US Variance Statement

United States Patient Care Summary (US-PCS) Implementation Guide
1.0.0 - STU 1 United States of America flag

This page is part of the US Patient Care Summary (US-PCS) Implementation Guide (v1.0.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Page standards status: Informative

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US Variance to IPS

US Variance to IPS

The US-PCS conforms with the IPS but it does not derive its Bundle or Composition profiles from the IPS. Only six sections of the IPS are profiled in US-PCS (with one new Encounters section available not from IPS), but resource expectations draw primarily from US Core rather than IPS clinical profiles.

US Variance in Must Support, Obligation and Actors

The US-PCS guide does not use the Must Support definition through obligations as defined in the IPS Implementation Guide.

In addition, the terms US-PCS Document Creator and US-PCS Document Consumer used in this guide share similarities with IPS Creator and IPS Consumer but do not use obligations as provided in the IPS Implementation Guide. Notably, Must Support elements in US-PCS means capable to populate and there are no display system requirements in US-PCS.

US Variance in Sections

Each of the IPS mandatory sections (i.e. Allergies, Problems and Medications) is also required in the US-PCS.

For "recommended" IPS sections where support is specified through obligations, the following changes have been introduced:

The US-PCS Immunizations, Procedures, and Results sections have been flagged as "Must Support" as defined in US-PCS which varies from the obligations defined in IPS
The US-PCS has removed Must Support from the Medical Devices section, which is considered optional and not profiled in this guide

All other "optional" sections in IPS are not profiled in this guide, although resources from US Core resources have been recommended for use when available.

Finally the US-PCS introduces an "Encounters" section to its Composition profile. This section contains the same Must Support flags as the sections of Immunizations, Procedures, and Results.

US Core Profile Variances to IPS Profiles

The following tables provide a comparison of US Core 6.1.0 clinical profiles to IPS 2.0.1 clinical profiles for all the mandatory and Must Support sections of US-PCS.

Note that IPS and US Core profile links below refer to the most recent published version while the variances listed are from a specific comparison of US Core 6.1.0 and IPS 2.0.1

The following design conventions were applied in these tables:

US Core and IPS vary in the definition of Must Support in US Core and Must Support/Obligations in IPS. MustSupport/obligations definitional differences are not included in table below, although it is indicated where one guide includes the MustSupport flag but the other does not
CodeableConcepts within IPS use a specialized CodeableConcept IPS DataType. For simplicity, differences in this datatype are not repeated for every profile. Implementers are recommended to consider this difference wherever CodeableConcept is used. Specifically:
- IPS places MustSupport/Obligations CodeableConcept.coding.code and CodeableConcept.coding.system
- IPS places MustSupport/Obligations CodeableConcept.text
- IPS includes the language translation extension within CodeableConcept IPS and Coding IPS datatype
IPS universally includes the patient.reference or subject.reference element in its clinical profiles, while US Core does not specify that .reference must be included. These differences are shown due to the cardinality variance.
Differences in element or extension inclusion are shown, focusing on MustSupport and cardinality differences. US Core's Additional USCDI data elements are treated as optional for this comparison
Differences in terminology bindings are shown