This page is part of the US Core (v5.0.0: STU5) 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
Change Log
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
- Applied: Remove requirement for component SDOH Assessment’s Observations FHIR-34384 See Change Here
- Applied: Clarify clinicalStatus invariant FHIR-34468 See Change Here
- Applied: Fix Ethnicity ValueSet description FHIR-34488 See Change Here
- Applied: Remove MS from ServiceRequest.occurrenceDateTime add MS to ServiceRequest.occurrencePeriod FHIR-34493 See Change Here
- Applied: Change Goal.description search requirement from SHALL to SHOULD FHIR-34546 See Change Here
- Applied: Warn client that categorization is fuzzy for SDOH FHIR-34550 See Change Here
- Applied: Split US Core Condition into two profile: Encounter Diagnosis and Problems/Health Concerns FHIR-34553 See Change:
- Applied: Update narrative on abatement date FHIR-34554 See Change Here
- Applied: Change Clinical Tests Observations category to “clinical-test” and add guidance FHIR-34555 See Changes:
- 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
- Applied: Referencing US Core Profiles FHIR-34623 See Change Here
- Applied: Correct code system in example snippetFHIR-34624 See Change Here
- Applied: Add further clarification between slicing a binding (4.1.0) vs using extensible binding (4.0.0) FHIR-34626 See Change Here
- Applied: Fix typo FHIR-34627
- Applied: Clarify reported guidance on how secondary sourced MedicationRequest information can be represented. FHIR-34628 See Change Here
- Applied: Fix contextDirection in Example 1FHIR-34629 See Change Here
- Applied: Fix Medication List Examples FHIR-34630 See Change Here
- Applied: Correct Careteam Narrative errors (remove reference to Organization) FHIR-34637 See Change Here
- Applied: Fix typo FHIR-34638
- Applied: Added missing search query parameter values FHIR-34642 See Change Here
- Applied: Inconsistent on conditional required element FHIR-34643 See Change:
- Applied: ServiceRequest.category:us-core should be required? FHIR-34645 See Change Here
- 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:
- Applied: Clarify that SDOH data elements does not include work information (see ODH) FHIR-34701 See Change:
- Applied: Add 386053000 “Evaluation procedure” ,410606002 “Social service procedure” to the ServiceRequest Category Code FHIR-34747 See Change Here
- Applied: Broaden Common SDOH assessment concepts and clarify is a starter set FHIR-34752 See Change:
- 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
- Applied: Clarify guidance for use of Patient.genderIdentity, Patient.birthsex, and pre-existing Patient.gender FHIR-34754 See Change Here
- Resolved - change required: List profiles by type and create table comparing Observation Profiles FHIR-34890 See Changes:
- Applied: Lab Result and Specimen Information for RBC Observation is Missing FHIR-34910 See Change
- Applied: Added guidance on Observation.category limitations FHIR-34949 See Change Here
- Applied: Add guidance on Imaging DiagnosticReport ontology FHIR-34958 See Change Here
- Applied: Clarify that the profile guidance is not limited to profiled elements FHIR-34971 See Change Here
- Applied: Fix asterisk notation in profiles FHIR-34972 See Change Here
- Applied: Clarify “time” elements used in the DiagnosticReport profiles FHIR-34973 See Change:
- Applied: Change the query parameter value to be consistent with previous statement FHIR-35047 See Change Here
- Applied: Re-ordered sections in Downloads page and provide a zip file of schematrons FHIR-35064 See Change Here
- 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:
- Applied: Clarify expectations for supporting multiple versions of US Core.FHIR-35067 See Change Here
- Applied: Clarify that Changes Between Versions (né DSTU2 to R4 Conversion) page documents a set of best practices FHIR-35068 See Change Here
- Applied: Typo in Category Codes section FHIR-35072 See Change Here
- Applied: Typo FHIR-35115
- Applied: Provide guidance when specific code systems are to be used in ServiceRequest FHIR-35122 See Change Here
- Applied: Clarify description for effective time. FHIR-35125 See Change Here
- Applied: Fix CareTeam example’s participant.role value FHIR-35152 See Change Here
