US Core Implementation Guide
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This page is part of the US Core (v8.0.0-ballot: STU8 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 7.0.0. For a full list of available versions, see the Directory of published versions

Using Provenance To Target Resource Elements

Page standards status: Informative

This section is informative and not a requirement for systems conforming to the US Core Provenance Profile.

Provenance typically communicates a single activity about one or more target resources identified via Provenance.target. However, it can focus on one or more resource elements using the FHIR Target Element extension on Provenance.target and identifying the target elements using element ids. For example, to document how and who supplied patient demographic data such as race and ethnicity, gender identity, and sexual orientation.

Example:

In the following US Core Patient Profile example, the patient demographic data such as race,ethnicity, etc.have individual element ids within a resource for internal and external referencing:

{
    "resourceType": "Patient",
    "id": "example-targeted-provenance/_history/1",
    "meta": {
        "versionId": "1",
        "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
        ]
    },
    "extension": [
        {
            "id": "race",
            "extension": [
                {
                    "url": "ombCategory",
                    "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2106-3",
                        "display": "White"
                    }
                },
                {
                    "url": "text",
                    "valueString": "Mixed"
                }
            ],
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
        },
        {
            "id": "ethnicity",
            "extension": [
                {
                    "url": "ombCategory",
                    "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2135-2",
                        "display": "Hispanic or Latino"
                    }
                },
                {
                    "url": "text",
                    "valueString": "Hispanic or Latino"
                }
            ],
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
        },
        {
            "id": "birthsex",
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
            "valueCode": "F"
        },
        {
            "id": "sex",
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex",
            "valueCode": "248152002"
        },
        {
            "id": "genderIdentity",
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity",
            "valueCodeableConcept": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                        "code": "UNK"
                    }
                ]
            }
        }
    ],
    "identifier": [
        {
            "system": "http://hospital.smarthealthit.org",
            "value": "1032702"
        }
    ],
    "active": true,
    "name": [
        {
            "family": "Shaw",
            "given": [
                "Amy",
                "V."
            ]
        }
    ],
    "telecom": [
        {
            "system": "phone",
            "value": "555-555-5555"
        }
    ],
    "gender": "female",
    "_gender": {
        "id": "gender"
    },
    "birthDate": "1987-02-20",
    "address": [
        {
            "line": [
                "183 MOUNTAIN VIEW ST"
            ],
            "city": "MOUNDS",
            "state": "OK",
            "postalCode": "74048"
        }
    ]
}

The following US Core Provenance Profile resource communicates who, how, and when elements such as Race and Ethnicity (R/E), gender identity, etc., were collected. Note that the Target Element Extension references the element id "race" within the Patient resource:

{
    "resourceType": "Provenance",
    "id": "example-targeted-provenance",
    "meta": {
        "versionId": "1",
        "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance"
        ]
    },
    "target": [
        {
            "reference": "Patient/example-targeted-provenance/_history/1",
            "extension": [
                {
                    "url": "http://hl7.org/fhir/StructureDefinition/targetElement",
                    "valueUri": "race"
                }
            ]
        }
    ],
    "recorded": "2023-02-28T15:26:23.217+00:00",
    "agent": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
                        "code": "informant",
                        "display": "Informant"
                    }
                ]
            },
            "who": {
                "reference": "Patient/example-targeted-provenance"
            }
        }
    ],
    "entity": [
        {
            "role": "source",
            "what": {
                "display": "admission form"
            }
        }
    ]
}