eLTSS Server - Electronic Long-Term Services and Supports (eLTSS) Release 1

This page is part of the electronic Long-Term Services and Supports Implementation Guide (v2.0.0-ballot: STU2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

CapabilityStatement: eLTSS Server

Official URL: http://hl7.org/fhir/us/eltss/CapabilityStatement/eltss-server				Version: 2.0.0-ballot
Standards status: Trial-use			Maturity Level: 2	Computable Name: ELTSSSERVERCAPABILITYSTATEMENT

This Section describes the expected capabilities of the eLTSS/ US Core Server actor which is responsible for providing responses to the queries submitted by the Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by US Core Servers are defined. Systems implementing this capability statement should meet the ONC 2015 Common Clinical Data Set (CCDS) access requirement for Patient Selection 170.315(g)(7) and Application Access - Data Category Request 170.315(g)(8) and and the ONC U.S. Core Data for Interoperability (USCDI). eLTSS/ US Core Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.

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eLTSS Server Capability Statement

Implementation Guide Version: 2.0.0-ballot
FHIR Version: 4.0.1
Supported Formats: SHALL support json, SHOULD support xml
Supported Patch Formats: SHOULD support application/json-patch+json
Published on: Mon Nov 20 08:35:01 UTC 2023
Published by: HL7 International / Human and Social Services

Note to Implementers: FHIR Capabilities
Any FHIR capability may be 'allowed' by the system unless explicitly marked as "SHALL NOT". A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.

SHALL Support the Following Implementation Guides

SHOULD Support the Following Implementation Guides

FHIR RESTful Capabilities

Mode: `server`

The eLTSS/ US CORE Server SHALL:

Support the eLTSS/ US CORE Patient resource profile.
Support at least one additional resource profile from the list of eLTSS/ US CORE Profiles.
Implement the RESTful behavior according to the FHIR specification.
Return the following response classes:
- (Status 400): invalid parameter
- (Status 401/4xx): unauthorized request
- (Status 403): insufficient scope
- (Status 404): unknown resource
- (Status 410): deleted resource.
Support json source formats for all US Core interactions.

The eLTSS/ US CORE Server SHOULD:

Follow US CORE guidance on Must Support
Support xml source formats for all eLTSS/ US CORE interactions.
Identify the US Core profiles supported as part of the FHIR meta.profile attribute for each instance.
Support xml resource formats for all Argonaut questionnaire interactions.

Security

See the General Security Considerations section for requirements and recommendations.

A server SHALL reject any unauthorized requests by returning an HTTP 401 unauthorized response code.

Summary of System-wide Interactions

MAY support the transaction interaction.
MAY support the batch interaction.
MAY support the search-system interaction.
MAY support the history-system interaction.

Capabilities by Resource/Profile

Summary

The summary table lists the resources that are part of this configuration, and for each resource it lists:

The relevant profiles (if any)
The interactions supported by each resource (Read, Search, Update, and Create, are always shown, while VRead, Patch, Delete, History on Instance, or History on Type are only present if at least one of the resources has support for them.
The required, recommended, and some optional search parameters (if any).
The linked resources enabled for _include
The other resources enabled for _revinclude
The operations on the resource (if any)