- Applied: US Core Condition profile ““status”” is ambiguous; clarify to be clinicalStatus FHIR-35280 See Change Here
- Applied: Align Observation category for SDOH assessments FHIR-35282 See Change Here
- Applied: Add effective[x] 0..1 MS to US Core Observation Social History Profile FHIR-35283 See Change Here
- Applied: Clarify Condition.clinicalStatus requirements and searching using clinical-status FHIR-35318 See Change Here
- Applied: Fix link FHIR-35362
- Applied: Modify example usage text in all profile pages FHIR-35363 See Change Here
- Applied: Clarify modeling of SDOH screening using Observations, Add QuestionnaireResponse profile as alternative screening instrument FHIR-35364 See Changes:
- Applied: Clarify $docref operation expectations FHIR-35380 See Change Here
- Applied: Typo FHIR-35388
- Applied: Duplicate sections in US Core RelatedPerson Profile profile FHIR-35452
- Applied: Updated guidance on changes between versions FHIR-35576 See Change Here
- Applied: Split section on “deleted” from “entered in error” FHIR-35622 See Change Here
- Applied: Use “sdoh” instead of “LG41762-2” for SDOH Categories and Tags FHIR-35644 See Changes:
- Applied: Update Gender Identity Value setFHIR-35677 See Change Here
- Applied: Remove “OTH” from OMB Race Category valueSet FHIR-35694 See Change Here
- Applied:Add basic introduction to the FHIR RESTful Search interaction in the home page FHIR-35755 See Change Here
- Applied: Remove MS from DiagnosticReport.imagingStudy FHIR-35759 See Change Here
- Applied: Media example data value fails regex FHIR-35790 See Change Here
- Applied: Typo FHIR-35844
- Applied: Typo FHIR-35851
- Applied: Change fixed category slice to max=1 FHIR-35854 See Change Here
- Applied: Clarify narrative of status “active” element. FHIR-35870 See Change Here
- Applied: allow ethnicity extension in FamilyMemberHistory FHIR-35997 See Change Here
- Applied: allow race extension in FamilyMemberHistory FHIR-35998 See Change Here
- Applied: Update Condition Implementation Guidance to reflect current USCDI terminology standards FHIR-36056 See Change Here
- Applied: Clarify expectations for reader FHIR-36057 See Changes:
- Applied: Update US Core Yearly Updates FHIR-36058 See Change Here
- Applied: Remove “Cause of death” from Condition.category and remove US Core Condition Category Codes ValueSet FHIR-36104
- Applied: Add OTH to sexual orientation ValueSet FHIR-36166 See Change Here
- Applied: Updated coding
system
in Missing Data documentation FHIR-36177 See Change Here
- Applied: Add “Other Race” to OMB Race Categories FHIR-36247 See Change Here
- Applied: Add MS to Device.distinctIdentifier to correct editorial error FHIR-36303 See Change Here
- Applied: Fix provenance-1 invariant FHIR-36328 See Change Here
- Applied: Correct _targetProfile element in Provenance StructureDefinition FHIR-36344 See Change Here
- Applied: Correct guidance on accessing VSAC Valuesets FHIR-36639 See Change Here
- Applied: Move change log from version history to new change log page in IG FHIR-36703 See Change Here
- Applied: Remove redundant example sections FHIR-36728
- Applied: Realign ids names and titles for all new profiles for consistency FHIR-36766 See Change Here
- Applied: Move profile page introduction into structuredefinition description FHIR-36824 See Change Here
- Applied: Fixed profile, Added STU Note, Updated FHIR Core Vitals Profile binding in FHIR R4B. FHIR-27845 See Change Here
- Applied: Change Encounter.reasonReference from 0..1 to 0..* FHIR-36862 See Change Here
- 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
- 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.
- Resolved - change required: valueset-simple-language.xml QA Error FHIR-30107 Working with HL7 publishing to fix.
- 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
- 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
- Resolved - change required: AllergyIntolerance does not show constraint FHIR-34636
- 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:
- 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
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:
- 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.
- 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
- 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
- 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.
