The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2025 HL7 balloting process. The HL7 International Cross-Group Projects work group members have agreed to and voted on the resolution of the community comments. For a detailed list of the changes for this version, see the Change Notes: http://hl7.org/fhir/us/core/STU8/changes.html.
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The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2025 HL7 balloting process. The HL7 International Cross-Group Projects work group members have agreed to and voted on the resolution of the community comments. For a detailed list of the changes for this version, see the Change Notes.
01. === Added this STU NOTE: This profile is technically non-conformant with the base FHIR ver 4.0.1 vitals profile, which defines a required binding that excludes the concept for L/min for Observation.component.value(x). This is a known issue, which means validation errors may occur when validating against this version of the US Core Pulse Oximetry Profile. This issue has been corrected in base FHIR ver 4.3.0 ("Release 4B"), which will correct this error when this guide is based on a newer version of FHIR. ===
ERROR: Observation/satO2-fiO2: Observation.component[0].value.ofType(Quantity): The code provided (http://unitsofmeasure.org#L/min) was not found in the value set' Vital Signs Units' (http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1), and a code from this value set is required: The provided code 'http://unitsofmeasure.org#L/min' was not found in the value set 'http://hl7.org/fhir/ValueSet/ucum-vitals-common|4.0.1' (0 uses)
ERROR: US Core Vital Signs Profile.Observation.component.value[x]: illegal attempt to change the binding on Observation.component.value[x] from required to extensible (0 uses)
04. === Several examples derived from this profile are provided in this guide (1) ===
WARNING: StructureDefinition.where(URL = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-vital-signs'): The Implementation Guide contains no examples for this profile (1 uses)
05. === These questionnaires are created using NLM tooling based on LOINC LFORMs. They use standard FHIR Questionnaire Extensions that "extend" the base SDC profile ===
This element does not match any known slice defined in the profile http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|3.0.0 (10 uses)
06. === The code is from the US Core defined NUCC binding and not from base FHIR preferred c80-practice-codes value set (updated text from 7.0.0) ===
None of the codings provided are in the value set 'Practice Setting Code Value Set' (http://hl7.org/fhir/ValueSet/c80-practice-codes|4.0.1), and a coding is recommended to come from this value set (codes = http://nucc.org/provider-taxonomy#208D00000X) (1 uses)
INFORMATION: StructureDefinition.where(url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole'): The Implementation Guide contains no explicitly linked examples for this profile (1 uses)
08. ==== The following content is inherited from the base standard and cannot be changed ====
The string value contains text that looks like embedded HTML tags. If this content is rendered to HTML without appropriate post-processing, it may be a security risk (1 uses)
09. ==== The pattern is set in a repeating slice. The pattern is expected to hold for all repetitions of that slice. (It's fixing the 'system' for the identifier.) ====
The repeating element has a pattern. The pattern will apply to all the repeats (this has not been clear to all users) (4 uses)
10. ==== The self-link for these searchset bundles is to the $docref operation and not to a FHIR search string====
No types could be determined from the search string, so the types can't be checked (2 uses)
11. === Using the extension US Core Extension Questionnaire URI pointing to a pdf form of the Questionnaire for this example. Regarding the message: "No questionnaire is identified, so no validation can be performed against the base questionnaire" ===
INFORMATION: QuestionnaireResponse/glascow-coma-score: QuestionnaireResponse: No questionnaire is identified, so no validation can be performed against the base questionnaire (1 uses)
15. === This Search Parameter expression `Goal.target.due as date` is inherited from the FHIR base. Since US Core inherits from the FHIR R4 base, this warning is acknowledged as an issue with the base specification. In R5, this expression has been updated to `(Goal.target.due.ofType(date))`. ===
