US Core Implementation Guide
7.0.0-ballot - Ballot
US Core Implementation Guide
7.0.0-ballot - Ballot
This page is part of the US Core (v7.0.0-ballot: STU7 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 6.1.0. For a full list of available versions, see the Directory of published versions
| Official URL: http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core | Version: 7.0.0-ballot | |||
| IG Standards status: Trial-use | Maturity Level: 3 | Computable Name: USCore | ||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
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| Page standards status: Informative |
This ballot addresses the following:
We have updated US Core to include the new U.S. Core Data for Interoperability (USCDI) v4 Data Elements and Classes that the Office of the National Coordinator (ONC) published in July of 2023:
For the USCDI Allergies and Intolerances Substance (Non-Medication) data element, no change was needed for the US Core AllergyIntolerance Profile because the existing code element binding to Common substances for allergy and intolerance documentation including refutations already includes “Non-pharmacologic agent”
For the USCDI Encounter Identifier data element, no changes were needed because the US Core Encounter Profile already supports Encounter.identifier as a Must Support element.
Procedure.performed[x] as a Must Support element.DiagnosticReport.performed[x] as a Must Support element.Immunization.occurrence[x] as a Must Support element.For the USCDI Average Blood Pressure data class, the new US Core Average Blood Pressure Profile has been added to US Core. It is based on the US Core Blood Pressure Profile and uses the Vital Signs with Qualifying Elements: Average Blood Pressure Profile as a blueprint.
For the USCDI Medications data class and elements, the US Core MedicationRequest Profile already supports Medication Instructions and has been updated to support Medication Adherence as an Additional USCDI Requirement using the new US Core Medication Adherence Extension.
For the USCDI Laboratory data class and elements, the US Core Laboratory Result Observation Profile already supports Result Unit of Measure data element for using UCUM for coded quantity units and has been updated to support Result Reference Range and Result Interpretation as a Must Support elements. The US Core Specimen Profile has been updated to support Specimen Identifier as a Must Support element, and Specimen Source Site and Specimen Condition Acceptability as Additional USCDI Requirements.
For the USCDI Goals and Preferences data class Treatment Intervention Preference and Care Experience Preference data elements, US Core Treatment Intervention Preference Profile and US Core Care Experience Preference Profile have been added to US Core and use the PACIO Advance Directive Interoperability Implementation Guide’s Care Experience Preference Profile and Personal Intervention Preference Profile as blueprints.
We continue our efforts to link terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) where applicable and, as a result, align terminology between US Core and HL7 C-CDA. The Following Valueset has been moved:
| Pre 7.0.0-Ballot US Core ValueSet | 7.0.0-Ballot VSAC ValueSet |
|---|---|
| US Core Sexual Orientation | Sexual Orientation |
Scopes: To meet the ONC’s granular scope requirement in HTI-1 proposed rule, We added required support for granular scopes as defined in Version 2.0.0 of SMART App Launch and moved the SMART scopes guidance from Future of US Core to a Conformance Page and updated requirements for each profile.
FHIR Write: Add Argonaut Write Guidance for Vital Sign Observations to Record or Update Data section on the Future of US Core Page. See Changes Here and Here
Based on the feedback from the US Core variance request process, we updated several profiles to permit implementers can references to other subject entities as defined in the base standard. This is in addition to the Must Support reference to US Core Patient. We are interested in comments on what the impact on client applications will be. For an example of this change Here)
Where possible, new and updated pre-publishing content are highlighted with green text and background - This highlighting will be removed prior to publication
Key updates and detailed changes between this and prior versions are available on the US Core Change Log and Changes Between Versions pages.
This guide and the US Core profiles have become the foundation for US Realm FHIR implementation guides. This annual release reflects changes to U.S. Core Data for Interoperability (USCDI) v3 and comments and requests from the US Realm FHIR community. (The Future of US Core page outlines this approach to yearly updates.) US Core has benefitted from testing and guidance by the Argonaut Project Team. Their feedback continues to lay the groundwork for documenting the US Core Profile design, interactions, requirements, and guidelines for patient data access and ONC Certification testing. 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.
The US Core Implementation Guide is based on FHIR Version R4. It defines the minimum constraints on the FHIR resources to create the US Core Profiles. The elements, extensions, vocabularies, and value sets that SHALL be present are identified, and how they are used is defined. It also documents the minimum FHIR RESTful interactions for each US Core Profiles to access patient data. Establishing the “floor” of standards to promote interoperability and adoption through common implementation allows for further standards development evolution for specific use cases. There are two different ways to implement US Core:
For a detailed description of these different usages of US Core, see the Conformance Requirements page.
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).
This Guide is divided into several pages, which are listed at the top of each page in the menu bar.
The following actors are part of the US Core IG:
An application that initiates a data access request to retrieve patient data. The US Core Requestor is 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. For example, payers and other users can use the same technology. These terms are a short-hand notation for “user application”.
A system that responds to the data access request providing patient data. The US Core responder is the server in a client-server interaction. The terms “US Core Responder”, “Server”, and “EHR” are used interchangeably throughout this guide and are not meant to limit this actor to electronic health record systems. For example, HIEs, care coordination platforms, population health systems, etc., can use the same technology. These terms are a short-hand notation for “interoperable healthcare platform”.
The list of US Core Profiles is shown below. Each profile identifies which core elements, extensions, vocabularies, and ValueSets SHALL be present in the resource when using this profile. Together they promote interoperability and adoption through common implementation and provide the floor for standards development for specific use cases. See the USCDI page, for a mapping to the U.S. Core Data for Interoperability (USCDI).
A simple narrative summary gives each profile’s requirements and guidance. A formal hierarchical table presents a logical view of the content in both a differential and snapshot view and references to appropriate terminologies and examples are provided.
For systems that support the US Core Profile content structure and the RESTful interactions defined for a resource, the requirements are formally defined in the US Core CapabilityStatements. In addition, each profile page has a Quick Start Section that documents the required FHIR RESTful search and read operations. These sections demonstrate how to access a patient’s clinical and administrative data:
See the FHIR specification for details on FHIR RESTful Search API and the SMART App Launch for how an application gets access to a patient record.
Primary Authors: Brett Marquard, Eric Haas, Gay Dolin
IG © 2023+ HL7 International / Cross-Group Projects. Package hl7.fhir.us.core#7.0.0-ballot based on FHIR 4.0.1. Generated 2023-12-19
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