- 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
- Applied:Update PractitionerRole.practitioner to )..1 MS (FHIR-29681) See Change Here
- Applied:Change CareTeam
status
search parameter compositeOR expectation to SHOULD (FHIR-29768) See Change Here
- Applied:Provide guidance on the population of narrative (FHIR-29777) See Change Here
- Applied: Change $docref start and end input parameter types from
date
to dateTime
(FHIR-29825) See Change Here
- Applied: The history file markdown rendering of the table (FHIR-30100) See Change Here
- Applied:footnote rendering - pre-applied (FHIR-30101) See Change Here
- Applied:Random Section Numbering (Reminder for tooling issue) (FHIR-30102) See Change Here
- Applied:Move section 1.5 US Core Conformance Requirements (FHIR-30103) See Change Here
- Applied:Make custodian optional on document reference (FHIR-30108) See Change Here
- Applied:Remove required binding on procedure and condition (FHIR-30109) See Changes:
- Applied:Update DocumentReference CCD operation (FHIR-30110) See Change Here
- Applied:Update DocumentReference MustSupport to choice of data or url (FHIR-30111) See Change Here
- Applied:Reference to 3 new document types - addressing corresponding metadat (FHIR-30112) See Change Here AND See Change Here
- Applied:Typo (FHIR-30113)
- Applied:Clarify Must Support of Complex elements (FHIR-30321) See Change Here
- Applied:Clarify that VSAC FHIR API only retrieves a definition (FHIR-30344) See Change Here
- Applied:Allergy Intolerance example for UNKNOWN allergy status does not use unknown (FHIR-30345) See Change Here
- Applied:Corrected allergy intolerance example SNOMED CT code (FHIR-30346) See Change Here
- Applied:Allergy codes updated to snomed product hierarchy in VSAC(FHIR-30347) See Change Here
- Applied:Clarify plans to align with Gender Harmony(FHIR-30350) See Change Here
- Applied:Typos on Conformance Expectations Page (FHIR-30353) See Change Here
- Applied:clarify use of additional codings (FHIR-30354) See Change Here
- Applied:Clarify server requirements for Choice of Profile Elements scenario (FHIR-30355) See Change Here
- Applied:Add all options to Procedure.performed[x] (FHIR-30391) See Change Here
- Applied:Updated MedicationRequest.authoredOn from mandatory to must support(FHIR-30430) See Change Here
- Applied:Typo (FHIR-30460) See Change Here
- Applied: Update Encounter Type CPT Description (FHIR-30470) See Change Here
- Applied: Clarify Missing Data language for coded data elements with required binding strength (FHIR-30630) See Change Here
- Applied:Note re language codes(FHIR-30654) See Change Here
- Applied:Change URL for Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes(FHIR-30655) See Changes Here and Here
- Applied:Typo (FHIR-30656)
- Applied: Explain the relationship between US CORE and an evolving USCDI. (FHIR-30657) See Change Here
- Applied:Correct 2 bullet points in section 1.2. (FHIR-30658) See Change Here
- Applied:Clarify actors (FHIR-30659) See Change Here
- Applied:Edit basic provenance (FHIR-30660) See Change Here
- Applied:Clarify the duplication requirement for scanned documents in DocumentReference and DiagnosticReport. (FHIR-30662) See Change Here
- Applied:Clarify that clients should retain data visualization between DSTU2 to R4 upgrades. (FHIR-30665) See Change Here
- Applied:Add provenance to writing/updating guidance? (FHIR-30666) See Change Here
- Applied:Clarify Code System section and update codesystem table (FHIR-30667) See Change Here
- Applied: Clarify guidance on implantable medical devices. (FHIR-30669) [See Change Here
- Applied: Make udi_HRF a Must Support element. (FHIR-30670) See Change Here
- Applied: Clarify UDI information. (FHIR-30672) See Changes:
- Applied:Clarify text (FHIR-30673) See Change Here
- Applied:Typos (FHIR-30674)
- Applied:Clarify prohibition on using contained resources. (FHIR-30677) See Change Here
- Applied:Add guidance on suppressed data. (FHIR-30678) See Change Here
- Applied:Clarify what is meant by “support the other elements.” (FHIR-30680) See Change Here
- Applied:Typo(FHIR-30681)
- Applied:Fix typos (FHIR-30683) Various Changes
- Applied:Update on Guidance on DataAbsentReason for Observations (FHIR-30685) See Change Here
- Applied:Clarify use of qualifier LOINCs (FHIR-30690) See Change Here