WARNING: SearchParameter/us-core-goal-target-date: SearchParameter.expression: The left side is inherently a collection, and so the expression 'Goal.target.due as date' may fail or return false if there is more than one item in the content being evaluated (1 uses)
17. === The 'no-narrative' parameter is used for these resources instances because they are displayed as inline JSON examples to illustrate transactions, and the narrative degrades human readability ===
WARNING: Bundle/docref-example-1: Bundle.entry[0].resource/*DocumentReference/ccd123*/: Constraint failed: dom-6: 'A resource should have narrative for robust management' (defined in http://hl7.org/fhir/StructureDefinition/DomainResource) (Best Practice Recommendation) (1 uses)
WARNING: Bundle/docref-example-2: Bundle.entry[0].resource/*DocumentReference/procedure-note123*/: Constraint failed: dom-6: 'A resource should have narrative for robust management' (defined in http://hl7.org/fhir/StructureDefinition/DomainResource) (Best Practice Recommendation) (1 uses)
WARNING: Bundle/docref-example-2: Bundle.entry[1].resource/*DocumentReference/procedure-note456*/: Constraint failed: dom-6: 'A resource should have narrative for robust management' (defined in http://hl7.org/fhir/StructureDefinition/DomainResource) (Best Practice Recommendation) (1 uses)
WARNING: Bundle/docref-example-2: Bundle.entry[2].resource/*DocumentReference/discharge*/: Constraint failed: dom-6: 'A resource should have narrative for robust management' (defined in http://hl7.org/fhir/StructureDefinition/DomainResource) (Best Practice Recommendation) (1 uses)
WARNING: DocumentReference/discharge-summary: DocumentReference: Constraint failed: dom-6: 'A resource should have narrative for robust management' (defined in http://hl7.org/fhir/StructureDefinition/DomainResource) (Best Practice Recommendation) (1 uses)
18. === The following code system and value set are in FHIR Core/THO and not under the direct control of US Core editors ===
Reference to draft CodeSystem http://hl7.org/fhir/narrative-status|4.0.1 (1 uses)
Reference to draft CodeSystem http://terminology.hl7.org/CodeSystem/condition-category|1.0.0 (4 uses)
Reference to draft CodeSystem http://terminology.hl7.org/CodeSystem/coverage-class|1.0.0 (4 uses)
Reference to draft CodeSystem http://terminology.hl7.org/CodeSystem/observation-category|1.0.0 (54 uses)
Reference to draft CodeSystem http://terminology.hl7.org/CodeSystem/organization-type|2.0.0 (4 uses)
There are multiple different potential matches for the url 'http://terminology.hl7.org/ValueSet/v3-PurposeOfUse'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '3.1.0', found versions: 3.0.0, 3.1.0. Suggested fix: change the canonical reference from 'http://terminology.hl7.org/ValueSet/v3-PurposeOfUse' to 'http://terminology.hl7.org/ValueSet/v3-PurposeOfUse|3.1.0' (1 uses)
19. ==== The following code systems are not discoverable because they are code systems in THO, but THO doesn't define the codes. They have been checked, and the identifiers are correct (updated text from 7.0.0) ===========
WARNING: Observation/observation-occupation-industry-unknown: Observation.value.ofType(CodeableConcept).coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/PHOccupationalDataForHealthODH' could not be found, so the code cannot be validated (1 uses)
WARNING: Observation/observation-occupation-unknown: Observation.component[0].value.ofType(CodeableConcept).coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/PHOccupationalDataForHealthODH' could not be found, so the code cannot be validated (1 uses)
WARNING: Observation/observation-occupation: Observation.component[0].value.ofType(CodeableConcept).coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/PHOccupationalDataForHealthODH' could not be found, so the code cannot be validated (1 uses)
WARNING: Observation/observation-occupation: Observation.value.ofType(CodeableConcept).coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/PHOccupationalDataForHealthODH' could not be found, so the code cannot be validated (1 uses)
WARNING: ValueSet.where(id = 'us-core-condition-code'): Error from https://tx.fhir.org/r4: Unable to provide support for code system http://terminology.hl7.org/CodeSystem/icd9cm (1 uses)
21. === The following code system is not discoverable because they are code systems in THO, but THO doesn't define the codes due to AHA NUBC Patient Discharge Status Codes IP issues. These codes were checked manually (updated text from 7.0.0)===
WARNING: Encounter/1036: Encounter.hospitalization.dischargeDisposition.coding[0].system: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/nubc-UB92' could not be found, so the code cannot be validated (1 uses)
