Provenance of a resource is a record that describes entities and processes involved in producing and delivering or otherwise influencing that resource. Provenance provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility. Provenance assertions are a form of contextual metadata and can themselves become important records with their own provenance. Provenance statement indicates clinical significance in terms of confidence in authenticity, reliability, and trustworthiness, integrity, and stage in lifecycle (e.g. Document Completion - has the artifact been legally authenticated), all of which may impact security, privacy, and trust policies.

Some parties may be duplicated between the target resource and its provenance. For instance, the prescriber is usually (but not always) the author of the prescription resource. This resource is defined with close consideration for W3C Provenance.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The Reference(s) that were generated or updated by the activity described in this resource. A provenance can point to more than one target if multiple resources were created/updated by the same activity.

Target references are usually version specific, but may not be, if a version has not been assigned or if the provenance information is part of the set of resources being maintained (i.e. a document). When using the RESTful API, the identity of the resource may not be known (especially not the version specific one); the client may either submit the resource first, and then the provenance, or it may submit both using a single transaction. See the notes on transaction for further discussion.

The instant of time at which the activity was recorded.

This can be a little different from the time stamp on the resource if there is a delay between recording the event and updating the provenance and target resource.

An actor taking a role in an activity for which it can be assigned some degree of responsibility for the activity taking place.

Several agents may be associated (i.e. has some responsibility for an activity) with an activity and vice-versa.

An agent can be a person, an organization, software, device, or other entities that may be ascribed responsibility.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The individual, device or organization that participated in the event.

R4: Provenance.agent.who

Element Provenance.agent.who is mapped to FHIR STU3 element Provenance.agent.who[x] as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Provenance.agent.who with unmapped reference targets: PractitionerRole. Source element Provenance.agent.who has unmapped reference types. While the target element Provenance.agent.who[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. whoIdentity should be used when the agent is not a Resource type.

R4: Provenance.occurred[x] additional types (dateTime) additional types from child elements (value)

Element Provenance.occurred[x] is mapped to FHIR STU3 element Provenance.period as SourceIsBroaderThanTarget. The mappings for Provenance.occurred[x] do not cover the following types: dateTime. The mappings for Provenance.occurred[x] do not cover the following types based on type expansion: value. The period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.

R4: Provenance.reason additional types (CodeableConcept) additional types from child elements (text)

Element Provenance.reason is mapped to FHIR STU3 element Provenance.reason as SourceIsBroaderThanTarget. The mappings for Provenance.reason do not cover the following types: CodeableConcept. The mappings for Provenance.reason do not cover the following types based on type expansion: text.

R4: Provenance.activity additional types (CodeableConcept) additional types from child elements (text)

Element Provenance.activity is mapped to FHIR STU3 element Provenance.activity as SourceIsBroaderThanTarget. The mappings for Provenance.activity do not cover the following types: CodeableConcept. The mappings for Provenance.activity do not cover the following types based on type expansion: text.

R4: Provenance.agent.who

Element Provenance.agent.who is mapped to FHIR STU3 element Provenance.agent.who[x] as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Provenance.agent.who with unmapped reference targets: PractitionerRole. Source element Provenance.agent.who has unmapped reference types. While the target element Provenance.agent.who[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. whoIdentity should be used when the agent is not a Resource type.

R4: Provenance.agent.onBehalfOf

Element Provenance.agent.onBehalfOf is mapped to FHIR STU3 element Provenance.agent.onBehalfOf[x] as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Provenance.agent.onBehalfOf with unmapped reference targets: PractitionerRole. Source element Provenance.agent.onBehalfOf has unmapped reference types. While the target element Provenance.agent.onBehalfOf[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. onBehalfOfIdentity should be used when the agent is not a Resource type.

Provenance of a resource is a record that describes entities and processes involved in producing and delivering or otherwise influencing that resource. Provenance provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility. Provenance assertions are a form of contextual metadata and can themselves become important records with their own provenance. Provenance statement indicates clinical significance in terms of confidence in authenticity, reliability, and trustworthiness, integrity, and stage in lifecycle (e.g. Document Completion - has the artifact been legally authenticated), all of which may impact security, privacy, and trust policies.

Some parties may be duplicated between the target resource and its provenance. For instance, the prescriber is usually (but not always) the author of the prescription resource. This resource is defined with close consideration for W3C Provenance.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The Reference(s) that were generated or updated by the activity described in this resource. A provenance can point to more than one target if multiple resources were created/updated by the same activity.

Target references are usually version specific, but may not be, if a version has not been assigned or if the provenance information is part of the set of resources being maintained (i.e. a document). When using the RESTful API, the identity of the resource may not be known (especially not the version specific one); the client may either submit the resource first, and then the provenance, or it may submit both using a single transaction. See the notes on transaction for further discussion.

The period during which the activity occurred.