- Applied: Fix Typo (FHIR-30695) See Change Here
- Applied: Update on Guidance on DataAbsentReason for Observations (FHIR-30699) See Change Here
- Applied: Clarify what is intended with “additional observations”(FHIR-30772) See Change Here
- Applied: Add statement about clinical safety to the security page (FHIR-30776) See Change Here
- Applied: Added clarification to vitals profile regarding use of additional codings and component observations. (FHIR-30778) See Change Here
- Applied: Typo grammar. All codes SHALL have an system value. Correction “a value system”. (FHIR-30782) See Change Here
- Applied: Clarify resource search requirements CapabilityStatements and provide guidance on search for multiple patients using Bulk data (FHIR-30787) See Changes:
- Applied: Add MedicationAdministration to the Future Page. (FHIR-30788) See Change Here
- Applied: Fix text in $docref description (FHIR-30810) See Change Here
- Applied: Mandate that CapabilityStatement.instantiates refer to US Core (FHIR-30889) See Change Here
- Applied: Add binding so Vitals will render it in differential view (FHIR-31391) See Change Here
- Applied: Update to URI from OID for CDT in Procedure Code ValueSet (FHIR-31556) See Change Here
- Applied: Add DocumentReference.content is under “must have” list (FHIR-31364) See Change Here
- Applied: Update Must Support Bullet regarding missing data (FHIR-31507) See Change Here
- Applied: Update use context for Race and Ethnicity extensions (FHIR-31008) See Change Here
- Applied: Add guidance on “POST based search” (FHIR-31585) See Changes:
- Applied: Add reference to Mapping from LOINC scale type to FHIR data type (FHIR-31084) See Change Here
- Applied: Update Observation.value[x] definition (FHIR-31083) See Change Here
- Applied: Add LOINC to procedure codes (FHIR-31514) See Change Here
- Applied: Make PractitionerRole.organization must support and add invariant (FHIR-29680) See Change Here
- Applied: Fix FHIRPath constraint for provenance-1(FHIR-31020) See Change Here
- Applied: Add guidance to BMI Profile(FHIR-32658) See Change Here
- Applied: Write usage note for non-vaccination CVX codes(FHIR-31899) See Change Here
- Applied: Clarify that Extensible binding can always provide a mapped code(FHIR-32010) See Change Here
- Applied: Clarify RESTFul requirements(FHIR-31490) See Changes:
- 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
Terminology
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:
- 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)
- Publishing a set US Core Vital Signs independent of the FHIR core profile upon which it is based (see individual trackers below for details)
- Linking terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable
- 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)*
- Addressing over 95 outstanding trackers.
Trackers items and links to the updated content
listed below are the resolved trackers for this version:
-
Must Support Over Interpreted (FHIR-28375) Changes throughout the profiles – added conformance page See Change Here
-
Replace the US Core Update Allergy substances value set with VSAC reference (FHIR-29322) See Change Here
-
Update Organization Quick Start Example Search. (FHIR-29269) See Change Here
-
birthsex binding applied to the wrong element in US Core Patient StructuredDefinition/differential (FHIR-29262) See Change Here
-
us-core-12 invariant interpretation (FHIR-28942) See Changes Here
-
Incorrect Description Observation.component (Pulse Ox) (FHIR-28934) See Change Here
-
References should be constrained to use reference
not identifier
(FHIR-28573) See Change Here
-
Update USCorePatientName search description for consistency (FHIR-28540) See Change Here
-
Make Provenance.author optional (FHIR-28517) See Change Here
-
Add must support type choices for US Core Goal.target.due[x]. (FHIR-28477) See Change Here
-
Immunization Profile Mandatory and Must Support Intro is missing attributes (FHIR-28452) See Change Here
-
DiagnosticReport-cardiology-report JSON and XML samples contain invalid hashes (FHIR-28408) See Change Here
-
MedicationRequest.medication[x] (FHIR-28395) See Change Here
-
Fix MedicationRequest.encounter reference (FHIR-28258) See Change Here
-
Fix typo: “an another” -> “another” (FHIR-28227) See Change Here
-
Declare mustSupport on Organization telecom children (FHIR-28216) See Change Here