WARNING: Encounter/1036: Encounter.hospitalization.dischargeDisposition: A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/nubc-UB92' could not be found, so the code cannot be validated; Unable to check whether the code is in the value set 'http://terminology.hl7.org/ValueSet/v3-USEncounterDischargeDisposition|3.0.0' because the code system http://terminology.hl7.org/CodeSystem/nubc-UB92 was not found (1 uses)
WARNING: Encounter/1036: Encounter.hospitalization.dischargeDisposition: Unable to check whether the code is in the value set 'http://terminology.hl7.org/ValueSet/v3-USEncounterDischargeDisposition|3.0.0' because the code system http://terminology.hl7.org/CodeSystem/nubc-UB92 was not found (1 uses)
22. ====FHIR R4 http://hl7.org/fhir/ValueSet/formatcodes is in error which has been corrected in the FHIR R5. The guide is referencing the "HL7 ValueSet of Format Codes for use with Document Sharing" that is used in R5 (updated text from 7.0.0) ===
INFORMATION: Bundle/docref-example-1: Bundle.entry[0].resource/*DocumentReference/ccd123*/.content[0].format: The Coding provided (http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes#urn:hl7-org:sdwg:ccda-structuredBody:2.1) was not found in the value set 'DocumentReference Format Code Set' (http://hl7.org/fhir/ValueSet/formatcodes|4.0.1), and a code is recommended to come from this value set. (error message = The provided code 'http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes#urn:hl7-org:sdwg:ccda-structuredBody:2.1: 'ccda-structuredBody:2.1'' was not found in the value set 'http://hl7.org/fhir/ValueSet/formatcodes|4.0.1') (1 uses)
23. ==== The US Core Team is aware of this and will budget and move these values to THO in a future publication cycle ===
Most code systems defined in HL7 IGs will need to move to THO later during the process. Consider giving this code system a THO URL now (See https://confluence.hl7.org/display/TSMG/Terminology+Play+Book, and/or talk to TSMG) (5 uses)
24. ==== Understood and note that this is rendered by the ig-publisher in the ig ====
The value set expansion is too large, and only a subset has been displayed (3 uses)
26. === Using the standard CapabilityStatementExpectation extension in additional contexts to fully express intended capabilities: see FHIR-12419 (115) (updated text from 7.0.0-ballot) ===
This element does not match any known slice defined in the profile http://hl7.org/fhir/StructureDefinition/capabilitystatement-search-parameter-combination|5.2.0 (this may not be a problem, but you should check that it's not intended to match a slice) (138 uses)
27. === These Examples demonstrate the use of additional Codes or Identifiers not defined in US Core profiles Updated from 8.0.0-ballot ===
A definition for CodeSystem 'http://example.org/fhir/michigan.gov/lara/license-type' could not be found, so the code cannot be validated (1 uses)
This element does not match any known slice defined in the profile http://hl7.org/fhir/us/core/StructureDefinition/us-core-average-blood-pressure|8.0.0 (1 uses)
This element does not match any known slice defined in the profile http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|8.0.0 (2 uses)
This element does not match any known slice defined in the profile http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|8.0.0 (4 uses)
This element does not match any known slice defined in the profile http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry|8.0.0 (1 uses)
28. === In this example, representing the concept clearly with human-readable annotations {pack-years} is not misleading. It clearly illustrates how to use the Observation with the code and demonstrates a clinical need outweighing concerns about using annotations. ===
WARNING: Observation/pack-years-example: Observation.value.ofType(Quantity): UCUM Codes that contain human readable annotations like {pack-years} can be misleading (e.g. they are ignored when comparing units). Best Practice is not to depend on annotations in the UCUM code, so this usage should be checked (1 uses)
29. === US Core thoroughly documents its Must Support expectations for the must supports, including how they apply to the choice of target references. See this chat https://chat.fhir.org/#narrow/channel/179252-IG-creation/topic/Must.20Support.20Target.20Error.20for.20Reference.20type.20Element ===
The element Procedure.performer.actor has types/profiles/targets that are marked as must support, but the element itself is not marked as must-support (1 uses)
30. === Two Bundle examples use this profile and one non-validated inline example that conforms to it as well - when the publisher understands versioned examples, we will create a published example to replace it. ===