Resource Type	Profile	R	V-R	S	U	P	C	D	H-I	H-T	Searches	`_include`	`_revinclude`	Operations
AllergyIntolerance	Supported profiles: US Core AllergyIntolerance Profile	y	y	y	y	y	y	y	y	y	clinical-status, patient, patient+clinical-status		`Provenance:target`
CarePlan	Supported profiles: CarePlan_eltss	y	y	y	y	y	y	y	y	y	category, date, patient, status, patient+category+status+date, patient+category+date, patient+category, patient+category+status		`Provenance:target`	`$all-eltss-careplan`
CareTeam	Supported profiles: US Core CareTeam Profile	y	y	y	y	y	y	y	y	y	patient, status, patient+role, patient+status	`CareTeam:participant:PractitionerRole`, `CareTeam:participant:Practitioner`, `CareTeam:participant:Patient`, `CareTeam:participant:RelatedPerson`	`Provenance:target`
Condition	Supported profiles: Condition_eltss	y	y	y	y	y	y	y	y	y	category, clinical-status, code, onset-date, patient, patient+onset-date, patient+category+encounter, patient+abatement-date, patient+category+clinical-status, patient+recorded-date, patient+clinical-status, patient+code, patient+asserted-date, patient+category		`Provenance:target`
Coverage		y	y	y	y	y	y	y	y	y			`Provenance:target`
Device	Supported profiles: US Core Implantable Device Profile	y	y	y	y	y	y	y	y	y	patient, type, patient+status, patient+type		`Provenance:target`
DiagnosticReport	Supported profiles: US Core DiagnosticReport Profile for Report and Note exchange US Core DiagnosticReport Profile for Laboratory Results Reporting	y	y	y	y	y	y	y	y	y	category, code, date, patient, status, patient+status, patient+code+date, patient+code, patient+category+date, patient+category		`Provenance:target`
DocumentReference	Supported profiles: US Core DocumentReference Profile	y	y	y	y	y	y	y	y	y	_id, category, date, patient, period, status, type, patient+status, patient+type, patient+type+period, patient+category+date, patient+category		`Provenance:target`	`$docref`
Encounter	Supported profiles: US Core Encounter Profile	y	y	y	y	y	y	y	y	y	_id, class, date, identifier, patient, status, type, patient+status, patient+type, patient+discharge-disposition, date+patient, patient+location, class+patient		`Provenance:target`
Endpoint		y	y	y	y	y	y	y	y	y
Goal	Supported profiles: Goal_eltss	y	y	y	y	y	y	y	y	y	lifecycle-status, patient, target-date, patient+lifecycle-status, patient+target-date, patient+description		`Provenance:target`
HealthcareService		y	y	y	y	y	y	y	y	y
Immunization	Supported profiles: US Core Immunization Profile	y	y	y	y	y	y	y	y	y	date, patient, status, patient+date, patient+status		`Provenance:target`
Location	Supported profiles: Location_eltss	y	y	y	y	y	y	y	y	y	address, address-city, address-postalcode, address-state, name
Media		y	y	y	y	y	y	y	y	y
Medication	Supported profiles: US Core Medication Profile	y	y	y	y	y	y	y	y	y
MedicationDispense		y	y	y	y	y	y	y	y	y	patient+status, patient+status+type	`MedicationDispense:medication`	`Provenance:target`
MedicationRequest	Supported profiles: US Core MedicationRequest Profile	y	y	y	y	y	y	y	y	y	authoredon, encounter, intent, patient, status, patient+intent+status, patient+intent+encounter, patient+intent, patient+intent+authoredon	`MedicationRequest:medication`	`Provenance:target`
Observation	Supported profiles: Observation_eltss US Core Smoking Status Observation Profile US Core Pediatric Weight for Height Observation Profile US Core Laboratory Result Observation Profile US Core Pediatric BMI for Age Observation Profile US Core Pulse Oximetry Profile US Core Pediatric Head Occipital-frontal Circumference Percentile Profile	y	y	y	y	y	y	y	y	y	category, code, date, patient, status, patient+category+status, patient+code+date, patient+code, patient+category+date, patient+category		`Provenance:target`
Organization	Supported profiles: US Core Organization Profile	y	y	y	y	y	y	y	y	y	address, name
Patient	Supported profiles: Patient_eltss	y	y	y	y	y	y	y	y	y	_id, birthdate, family, gender, given, identifier, name, family+gender, death-date+family, birthdate+family, gender+name, birthdate+name		`Provenance:target`
Practitioner	Supported profiles: Practitioner_eltss	y	y	y	y	y	y	y	y	y	identifier, name
PractitionerRole	Supported profiles: eLTSS PractitionerRole Profile	y	y	y	y	y	y	y	y	y	practitioner, specialty	`PractitionerRole:endpoint`, `PractitionerRole:practitioner`
Procedure	Supported profiles: US Core Procedure Profile	y	y	y	y	y	y	y	y	y	code, date, patient, status, patient+date, patient+status, patient+code+date		`Provenance:target`
Provenance	Supported profiles: US Core Provenance Profile	y	y	y	y	y	y	y	y	y
Questionnaire	Supported profiles: Questionnaire_eltss	y	y	y	y	y	y	y	y	y
QuestionnaireResponse	Supported profiles: US Core QuestionnaireResponse Profile	y	y	y	y	y	y	y	y	y	patient+authored, patient+status, patient+questionnaire		`Provenance:target`
RelatedPerson	Supported profiles: eLTSS RelatedPerson Profile	y	y	y	y	y	y	y	y	y	patient+name		`Provenance:target`
ServiceRequest	Supported profiles: ServiceRequest_eltss	y	y	y	y	y	y	y	y	y	patient+category+authored, patient+status, patient+code, patient+category, patient+code+authored		`Provenance:target`
Specimen		y	y	y	y	y	y	y	y	y
ValueSet														`$expand`