- Resolve remaining discrepancies with FHIR R4 Search Parameters (FHIR-28181) See Changes Here:
-
Provenance without activity is not very useful (FHIR-28179) See Change Here
-
Make Provenance.target.reference mandatory (FHIR-28165) See Change Here
-
Missing narrative Element (FHIR-28159) See Change Here
-
“Updated guidance regarding gender and sex.” (FHIR-28138) See Change Here
-
Replace the US Core Smoking Status with VSAC reference (FHIR-28123,FHIR-26059) See Change Here
-
Timing association for smoking status changed from issued
to effectiveDateTime
(FHIR-28090) See Change Here
-
Remove Must Support from Patient.telecom (FHIR-27731) See Change Here
-
Remove Must Support from Patient.communication.language (FHIR-27730) See Change Here
-
Remove Must Support from us-core-birthsex extension (FHIR-27729) See Change Here
-
Remove Must Support from us-core-ethnicity extension (FHIR-27728) See Change Here
-
Remove Must Support from us-core-race extension (FHIR-27727) See Change Here
-
Expand US Core state value set to include US Military codes (FHIR-26833) See Change Here
-
Fixed Value Set Expansion Operation examples (FHIR-26625) See Change Here
-
Add must support reference type choices for US Core laboratory DiagnosticReport.performer (FHIR-25120) See Change Here
-
Fix US-Core-1 constraint on Observation.effectivePeriod (FHIR-29658) See Change Here
- 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:
-
Remove text “an author responsible for the update”. Keep author organization (FHIR-28516) See Change Here
-
“Clarify expectations when accessing “other endpoint” for DocumentReference.content.attachment.url” (FHIR-28472) See Change Here
-
Add a required category to smoking status (FHIR-28436) See Change Here
-
Use of US Core Profile when not explicitly referenced when using Contained resources (FHIR-28396) See Change Here
-
DocumentReference.custodian to be Optional (FHIR-28393) See Proposed Change Here
-
Encounter.serviceProvider Must Support and Encounter.location.location Optional (FHIR-28392) See Change Here
-
Observation.hasMember Vital Signs Panel Profile Reference Choice (FHIR-28391) See Change Here
-
Add must support type choices for Observation.value[x] for Lab Observation Profile (FHIR-28390) See Change Here
-
Add must support type choices for Observation.effective[x] for Lab Observation Profile (FHIR-28389) See Change Here
-
Add must support type choices for Immunization.occurrence[x] (FHIR-28388) See Change Here
-
Add must support type choices for DiagnosticReport.effective[x] for Note Data (FHIR-28387) See Change Here
-
Add must support type choices for DiagnosticReport.effective[x] for Lab Data Type (FHIR-28385) See Change Here
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Add must support reference type choices for Provenance.agent.who Reference (FHIR-28383) See Change Here
-
Add must support reference type choices for MedicationRequest.requester Reference (FHIR-28382) See Change Here
-
Add must support reference type choices for MedicationRequest.reported Choice (FHIR-28381) See Change Here
-
Add must support reference type choices for DocumentReference.author Reference (FHIR-28380) See Change Here
-
Add must support reference type choices for DiagnosticReport.performer for Note (FHIR-28379) See Change Here
-
Add must support reference type choices for DiagnosticReport.performer for Lab (FHIR-28378) See Change Here
-
Add must support reference type choices for CareTeam.participant.member Reference (FHIR-28376) See Change Here
-
Add choice for and type choices for Encounter.reasonReference (FHIR-27951) See Change Here
-
Add choice for Procedure.performed[x] (FHIR-29695) See Change Here
-
Clarify deleted resources requirements and guidance (FHIR-28091) See Change Here
- Clarify search by date precision conformance expectations (FHIR-27906) See Change Here
- Clarify search by reference conformance expectations (FHIR-27905) See Changes Here:
-
Add “Cause of Death” to category codes to meet the Public Health Use Case for VRDR (FHIR-27904) See Change Here
-
Address non-implantable device and how to document usage (FHIR-27896, FHIR-23715, FHIR-23715) See Change Here
-
Resource constraints based on Jurisdiction which are not well documented (FHIR-27810) See Change Here
-
