Provenance is essential when sharing information in the payer space because any given record may have passed through multiple hands before it arrives at a payer. Provenance provides traceability as to where the data originated and helps in the evaluation of the information as well as rationalizing duplicate data acquired through multiple sources. Da Vinci makes a couple of improvements to the US Core Provenance profile that will hopefully be migrated into that profile in the future:

• Capturing the time of the creation/update, not just the time the Provenance instance was created
• Ensuring that the Provenance target in fact resolves to a specific resource reference, not allowing only display or an identifier

In addition, in Da Vinci, signatures on Provenances must be retained if present.

• Text Summary
• Differential Table
• Snapshot Table
• Snapshot Table (Must Support)
• All

This structure is derived from USCoreProvenance

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	USCoreProvenance	US Core Provenance
target		1..*	Reference(Resource)	The Resource this Provenance record supports
reference	S	1..1	string	Literal reference, Relative, internal or absolute URL
value	S	1..1	string	Primitive value for string
occurred[x]	S	0..1	Period, dateTime	When the activity occurred
signature	S	0..*	Signature	Signature on target
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	USCoreProvenance	US Core Provenance
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
target	SΣ	1..*	Reference(Resource)	The Resource this Provenance record supports
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣI	1..1	string	Literal reference, Relative, internal or absolute URL
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional content defined by implementations
value	S	1..1	string	Primitive value for string Max Length: 1048576
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
occurred[x]	S	0..1		When the activity occurred
occurredPeriod			Period
occurredDateTime			dateTime
recorded	SΣ	1..1	instant	Timestamp when the activity was recorded / updated
policy		0..*	uri	Policy or plan the activity was defined by
location		0..1	Reference(Location)	Where the activity occurred, if relevant
reason		0..*	CodeableConcept	Reason the activity is occurring Binding: PurposeOfUse (extensible): The reason the activity took place.
activity		0..1	CodeableConcept	Activity that occurred Binding: ProvenanceActivityType (extensible): The activity that took place.
Slices for agent	S	1..*	BackboneElement	Actor involved Slice: Unordered, Open by pattern:type
agent:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	CodeableConcept	How the agent participated Binding: US Core Provenance Participant Type Codes (extensible)
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	SΣ	1..1	Reference(US Core Practitioner Profile | US Core Patient Profile | US Core Organization Profile)	Who participated
onBehalfOf	SI	0..1	Reference(US Core Organization Profile)	Who the agent is representing provenance-1: onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
agent:ProvenanceAuthor	S	0..*	BackboneElement	Actor involved
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: author
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	Σ	1..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who participated
onBehalfOf		0..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who the agent is representing
agent:ProvenanceTransmitter	S	0..1	BackboneElement	Actor involved
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: transmitter
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	Σ	1..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who participated
onBehalfOf		0..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who the agent is representing
entity		0..*	BackboneElement	An entity used in this activity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
role	Σ	1..1	code	derivation | revision | quotation | source | removal Binding: ProvenanceEntityRole (required): How an entity was used in an activity.
what	Σ	1..1	Reference(Resource)	Identity of entity
agent		0..*	See agent (Provenance)	Entity is attributed to this agent
signature	S	0..*	Signature	Signature on target
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	USCoreProvenance	US Core Provenance
target	Σ	1..*	Reference(Resource)	The Resource this Provenance record supports
reference	ΣI	1..1	string	Literal reference, Relative, internal or absolute URL
value		1..1	string	Primitive value for string Max Length: 1048576
occurred[x]		0..1		When the activity occurred
occurredPeriod			Period
occurredDateTime			dateTime
recorded	Σ	1..1	instant	Timestamp when the activity was recorded / updated
Slices for agent		1..*	BackboneElement	Actor involved Slice: Unordered, Open by pattern:type
agent:All Slices				Content/Rules for all slices
type	Σ	0..1	CodeableConcept	How the agent participated Binding: US Core Provenance Participant Type Codes (extensible)
who	Σ	1..1	Reference(US Core Practitioner Profile | US Core Patient Profile | US Core Organization Profile)	Who participated
onBehalfOf	I	0..1	Reference(US Core Organization Profile)	Who the agent is representing provenance-1: onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
agent:ProvenanceAuthor		0..*	BackboneElement	Actor involved
type	Σ	1..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: author
agent:ProvenanceTransmitter		0..1	BackboneElement	Actor involved
type	Σ	1..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
code		1..1	code	Symbol in syntax defined by the system Fixed Value: transmitter
signature		0..*	Signature	Signature on target
Documentation for this format