INFORMATION: StructureDefinition.where(url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance'): The Implementation Guide contains no explicitly linked examples for this profile (1 uses)
31. === The binding applies to the Quantity data type for US Core Vitals Signs Profile. It inherits the structure from Core, and a change request to correct this has been applied to the base FHIR ver 4.3.0 ("Release 4B"). Will need to slice value[x] in future (updated text from 7.0.0) ===
The element Observation.component.value[x] has a binding, and has multiple types subject to bindings ([dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, Range, CodeableConcept]). The binding will apply to all the types (1 uses)
The element Observation.value[x] has a binding, and has multiple types subject to bindings ([dateTime, boolean, string, SampledData, Quantity, Period, Ratio, integer, time, Range, CodeableConcept]). The binding will apply to all the types (1 uses)
33. === To comply with Executive Order 14168, the following changes were made: 1)Removed USCDI mapping, guidance, and examples for the US Core Observation Sexual Orientation Profile 2) Removed the US Core Birth Sex Extension, guidance, and examples from the US Core Patient Profile 3) Deprecated the US Core Gender Identity Extension and removed it from the US Core Profile, USCDI mapping, guidance, and examples. Although the profiles and extensions will remain in this version of US Core to allow for backward compatibility - no examples will be supplied. ===
WARNING: StructureDefinition.where(url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex'): The Implementation Guide contains no examples for this extension (1 uses)
WARNING: StructureDefinition.where(url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-sexual-orientation'): The Implementation Guide contains no examples for this profile (1 uses)
WARNING: StructureDefinition/us-core-genderIdentity: StructureDefinition: The resource status 'active' and the standards status 'deprecated' are not consistent (1 uses)
34. === US Core provides IG-specific guidance on interpreting Must Support for slices at `~/must-support.html#must-support---slices`. Where we state: "...the slicer's Must Support property only defines the element level Must Support/Additional USCDI property. In other words, the slicer's Must Support/Additional USCDI is not inherited by the slices, and each slice must be explicitly tagged with the Must Support/Additional USCDI property to define that slice's conformance strength. If no Must Support/Additional USCDI property is defined for the slice, this lengthy chat: https://chat.fhir.org/#narrow/channel/179252-IG-creation/topic/Slices.20not.20inheriting.20preferred.20bindings.20from.20root/with/514257770 and the resulting tracker FHIR-50391. ===
The slice 'CLIA' on path 'Organization.identifier' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
The slice 'NAIC' on path 'Organization.identifier' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
The slice 'screening-assessment' on path 'Condition.category' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
The slice 'screening-assessment' on path 'Observation.category' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
The slice 'us-core' on path 'Observation.category' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
The slice 'uscore' on path 'DocumentReference.category' is not marked as 'must-support' which is not consistent with the element that defines the slicing, where 'must-support' is true (1 uses)
35. ==== These messages have been acknowledged for this release. After reviewing the implications for conformant systems and downstream publications, we will consider adopting the recommended replacement in a future release. ====
The extension http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet|5.2.0 is deprecated (1 uses)
The extension http://hl7.org/fhir/StructureDefinition/elementdefinition-minValueSet|5.2.0 is deprecated (1 uses)
The extension http://hl7.org/fhir/StructureDefinition/ordinalValue|5.2.0 is deprecated with the note Replaced by [[[http://hl7.org/fhir/StructureDefinition/itemWeight]]] (1 uses)
The extension http://hl7.org/fhir/StructureDefinition/regex|5.2.0 is deprecated with the note This was deprecated in favor of using a constraint on the element using FHIRPath, since constraints allow for the provision of a human readable message associated with the regex (1 uses)