Updated CPT copyright to current year (FHIR-27770) See Change Here
-
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
-
Remove US Core Server Capability Statement requires support for HTTP status 410-deleted (FHIR-26597) See Change Here
-
Change US Core Condition Codes Value Set Logical Definition (FHIR-26060) See Change Here
-
Recommend against using SSN for Patient.identifier (FHIR-24903) See Change Here
-
Remove identifier (OID) from ValueSet: US Core Encounter Type (FHIR-29691) See Change Here
- Review vocabulary to align with CCDA and use VSAC valueset where possible (FHIR-22488) [See Changes Here:
-
Remove CVX-NDC mapping table (FHIR-29745) See Change Here
-
Since CarePlan.text.div is min== 1 add must support == true element to be consistent with US Core design (FHIR-29765) See Change Here
-
Remove unused US Core ICD-10-PCS Procedure Codes valueset (FHIR-29822)
- 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.:
- Add guidance for representing patient name suffix and previous patient name to the US Core Patient Profile (FHIR-28129)
- Correct copy/paste error in Goal Profile (FHIR-28109)
- Correct US Core Provider Specialty (NUCC) ValueSet to hide abstract grouping codes (FHIR-27975)
- Added example of US Core Direct Extension to Practitioner-2 Example (FHIR-27947)
- Corrected technical errors in pediatric profiles StructureDefinitions (FHIR-27946)
- Corrected errors in DiagnosticReport Cardiology Example (FHIR-27913)
- Update Federal Register link for OMB race and ethnicity category classifications. (FHIR-27907)
- Clarified token search syntax (FHIR-27897).
- Corrected US Core DocumentReference Profile to support multiple attachments (FHIR-25778).
- Fix FHIRPath Expression in USCoreGoalTargetDate (FHIR-27892).
- Fix FHIRPath Expression in USCoreProcedureDate(FHIR-27887).
- Add omitted “ge” comparators to SearchParameters (FHIR-27893).
- Remove Must Support References to non US Core Profiles (FHIR-27876)
- Add missing reaction to the US Core AllergyIntolerance Profile (FHIR-27867).
- Clarify reference to US Core Patient in Vitals Signs Profiles (FHIR-27857).
- 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)
- Correct UCUM Unit in US Core Pulse Oximetry Profile Text Summary (FHIR-27845)
- Update Procedure Codes Value Set to include ICD-10 PCS codes (FHIR-27836)
- Update Procedure Codes Value Set to include CDT codes (FHIR-27737)
- Clarify that pediatric vital sign percentile Observations should reference growth chart (FHIR-27549),
- Added Missing US core Head Occipital-frontal Circumference Percentile Profile (FHIR-27542).
- Correct requirements for supporting CLIA identifiers (FHIR-27158)
- Change Description of ICD-10-PCS Value Set (FHIR-27116)
- Correct AllergyIntolerance guidance for verificationStatus (FHIR-27096)
- Fix example US Core heart-rate example (FHIR-27086)
- review period comments Update smoking status codes to align with USCDI (FHIR-27082).
- Fix invariant provenance-1 (FHIR-27065)
- Fix invalid json snippet (FHIR-27001)
- 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).
- Correction on USCDI Table change “MedicationStatement” to “MedicationRequest” and remove references to MedicationStatement in the Medication Profile and CapabilityStatements (FHIR-26840).
- Clarify that US Core Location/PractitionerRole are not being referenced by other resources (FHIR-26840).
- Correct editing error restoring Write and Operation capability guidance into DocumentReference QuickStart (FHIR-26840).
- Clarify guidance that servers SHALL support search with status if status required (FHIR-26840).
- Correct canonical url for ImplementationGuide (FHIR-26686).
- Correct system URI for ICD-10 procedure codes (FHIR-26679).
- Fix invariant us-core-1 (FHIR-26605).
- 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).
- 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).
- Add page contents to Clinical Notes Guidance and Basic Provenance pages (FHIR-25785).
- Fix duplicate URL causing validation failure. (FHIR-25536).
- Fix Invariant us-core-8 (FHIR-25459).
- Corrected the wording “should support” to “shall support” in Clinical Notes Guidance (FHIR-25455).
- Fix Invariant us-core-8 to allow for Data Absent Reason Extension on Patient name.(FHIR-25249).
- Fix Link to LOINC LP29708-2 (FHIR-25213).
- 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