Resource Conformance: SHALLAllergyIntolerance

Core FHIR Resource
AllergyIntolerance

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	clinical-status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHOULD	patient+clinical-status	`reference`+`token`

Resource Conformance: SHALLCarePlan

Core FHIR Resource
CarePlan

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/CarePlan-eltss

Documentation

Additional considerations for systems aligning with HL7 Consolidated (C-CDA) Care Plan requirements:

US Core Goal SHOULD be present in CarePlan.goal

US Core Condition SHOULD be present in CarePlan.addresses

Assement and Plan MAY be included as narrative text

Search Parameters

Conformance	Parameter	Type	Documentation
MAY	category	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+category	`reference`+`token`
SHOULD	patient+category+status+date	`reference`+`token`+`token`+`date`
SHOULD	patient+category+date	`reference`+`token`+`date`
SHOULD	patient+category+status	`reference`+`token`+`token`

Extended Operations

Conformance	Operation	Documentation
SHALL	$all-eltss-careplan	A server MAY be capable of responding to a $all-eltss-careplan operation and capable of returning a bundle that provides all eLTSS data for a given Patient’s identified CarePlan. Given a CarePlan with a specific Patient and ID, this operation will return all the referenced artifacts necessary to satisfy the eLTSS data element set found in the DAM. The Operation reduces the number of queries that a client must make. GET [base]/CarePlan/[id]/$all-eltss-careplan

Resource Conformance: SHALLCareTeam

Core FHIR Resource
CareTeam

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam

Documentation

In order to access care team member's names, identifiers, locations, and contact information, the CareTeam profile supports several types of care team participants. They are represented as references to other profiles and include the following four profiles which are marked as must support:

US Core Practitioner Profile

US Core PractitionerRole Profile

US Core Patient Profile

US Core RelatedPerson Profile

Although both US Core Practitioner Profile and US Core PractitionerRole are must support, the server system is not required to support both types of references, but SHALL support at least one of them.

The client application SHALL support all four profile references.

Bacause the US Core PractitionerRole Profile supplies the provider's location and contact information and a reference to the Practitioner, server systems SHOULD reference it instead of the US Core Practitioner Profile.

Servers that supports only US Core Practitioner Profile SHALL provide implementation specific guidance how to access a provider's location and contact information using only the Practitioner resource.

Search Parameters

Conformance	Parameter	Type	Documentation
MAY	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+status	`reference`+`token`
SHOULD	patient+role	`reference`+`<unknown>`

Resource Conformance: SHALLCondition

Core FHIR Resource
Condition

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/Condition-eltss

Documentation

For Encounter Diagnosis use the US Core Condition Encounter Diagnosis Profile.

When Condition.category is "encounter-diagnosis" the encounter, SHOULD be referenced in Condition.encounter.

For Problems and Health Concerns use the US Core Condition Problems and Health Concerns Profile.

When Condition.category is a "problems-list-item", the `Condition.clinicalStatus SHOULD NOT be unknown.

There is no single element in Condition that represents the date of diagnosis. It may be the assertedDate Extension, Condition.onsetDateTime, or Condition.recordedDate.

Although all three are marked as must support, the server is not required to support all.

A server SHALL support Condition.recordedDate.

A server SHALL support at least one of the assertedDate Extension and Condition.onsetDateTime. A server may support both, which means they support all three elements.

The client application SHALL support all three elements.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	category	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	clinical-status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	code	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	onset-date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+category	`reference`+`token`
SHOULD	patient+onset-date	`reference`+`date`
SHOULD	patient+category+encounter	`reference`+`token`+`<unknown>`
SHOULD	patient+abatement-date	`reference`+`<unknown>`
SHOULD	patient+category+clinical-status	`reference`+`token`+`token`
SHOULD	patient+recorded-date	`reference`+`<unknown>`
SHOULD	patient+clinical-status	`reference`+`token`
SHOULD	patient+code	`reference`+`token`
SHOULD	patient+asserted-date	`reference`+`<unknown>`

Resource Conformance: SHALLCoverage

Core FHIR Resource
Coverage

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Resource Conformance: SHALLDevice

Core FHIR Resource
Device

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-implantable-device

Documentation

Implantable medical devices that have UDI information SHALL represent the UDI code in Device.udiCarrier.carrierHRF.