36. === These Extension StructureDefinitions were examined, and there are no substantive changes between versions and thus no reason to specify a version ===
There are multiple different potential matches for the url 'http://hl7.org/fhir/StructureDefinition/condition-assertedDate'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '5.2.0', found versions: 1.0.0, 4.0.1, 5.1.0, 5.2.0. Suggested fix: change the canonical reference from 'http://hl7.org/fhir/StructureDefinition/condition-assertedDate' to 'http://hl7.org/fhir/StructureDefinition/condition-assertedDate|5.2.0' (2 uses)
There are multiple different potential matches for the url 'http://hl7.org/fhir/StructureDefinition/ordinalValue'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '5.2.0', found versions: 4.0.1, 5.2.0. Suggested fix: change the canonical reference from 'http://hl7.org/fhir/StructureDefinition/ordinalValue' to 'http://hl7.org/fhir/StructureDefinition/ordinalValue|5.2.0' (1 uses)
There are multiple different potential matches for the url 'http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '5.2.0', found versions: 1.0.0, 4.0.1, 5.1.0, 5.2.0. Suggested fix: change the canonical reference from 'http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo' to 'http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo|5.2.0' (2 uses)
37. === The following Extensions are in SDC, a dependent IG, or the FHIR R4 specification and not under the direct control of US Core editors ===
There are multiple different potential matches for the url 'http://hl7.org/fhir/StructureDefinition/display'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '5.2.0', found versions: 1.0.0, 4.0.1, 5.1.0, 5.2.0. Suggested fix: change the canonical reference from 'http://hl7.org/fhir/StructureDefinition/display' to 'http://hl7.org/fhir/StructureDefinition/display|5.2.0' (1 uses)
There are multiple different potential matches for the url 'http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '5.2.0', found versions: 1.0.0, 4.0.1, 5.1.0, 5.2.0. Suggested fix: change the canonical reference from 'http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode' to 'http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode|5.2.0' (1 uses)
There are multiple different potential matches for the url 'http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '5.2.0', found versions: 1.0.0, 4.0.1, 5.1.0, 5.2.0. Suggested fix: change the canonical reference from 'http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature' to 'http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature|5.2.0' (2 uses)
38. === The differences between these code system versions have been evaluated, and there no differences or there are non breaking changes (forward compatible)
There are multiple different potential matches for the url 'http://terminology.hl7.org/CodeSystem/condition-category'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '1.0.0', found versions: 1.0.0, 1.0.1. Suggested fix: change the canonical reference from 'http://terminology.hl7.org/CodeSystem/condition-category' to 'http://terminology.hl7.org/CodeSystem/condition-category|1.0.0' (1 uses)
There are multiple different potential matches for the url 'http://terminology.hl7.org/CodeSystem/observation-category'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '1.0.0', found versions: 1.0.0, 1.0.1. Suggested fix: change the canonical reference from 'http://terminology.hl7.org/CodeSystem/observation-category' to 'http://terminology.hl7.org/CodeSystem/observation-category|1.0.0' (5 uses)
There are multiple different potential matches for the url 'http://terminology.hl7.org/CodeSystem/provenance-participant-type'. It might be a good idea to fix to the correct version to reduce the likelihood of a wrong version being selected by an implementation/implementer, or use the [IG Parameter `pin-canonicals`](https://hl7.org/fhir/tools/CodeSystem-ig-parameters.html). Using version '1.1.0', found versions: 1.0.0, 1.1.0. Suggested fix: change the canonical reference from 'http://terminology.hl7.org/CodeSystem/provenance-participant-type' to 'http://terminology.hl7.org/CodeSystem/provenance-participant-type|1.1.0' (1 uses)
39 === US Core reference the most recent published version of SDC. Ballot versions are released for public review and feedback during the HL7 balloting process and not intended for real-world implementation in production systems.
The ImplementationGuide uses package hl7.fhir.uv.sdc#3.0.0 released on 2022-03-08, but the most recent appropriate version is 4.0.0-ballot. This reference is getting old and the more recent version should be considered (0 uses)
hl7.fhir.us.core
hl7.fhir.uv.extensions