US Core.
- Guidance: These pages provides overall guidance in using the profiles and transactions defined in this guide.
- General Guidance provides guidance, definitions and requirements common to all actors used in this guide.
- Conformance Expectations defines how CapabilityStatements are used and the expectations for mandatory and must support elements in the US Core Profiles. It provides guidance on how a system may support only the resources as profiled by US Core to represent clinical information (Profile Support) versus a system claiming conformance to both the US Core Profile content structure and the RESTful interactions defined for it (Profile Support + Interaction Support).
- Clinical Notes Guidance gives guidance on the interactions between Consumers and Producers of clinical notes.
- Medication List Guidance gives guidance on how a patient or provider can access a patient’s medications.
- Basic Provenance provides implementers with important definitions to create and share the Provenance Resource.
- SDOH Guidance gives background on the exchange of Social Determinants of Health (SDOH) data elements.
- DSTU2 to R4 Conversion considers the user and developer experience when transitioning from FHIR DSTU2 to FHIR R4.
- Future of US Core outlines the approach to adding new content to US Core.
- FHIR Artifacts: These pages provides detailed descriptions and formal definitions for all the FHIR objects defined in this guide.
- Profiles and Extensions: This page lists the set of Profile and Extension that are defined in this guide to exchange quality data. Each Profile page includes a narrative introduction, formal definition and a “Quick Start” guide to the supported search transaction for each Profile.
- Search Parameters and Operations: This page lists the defined Operations and Search Parameters that are used in US Core transactions.
- Terminology: This page lists the value sets and code system defined for profiles.
- Capability Statements: This set of pages describes the expected FHIR capabilities of the various actors.
- Security: General security requirements and recommendations for actors.
- Examples: List of links to all the examples used in this guide.
- Downloads: This page provides links to downloadable artifacts.
US Core Actors
The following actors are part of the US Core IG:
US Core Requestor
An application that initiates a data access request to retrieve patient data. This can be thought of as the client in a client-server interaction. The terms “US Core Requestor” and “Client” are used interchangeably throughout this guide and are not meant to limit this actor to only patient and provider apps, the same technology can be used by payers and other users. Consider these terms as a short-hand notation for something like “user application”
US Core Responder
A product that responds to the data access request providing patient data. This can be thought of as the server in a client-server interaction. The terms “US Core Responder” and “Server” and “EHR” are used interchangeably throughout this guide and are not meant to limit this actor to electronic health record systems. The same technology can be used in HIEs, care coordination platforms, population health systems, etc. Consider these terms as a short-hand notation for something like “interoperable healthcare platform”.
US Core Profiles
The list of US Core Profiles is shown below. Each profile defines the minimum mandatory elements, extensions and terminology requirements that MUST be present. For each profile, requirements and guidance are given in a simple narrative summary. A formal hierarchical table that presents a logical view of the content in both a differential and snapshot view is also provided along with references to appropriate terminologies and examples. For each US Core Profile, an overview of the required set of RESTful FHIR interactions - for example, search and read operations - is provided in the Quick Start Section of the profile page when conforming to the US Core Capability Statements for this profile.
US Core AllergyIntolerance 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 CarePlan Profile
US Core CareTeam Profile
US Core Clinical Test Result Observation Profile
US Core Condition 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 Head Circumference Profile
US Core Heart Rate Profile
US Core Imaging Result Observation Profile
US Core Immunization Profile
US Core Implantable Device Profile
US Core Laboratory Result Observation Profile
US Core Location Profile
US Core Medication Profile
US Core MedicationRequest 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 Related Person
US Core Respiratory Rate Profile
US Core Screening Response Observation Profile
US Core Service Request
US Core Sexual Orientation Observation Profile
US Core Smoking Status Observation Profile
US Core Social History Assessment Observation Profile
US Core Vital Signs Profile
See the General Guidance page for a mapping to the U.S. Core Data for Interoperability (USCDI).
Primary Authors: Brett Marquard, Eric Haas, Gay Dolin
Secondary Authors: Grahame Grieve, Nagesh Bashyam
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