All of the five UDI-PI elements that are present in the UDI code SHALL be represented in the corresponding US Core Implantable Device Profile element.

UDI may not be present in all scenarios such as historical implantable devices, patient reported implant information, payer reported devices, or improperly documented implants. If UDI is not present and the manufacturer and/or model number information is available, they SHOULD be included to support historical reports of implantable medical devices as follows:

manufacturer -> Device.manufacturer
model -> Device.model

Servers SHOULD support query by Device.type to allow clients to request the patient's devices by a specific type. Note: The Device.type is too granular to differentiate implantable vs. non-implantable devices.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	type	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHOULD	patient+status	`reference`+`<unknown>`
SHOULD	patient+type	`reference`+`token`

Resource Conformance: SHALLDiagnosticReport

Core FHIR Resource
DiagnosticReport

Reference Policy
resolves

Interaction summary

SHALL support create, search-type, read.
SHOULD support vread, history-instance.
MAY support update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note
http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	category	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	code	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+code	`reference`+`token`
SHALL	patient+category+date	`reference`+`token`+`date`
SHALL	patient+category	`reference`+`token`
SHOULD	patient+status	`reference`+`token`
SHOULD	patient+code+date	`reference`+`token`+`date`

Resource Conformance: SHALLDocumentReference

Core FHIR Resource
DocumentReference

Reference Policy
resolves

Interaction summary

SHALL support create, search-type, read.
SHOULD support vread, history-instance.
MAY support update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference

Documentation

The DocumentReference.type binding SHALL support at a minimum the 5 Common Clinical Notes and may extend to the full US Core DocumentReference Type Value Set

The DocumentReference resources can represent the referenced content using either an address where the document can be retrieved using DocumentReference.attachment.url or the content as inline base64 encoded data using DocumentReference.attachment.data.

Although both are marked as must support, the server system is not required to support an address, and inline base64 encoded data, but SHALL support at least one of these elements.

The client application SHALL support both elements.

The content.url may refer to a FHIR Binary Resource (i.e. [base]/Binary/[id]), FHIR Document Bundle (i.e [base]/Bundle/[id] or another endpoint.

If the endpoint is outside the FHIR base URL, it SHOULD NOT require additional authorization to access.

If there are multiple DocumentReference.content element repetitions, these SHALL all represent the same document in different format or attachment metadata. The content element SHALL not contain different versions of the same content. For version handling use multiple DocumentReferences with DocumentReference.relatesTo

Every DocumentReference must have a responsible Organization. The organization responsible for the DocumentReference SHALL be present either in DocumentReference.custodian or accessible in the Provenance resource targeting the DocumentReference using Provenance.agent.who or Provenance.agent.onBehalfOf.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	_id	`token`
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	category	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	period	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	type	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+type	`reference`+`token`
SHALL	patient+category+date	`reference`+`token`+`date`
SHALL	patient+category	`reference`+`token`
SHOULD	patient+status	`reference`+`token`
SHOULD	patient+type+period	`reference`+`token`+`date`

Extended Operations

Conformance	Operation	Documentation
SHALL	$docref	A server SHALL be capable of responding to a $docref operation and capable of returning at least a reference to a generated CCD document, if available. MAY provide references to other 'on-demand' and 'stable' documents (or 'delayed/deferred assembly') that meet the query parameters as well. If a context date range is supplied the server SHOULD provide references to any document that falls within the date range If no date range is supplied, then the server SHALL provide references to last or current encounter. SHOULD document what resources, if any, are returned as included resources `GET [base]/DocumentReference/$docref?patient=[id]`

Resource Conformance: SHALLEncounter

Core FHIR Resource
Encounter

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter

Documentation

The Encounter resource can represent a reason using either a code with Encounter.reasonCode, or a reference with Encounter.reasonReference to Condition or other resource.

Although both are marked as must support, the server systems are not required to support both a code and a reference, but they SHALL support at least one of these elements.

The client application SHALL support both elements.

if Encounter.reasonReference references an Observation, it SHOULD conform to a US Core Observation if applicable. (for example, a laboratory result should conform to the US Core Laboratory Result Observation Profile)

The location address can be represented by either by the Location referenced by Encounter.location.location or indirectly through the Organization referenced by Encounter.serviceProvider.

Although both are marked as must support, the server systems are not required to support both Encounter.location.location and Encounter.serviceProvider, but they SHALL support at least one of these elements.