This structure is derived from USCoreProvenance

Summary

Mandatory: 2 elements
Must-Support: 4 elements

Maturity: 2

Differential View

This structure is derived from USCoreProvenance

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	USCoreProvenance	US Core Provenance
target		1..*	Reference(Resource)	The Resource this Provenance record supports
reference	S	1..1	string	Literal reference, Relative, internal or absolute URL
value	S	1..1	string	Primitive value for string
occurred[x]	S	0..1	Period, dateTime	When the activity occurred
signature	S	0..*	Signature	Signature on target
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	USCoreProvenance	US Core Provenance
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
target	SΣ	1..*	Reference(Resource)	The Resource this Provenance record supports
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣI	1..1	string	Literal reference, Relative, internal or absolute URL
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional content defined by implementations
value	S	1..1	string	Primitive value for string Max Length: 1048576
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
occurred[x]	S	0..1		When the activity occurred
occurredPeriod			Period
occurredDateTime			dateTime
recorded	SΣ	1..1	instant	Timestamp when the activity was recorded / updated
policy		0..*	uri	Policy or plan the activity was defined by
location		0..1	Reference(Location)	Where the activity occurred, if relevant
reason		0..*	CodeableConcept	Reason the activity is occurring Binding: PurposeOfUse (extensible): The reason the activity took place.
activity		0..1	CodeableConcept	Activity that occurred Binding: ProvenanceActivityType (extensible): The activity that took place.
Slices for agent	S	1..*	BackboneElement	Actor involved Slice: Unordered, Open by pattern:type
agent:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	CodeableConcept	How the agent participated Binding: US Core Provenance Participant Type Codes (extensible)
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	SΣ	1..1	Reference(US Core Practitioner Profile | US Core Patient Profile | US Core Organization Profile)	Who participated
onBehalfOf	SI	0..1	Reference(US Core Organization Profile)	Who the agent is representing provenance-1: onBehalfOf SHALL be present when Provenance.agent.who is a Practitioner or Device
agent:ProvenanceAuthor	S	0..*	BackboneElement	Actor involved
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: author
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	Σ	1..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who participated
onBehalfOf		0..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who the agent is representing
agent:ProvenanceTransmitter	S	0..1	BackboneElement	Actor involved
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: transmitter
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	Σ	1..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who participated
onBehalfOf		0..1	Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)	Who the agent is representing
entity		0..*	BackboneElement	An entity used in this activity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
role	Σ	1..1	code	derivation | revision | quotation | source | removal Binding: ProvenanceEntityRole (required): How an entity was used in an activity.
what	Σ	1..1	Reference(Resource)	Identity of entity
agent		0..*	See agent (Provenance)	Entity is attributed to this agent
signature	S	0..*	Signature	Signature on target
Documentation for this format

The following guidance applies to the use of Providence across Da Vinci IGs. IGs may impose additional expectations with respect to the use of Provenance either across their whole use-case or in the context of specific events.

Searching

There is no expectation for support for querying Provenance except using _revinclude using the ‘target’ parameter (to return Provenance instances associated with a returned resource).

Aligning Provenance and Resource elements

Provenance should align with information present in the record. Where a Provenance deals with the creation of an instance, the author, performer and (if present) informer should align with the equivalent elements on the record. Similarly, Provenance.occurred should align with the creation date for the record.

Populating Provenance.agent

The following table lists the various agent codes and what resource types are appropriate. These recommendations SHOULD be followed

| transmitter | This could be Patient, RelatedPerson, Practitioner or PractitionerRole or Organization. A second transmitter could capture the specific Device used | | enterer | Patient, RelatedPerson, Practitioner or PractitionerRole | | performer | could be anything | | author | could be anything | | verifier | generally only Practitioner or PractitionerRole | | legal | Only Practitioner or PractitionerRole | | attester | Patient, RelatedPerson, Practitioner or PractitionerRole | | informant | Patient, RelatedPerson, Practitioner or PractitionerRole | | custodian | usually Organization, could also be Device, Practitioner or PractitionerRole | | assembler | usually a Device, could be Practitioner or PractitionerRole | ——————————————

Handling agents with multiple roles

In general, the most important role to capture is “author”. If they are the only role present, the presumption is that they are also the enterer, performer, verifier, legal, attester, informant, etc. Specifying other roles is only necessary if they differ from the author. Not all systems will necessarily track all participants. Roles other than author only need to be shared if the system captures them and feels they may be relevant to downstream use of the information.

Populating onBehalfOf

Provenance.agent.onBehalfOf is only relevant in certain circumstances:

• onBehalfOf SHOULD NOT be populated if RelatedPerson is acting on behalf of the Patient. (Because that is the assumption and there is already a link to the Patient on that resource)
• onBehalfOf SHOULD NOT be populated with an Organization if the agent is Practitioner - use PractitionerRole instead (even if it is a contained PractitionerRole)
• onBehalfOf SHOULD NOT be populated with an Organization if the agent is PractitionerRole unless PractitionerRole is pointing to an organization and the onBehalfOf is different (i.e. Dr. Smith for Clinic A did something on behalf of clinic B)
• It is unusual for onBehalfOf to be populated if the agent is Patient or RelatedPerson
• onBehalfOf SHOULD NOT be populated with an Organization if it is the same as Device.owner