The period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Provenance.occurred[x] additional types (dateTime) additional types from child elements (value)

Element Provenance.occurred[x] is mapped to FHIR STU3 element Provenance.period as SourceIsBroaderThanTarget. The mappings for Provenance.occurred[x] do not cover the following types: dateTime. The mappings for Provenance.occurred[x] do not cover the following types based on type expansion: value. The period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.

The start of the period. The boundary is inclusive.

If the low element is missing, the meaning is that the low boundary is not known.

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

The instant of time at which the activity was recorded.

This can be a little different from the time stamp on the resource if there is a delay between recording the event and updating the provenance and target resource.

Policy or plan the activity was defined by. Typically, a single activity may have multiple applicable policy documents, such as patient consent, guarantor funding, etc.

For example: Where an OAuth token authorizes, the unique identifier from the OAuth token is placed into the policy element Where a policy engine (e.g. XACML) holds policy logic, the unique policy identifier is placed into the policy element.

Where the activity occurred, if relevant.

The reason that the activity was taking place.

The reason the activity took place.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Provenance.reason additional types (CodeableConcept) additional types from child elements (text)

Element Provenance.reason is mapped to FHIR STU3 element Provenance.reason as SourceIsBroaderThanTarget. The mappings for Provenance.reason do not cover the following types: CodeableConcept. The mappings for Provenance.reason do not cover the following types based on type expansion: text.

The identification of the code system that defines the meaning of the symbol in the code.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Need to be unambiguous about the source of the definition of the symbol.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Need to refer to a particular code in the system.

A representation of the meaning of the code in the system, following the rules of the system.

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

An activity is something that occurs over a period of time and acts upon or with entities; it may include consuming, processing, transforming, modifying, relocating, using, or generating entities.

Unless not suitable, these codes SHALL be taken from ProvenanceActivityType
(extensible to http://hl7.org/fhir/ValueSet/provenance-activity-type|1.1.0)

The activity that took place.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Provenance.activity additional types (CodeableConcept) additional types from child elements (text)

Element Provenance.activity is mapped to FHIR STU3 element Provenance.activity as SourceIsBroaderThanTarget. The mappings for Provenance.activity do not cover the following types: CodeableConcept. The mappings for Provenance.activity do not cover the following types based on type expansion: text.

The identification of the code system that defines the meaning of the symbol in the code.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Need to be unambiguous about the source of the definition of the symbol.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Need to refer to a particular code in the system.

A representation of the meaning of the code in the system, following the rules of the system.

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

An actor taking a role in an activity for which it can be assigned some degree of responsibility for the activity taking place.

Several agents may be associated (i.e. has some responsibility for an activity) with an activity and vice-versa.

An agent can be a person, an organization, software, device, or other entities that may be ascribed responsibility.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The function of the agent with respect to the activity. The security role enabling the agent with respect to the activity.

For example: author, performer, enterer, attester, doctor, nurse, clerk, etc.

Unless not suitable, these codes SHALL be taken from SecurityRoleType
(extensible to http://hl7.org/fhir/ValueSet/security-role-type|1.8.0)

The role that a provenance agent played with respect to the activity.

The individual, device or organization that participated in the event.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Provenance.agent.who

Element Provenance.agent.who is mapped to FHIR STU3 element Provenance.agent.who[x] as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Provenance.agent.who with unmapped reference targets: PractitionerRole. Source element Provenance.agent.who has unmapped reference types. While the target element Provenance.agent.who[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. whoIdentity should be used when the agent is not a Resource type.

The individual, device, or organization for whom the change was made.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: Provenance.agent.onBehalfOf

Element Provenance.agent.onBehalfOf is mapped to FHIR STU3 element Provenance.agent.onBehalfOf[x] as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Provenance.agent.onBehalfOf with unmapped reference targets: PractitionerRole. Source element Provenance.agent.onBehalfOf has unmapped reference types. While the target element Provenance.agent.onBehalfOf[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. onBehalfOfIdentity should be used when the agent is not a Resource type.

The type of relationship between agents.

Type of relationship between two provenance agents.

An entity used in this activity.

Multiple userIds may be associated with the same Practitioner or other individual across various appearances, each with distinct privileges.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

How the entity was used during the activity.

How an entity was used in an activity.

Identity of the Entity used. May be a logical or physical uri and maybe absolute or relative.

Identity may be a reference to a resource or to something else, depending on the type.

The entity is attributed to an agent to express the agent's responsibility for that entity, possibly along with other agents. This description can be understood as shorthand for saying that the agent was responsible for the activity which generated the entity.

A usecase where one Provenance.entity.agent is used where the Entity that was used in the creation/updating of the Target, is not in the context of the same custodianship as the Target, and thus the meaning of Provenance.entity.agent is to say that the entity referenced is managed elsewhere and that this Agent provided access to it. This would be similar to where the Entity being referenced is managed outside FHIR, such as through HL7 v2, v3, or XDS. This might be where the Entity being referenced is managed in another FHIR resource server. Thus it explains the Provenance of that Entity's use in the context of this Provenance activity.

A digital signature on the target Reference(s). The signer should match a Provenance.agent. The purpose of the signature is indicated.