The client application SHALL support both elements.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	_id	`token`
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
SHOULD	identifier	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	class	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	type	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	date+patient	`date`+`reference`
SHOULD	patient+status	`reference`+`token`
SHOULD	patient+type	`reference`+`token`
SHOULD	patient+discharge-disposition	`reference`+`<unknown>`
SHOULD	patient+location	`reference`+`<unknown>`
SHOULD	class+patient	`token`+`reference`

Resource Conformance: SHALLEndpoint

Core FHIR Resource
Endpoint

Reference Policy
resolves

Interaction summary

SHOULD support read, vread.
MAY support create, search-type, update, patch, delete, history-instance, history-type.

Documentation

The Media Resource is a Must Suppot referenced resource when using the US Core PracitionerRole Profile.

Resource Conformance: SHALLGoal

Core FHIR Resource
Goal

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/Goal-eltss

Documentation

Although both Goal.startDate and Goal.target.dueDate are marked as must support, the server system is not required to support both, but SHALL support at least one of these elements. The client application SHALL support both elements.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	lifecycle-status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	target-date	`date`	A client SHALL provide a value precise to the day. A server SHALL support a value a value precise to the day.

Combined Search Parameters

Conformance	Parameters	Types
SHOULD	patient+lifecycle-status	`reference`+`token`
SHOULD	patient+target-date	`reference`+`date`
SHOULD	patient+description	`reference`+`<unknown>`

Resource Conformance: MAYHealthcareService

Core FHIR Resource
HealthcareService

Reference Policy
resolves

Interaction summary

SHOULD support read, vread.
MAY support create, search-type, update, patch, delete, history-instance, history-type.

Documentation

The HealthcareService Resource is a referenced resource when using the US Core PracitionRole Profile and subject to constraint us-core-13: "SHALL have a practitioner, an organization, a healthcare service, or a location."

Resource Conformance: SHALLImmunization

Core FHIR Resource
Immunization

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization

Documentation

Based upon the ONC U.S. Core Data for Interoperability (USCDI) requirements, CVX vaccine codes are required and the NDC vaccine codes SHOULD be supported as translations to them.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHOULD	patient+date	`reference`+`date`
SHOULD	patient+status	`reference`+`token`

Resource Conformance: SHALLLocation

Core FHIR Resource
Location

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/Location-eltss

Search Parameters

Conformance	Parameter	Type
SHALL	address	`string`
SHALL	name	`string`
SHOULD	address-city	`string`
SHOULD	address-postalcode	`string`
SHOULD	address-state	`string`

Resource Conformance: SHALLMedia

Core FHIR Resource
Media

Reference Policy
resolves

Interaction summary

SHOULD support read, vread.
MAY support create, search-type, update, patch, delete, history-instance, history-type.

Documentation

The Media Resource is a Must Suppot referenced resource when using the US Core DiagnosticReport Profile for Report and Note Exchange.

Resource Conformance: SHALLMedication

Core FHIR Resource
Medication

Reference Policy
resolves

Interaction summary

SHALL support read.
SHOULD support vread, history-instance.
MAY support create, search-type, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication

Documentation

The MedicationRequest resource can represent a medication, using an external reference to a Medication resource. If an external Medication Resource is used in a MedicationRequest, then the READ SHALL be supported.

Resource Conformance: SHALLMedicationDispense

Core FHIR Resource
MedicationDispense

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Documentation

The MedicationDispense resources can represent a medication using either a code or refer to the Medication resource. When referencing Medication, the resource may be contained or an external resource. The server application MAY choose any one way or more than one method, but if an external reference to Medication is used, the server SHALL support the _include` parameter for searching this element. The client application must support all methods.

For example, A server SHALL be capable of returning dispense records for all medications for a patient using one of or both:

GET /MedicationDispense?patient=[id]

GET /MedicationDispense?patient=[id]&_include=MedicationDispense:medication

Search Parameters

Conformance	Parameter	Type	Documentation

Combined Search Parameters

Conformance	Parameters	Types
SHOULD	patient+status	`<unknown>`+`<unknown>`
SHOULD	patient+status+type	`<unknown>`+`<unknown>`+`<unknown>`

Resource Conformance: SHALLMedicationRequest

Core FHIR Resource
MedicationRequest

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest

Documentation

The MedicationRequest resources can represent a medication using either a code or refer to the Medication resource. When referencing Medication, the resource may be contained or an external resource. The server application MAY choose any one way or more than one method, but if an external reference to Medication is used, the server SHALL support the _include` parameter for searching this element. The client application must support all methods.

For example, A server SHALL be capable of returning all medications for a patient using one of or both:

GET /MedicationRequest?patient=[id]

GET /MedicationRequest?patient=[id]&_include=MedicationRequest:medication

The MedicationRequest resource can represent that information is from a secondary source using either a boolean flag or reference in MedicationRequest.reportedBoolean, or a reference using MedicationRequest.reportedReference to Practitioner or other resource.

Although both are marked as must support, the server systems are not required to support both a boolean and a reference, but SHALL choose to support at least one of these elements.

The client application SHALL support both elements.

Search Parameters

Conformance	Parameter	Type	Documentation
MAY	authoredon	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	encounter	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	intent	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+intent+status	`reference`+`token`+`token`
SHALL	patient+intent	`reference`+`token`
SHOULD	patient+intent+encounter	`reference`+`token`+`reference`
SHOULD	patient+intent+authoredon	`reference`+`token`+`date`

Resource Conformance: SHALLObservation

Core FHIR Resource
Observation

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/Observation-eltss
http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus
http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height
http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab
http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age
http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry
http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile

Documentation

Systems SHOULD support Observation.effectivePeriod to accurately represent tests that are collected over a period of time (for example, a 24-Hour Urine Collection test).

An Observation without a value, SHALL include a reason why the data is absent unless there are component observations, or references to other Observations that are grouped within it

Systems that never provide an observation without a value are not required to support Observation.dataAbsentReason

An Observation.component without a value, SHALL include a reason why the data is absent.

Systems that never provide an component observation without a component value are not required to support Observation.component.dataAbsentReason.

Search Parameters

Conformance	Parameter	Type	Documentation
MAY	category	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	code	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+code	`reference`+`token`
SHALL	patient+category+date	`reference`+`token`+`date`
SHALL	patient+category	`reference`+`token`
SHOULD	patient+category+status	`reference`+`token`+`token`
SHOULD	patient+code+date	`reference`+`token`+`date`

Resource Conformance: SHALLOrganization

Core FHIR Resource
Organization

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization

Documentation

Systems SHALL support National Provider Identifier (NPI) for organizations and SHOULD support Clinical Laboratory Improvement Amendments (CLIA) identifiers for Organization.Identifier.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	address	`string`
SHALL	name	`string`

Resource Conformance: SHALLPatient

Core FHIR Resource
Patient

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/Patient-eltss

Documentation

For ONC's USCDI requirements, each Patient must support the following additional elements. These elements are included in the formal definition of the profile. The patient examples include all of these elements.

contact detail (e.g. a telephone number or an email address)

a communication language

a race

an ethnicity

a birth sex*

previous name

Previous name is represented by providing an end date in the Patient.name.period element for a previous name.

suffix

Suffix is represented using the Patient.name.suffix element.

The Patient's Social Security Numbers SHOULD NOT be used as a patient identifier in Patient.identifier.value.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	_id	`token`
SHALL	identifier	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
SHALL	name	`string`
MAY	birthdate	`date`	A client SHALL provide a value precise to the day. A server SHALL support a value a value precise to the day.
MAY	family	`string`	A server SHALL support a value precise to the day.
MAY	gender	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	given	`string`

Combined Search Parameters

Conformance	Parameters	Types
SHALL	gender+name	`token`+`string`
SHALL	birthdate+name	`date`+`string`
SHOULD	family+gender	`string`+`token`
SHOULD	death-date+family	`<unknown>`+`string`
SHOULD	birthdate+family	`date`+`string`

Resource Conformance: SHALLPractitioner

Core FHIR Resource
Practitioner

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/Practitioner-eltss

Documentation

Servers that support only US Core Practitioner Profile SHALL provide implementation specific guidance how to access a provider’s location and contact information using only the Practitioner resource.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	identifier	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
SHALL	name	`string`

Resource Conformance: SHALLPractitionerRole

Core FHIR Resource
PractitionerRole

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/PractitionerRole-eltss

Documentation

Due to implementer feedback, some US Core Profiles reference the PractitionerRole resource instead of the US Core PractitionerRole Profile. However the US Core PractitionerRole Profile SHOULD be used as the default profile if referenced by another US Core profile.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	practitioner	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
SHALL	specialty	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Resource Conformance: SHALLProcedure

Core FHIR Resource
Procedure

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure

Documentation

Procedure codes can be taken from SNOMED-CT, CPT, HCPCS II, ICD-10-PCS, CDT. LOINC.

Only LOINC concepts that reflect actual procedures SHOULD be used

A procedure including an implantable device SHOULD use Procedure.focalDevice with a reference to the US Core Implantable Device Profile.

The Reason or justification for a referral or consultation is communicated through:

ServiceRequest.reason or ServiceRequest.reason, and Procedure.basedOn that links the Procedure to the US Core ServiceRequest Profile.

ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements. The certifying server system is not required to support both but SHALL support at least one of these elements. The certifying client application SHALL support both elements.

As documented here, when using ServiceRequest.reasonReference, the referenced resources SHOULD be a US Core Profile.

Procedure.reasonCode or Procedure.reasonReference when the Procedure does not have an associated ServiceRequest.

Although both Procedure.reasonCode and Procedure.reasonReference are marked as Additional USCDI Requirements. The certifying server system is not required to support both but SHALL support at least one of these elements. The certifying client application SHALL support both elements.

As documented here, when using Procedure.reasonReference, the referenced resources SHOULD be a US Core Profile.

Certifying Servers and Clients SHALL support options 1 and 2 as Additional USCDI Requirements.

Search Parameters

Conformance	Parameter	Type	Documentation
SHALL	patient	`reference`	The client SHALL provide at least a id value and MAY provide both the Type and id values. The server SHALL support both.
MAY	code	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.
MAY	date	`date`	A client SHALL provide a value precise to the second + time offset. A server SHALL support a value precise to the second + time offset.
MAY	status	`token`	The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both.

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+date	`reference`+`date`
SHOULD	patient+status	`reference`+`token`
SHOULD	patient+code+date	`reference`+`token`+`date`

Resource Conformance: SHALLProvenance

Core FHIR Resource
Provenance

Reference Policy
resolves

Interaction summary

SHALL support read.
SHOULD support vread, history-instance.
MAY support create, search-type, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance

Documentation

The US Core Provenance resource SHALL be supported for these US Core resources:

AllergyIntolerance

CarePlan

CareTeam

Condition

Coverage

Device

DiagnosticReport

DocumentReference

Encounter

Goal

Immunization

MedicationDispense

MedicationRequest

Observation

Patient

Procedure

QuestionnaireResponse

RelatedPerson

ServiceRequest

If a system receives a provider in Provenance.agent.who as free text they must capture who sent them the information as the organization. On request they SHALL provide this organization as the source and MAY include the free text provider.

Systems that need to know the activity has occurred SHOULD populate the activity.

Resource Conformance: SHOULDQuestionnaire

Core FHIR Resource
Questionnaire

Reference Policy

Interaction summary

SHOULD support read, vread.
MAY support create, search-type, update, patch, delete, history-instance, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/Questionnaire-eltss

Documentation

US Core defines two ways to represent the questions and responses to screening and assessment instruments:

Observation: US Core Observation Screening Assessment Profile

Questionnaire/QuestionnaireResponse: SDC Base Questionnaire/US Core QuestionnaireResponse Profile

US Core Servers SHALL support US Core Observation Screening Assessment Profile and SHOULD support the SDC Base Questionnaire Profile/US Core QuestionnaireResponse Profile

Resource Conformance: SHOULDQuestionnaireResponse

Core FHIR Resource
QuestionnaireResponse

Reference Policy

Interaction summary

SHOULD support search-type, read, vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/QuestionnaireResponse-eltss

Documentation

US Core defines two ways to represent the questions and responses to screening and assessment instruments:

Observation: US Core Observation Screening Assessment Profile

Questionnaire/QuestionnaireResponse: SDC Base Questionnaire/US Core QuestionnaireResponse Profile

US Core Servers SHALL support US Core Observation Screening Assessment Profile and SHOULD support the SDC Base Questionnaire Profile/US Core QuestionnaireResponse Profile

Search Parameters

Conformance	Parameter	Type	Documentation

Combined Search Parameters

Conformance	Parameters	Types
SHOULD	patient+authored	`<unknown>`+`<unknown>`
SHOULD	patient+status	`<unknown>`+`<unknown>`
SHOULD	patient+questionnaire	`<unknown>`+`<unknown>`

Resource Conformance: SHALLRelatedPerson

Core FHIR Resource
RelatedPerson

Reference Policy
resolves

Interaction summary

SHALL support search-type, read.
SHOULD support vread, history-instance.
MAY support create, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/RelatedPerson-eltss

Search Parameters

Conformance	Parameter	Type	Documentation

Combined Search Parameters

Conformance	Parameters	Types
SHOULD	patient+name	`<unknown>`+`<unknown>`

Resource Conformance: SHALLServiceRequest

Core FHIR Resource
ServiceRequest

Reference Policy
resolves

Interaction summary

SHALL support read.
SHOULD support vread, history-instance.
MAY support create, search-type, update, patch, delete, history-type.

Supported Profiles

http://hl7.org/fhir/us/eltss/StructureDefinition/ServiceRequest-eltss

Documentation

The Reason or justification for a referral or consultation is communicated through:

ServiceRequest.reason or ServiceRequest.reason, and Procedure.basedOn that links the Procedure to the US Core ServiceRequest Profile.

ServiceRequest.reasonCode and ServiceRequest.reasonReference are marked as Additional USCDI Requirements. The certifying server system is not required to support both but SHALL support at least one of these elements. The certifying client application SHALL support both elements.

As documented here, when using ServiceRequest.reasonReference, the referenced resources SHOULD be a US Core Profile.

Procedure.reasonCode or Procedure.reasonReference when the Procedure does not have an associated ServiceRequest.

Although both Procedure.reasonCode and Procedure.reasonReference are marked as Additional USCDI Requirements. The certifying server system is not required to support both but SHALL support at least one of these elements. The certifying client application SHALL support both elements.

As documented here, when using Procedure.reasonReference, the referenced resources SHOULD be a US Core Profile.

Certifying Servers and Clients SHALL support options 1 and 2 as Additional USCDI Requirements.

Search Parameters

Conformance	Parameter	Type	Documentation

Combined Search Parameters

Conformance	Parameters	Types
SHALL	patient+category+authored	`<unknown>`+`<unknown>`+`<unknown>`
SHALL	patient+code	`<unknown>`+`<unknown>`
SHALL	patient+category	`<unknown>`+`<unknown>`
SHOULD	patient+status	`<unknown>`+`<unknown>`
SHOULD	patient+code+authored	`<unknown>`+`<unknown>`+`<unknown>`

Resource Conformance: SHALLSpecimen

Core FHIR Resource
Specimen

Reference Policy
resolves

Interaction summary

SHALL support read.
SHOULD support vread, history-instance.
MAY support create, search-type, update, patch, delete, history-type.

Resource Conformance: SHOULDValueSet

Core FHIR Resource
ValueSet

Reference Policy

Interaction summary

Extended Operations

Conformance	Operation	Documentation
SHOULD	$expand	A client can determine the note and report types support by a server by invoking the standard FHIR Value Set Expansion ($expand) operation defined in the FHIR R4 specification. Because servers may support different read and write formats, it also is used to determine the formats (for example, text, pdf) the server supports read and write transactions.

CapabilityStatement: eLTSS Server

eLTSS Server Capability Statement

SHALL Support the Following Implementation Guides

SHOULD Support the Following Implementation Guides

FHIR RESTful Capabilities

Mode: server

Capabilities by Resource/Profile

Summary

Resource Conformance: SHALLAllergyIntolerance

Resource Conformance: SHALLCarePlan

Resource Conformance: SHALLCareTeam

Resource Conformance: SHALLCondition

Resource Conformance: SHALLCoverage

Resource Conformance: SHALLDevice

Resource Conformance: SHALLDiagnosticReport

Resource Conformance: SHALLDocumentReference

Resource Conformance: SHALLEncounter

Resource Conformance: SHALLEndpoint

Resource Conformance: SHALLGoal

Resource Conformance: MAYHealthcareService

Resource Conformance: SHALLImmunization

Resource Conformance: SHALLLocation

Resource Conformance: SHALLMedia

Resource Conformance: SHALLMedication

Resource Conformance: SHALLMedicationDispense

Resource Conformance: SHALLMedicationRequest

Resource Conformance: SHALLObservation

Resource Conformance: SHALLOrganization

Resource Conformance: SHALLPatient

Resource Conformance: SHALLPractitioner

Resource Conformance: SHALLPractitionerRole

Resource Conformance: SHALLProcedure

Resource Conformance: SHALLProvenance

Resource Conformance: SHOULDQuestionnaire

Resource Conformance: SHOULDQuestionnaireResponse

Resource Conformance: SHALLRelatedPerson

Resource Conformance: SHALLServiceRequest

Resource Conformance: SHALLSpecimen

Resource Conformance: SHOULDValueSet

Mode: `server`