United States Patient Care Summary (US-PCS) Implementation Guide - Downloaded Version 1.0.0 See the Directory of published versions

Use Case

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The US-PCS for Care Continuity

The primary use case of the United States Patient Care Summary (US-PCS) is to conform with the use case from ISO 27269 and the IPS FHIR Implementation Guide 2.0.1. From ISO 27269 "the primary value of a patient summary, normalized by the IPS, is to facilitate and support appropriate clinical decision-making for the patient at the point of care. The IPS is designed to provide relevant information to assist planned and unplanned care across any organizational boundary, including country borders and their jurisdictional requirements (e.g. local, regional, state/provincial, national and international contexts)." Both ISO 27269 and the FHIR IPS Implementation guides emphasize that patient summaries are minimal and non-exhaustive.

The US-PCS use case builds off of the original intent of the Continuity of Care Document (CCD) as now published in the Consolidated Clinical Document Architecture (C-CDA) and widely used in the United States. The original intent of the CCD had several principles that align strongly with IPS and US-PCS:

• "Golden Minimum Dataset": Defined as a limited, clinically relevant snapshot (medications, allergies, problems) to support safe care transitions. Modeled after the paper-chart "Face Sheet" a front-of-chart snapshot of essential patient information.
• Human-Readable First: A core requirement that systems can easily render content for humans (i.e. the Narrative Blocks of US-PCS Composition.section) without advanced information systems.
• A "Snapshot" not a "Complete History": It was intended to be a static moment in time - "Here is the patient's status when last seen" - not a longitudinal dump of every blood pressure reading from the last 10 years.

Leveraging the above guidance, we define that the primary US-PCS use case is to provide a minimal, non-exhaustive summary that supports clinical decision-making at the point of care for both planned and unplanned care across organizational boundaries. It is not a longitudinal export of all patient data and it does not replace the full scope of documents in C-CDA. While the US-PCS use-case supports crossing organizational borders within the United States, it may also be used in transitions across regional and national jurisdictions. Considering the US-PCS terminology guidance is an important consideration for international use given global expectations for coded clinical content.

In addition to the principles from the original intent of the CCD, the US-PCS use-case adds the following principle:

• US-PCS documents generally include sufficient references to underlying data sources so implementers can retrieve additional clinical information beyond what is contained in the summary.

This principle as applied to the US health data ecosystem is further elaborated in the following two sub-sections.

Networks Supporting US-PCS

In keeping with guidance from the IPS, the US-PCS only requires three sections of Problems, Allergies and Medications along with key patient and document information. There are many scenarios where information not included in US-PCS documents will be necessary for optimal clinical care. When appropriate, providers can leverage the ecosystem of US health information exchange capabilities to query for additional data. These may include organizational FHIR endpoints, regional health information exchange organizations (HIEs), networks available through electronic health record (EHR) vendors (e.g. CareQuality and Commonwell) as well as Qualified Health Information Networks (QHIN) through the Trusted Exchange Framework and Common Agreement (TEFCA). Establishing patterns to request additional information supports the principles of US-PCS as aligned with the IPS, as illustrated below.

Figure 4: Supporting Networks for Additional Data Beyond US-PCS

Queries for Additional Data using US Core FHIR servers

FHIR Servers that support the US Core Implementation Guide will generally contain additional information not included in US-PCS documents. To search for and retrieve additional data, implementers can access US Core servers using authentication methods outlined in that guide.

When resources in US-PCS documents are from a US Core FHIR server, the entry.fullUrl in the US-PCS Bundle profile specify originating information. This entry.fullUrl and other identifiers allow downstream receivers to query for additional data when clinically appropriate. For example, using the entry.fullUrl of the Patient resource (as well as the patient.id) allows for additional data requests without performing a $match operation. The US Core Implementation Guide defines a wide range of search parameters that provide implementers several options to request additional data.

Patient Mediated Interoperability with US-PCS

Patients are expected to be a participant in the sharing and review of US-PCS documents. In 2025, the US Centers for Medicare and Medicaid Services (CMS) launched the "Kill the Clipboard" initiative that aims to eliminate the manual, error‑prone transfer of medical information by empowering patients and providers with seamless, standards‑based data exchange. This initiative, pledged by over 60 organizations, will facilitate record sharing using QR codes (e.g. SMART Health Cards and Links) with FHIR Bundles. The US-PCS FHIR Bundle profile is designed to facilitate sharing essential health information across systems and aligns with this use case.

When paired with SMART Health Links, US-PCS data can be packaged into a secure, portable URL that patients can easily share across healthcare organizations. While this US-PCS Implementation Guide does not offer full guidance on this use case, it is anticipated that US-PCS will be a component in initiatives like "Kill the Clipboard" that replace paper‑based intake forms with digital, patient‑mediated interoperability. In addition several early implementations of this (such as Washington State Health Summary and CommonHealth) show the potential of this approach.

Receiving and Sending Patient Summaries Across National Borders

While this implementation guide is designed so US-PCS documents also conform to the FHIR IPS Implementation Guide, it adds guidance and constraints that vary from IPS. Notably these include:

• Defining US-PCS Must Support differently than how the IPS defines Must Support
• Deriving the US-PCS Composition from FHIR Clinical Documents and modifying guidance, sections and constraints
• Using US Core Profiles for the individual resources within US-PCS sections, which adds additional constraints and data expectations from that implementation guide

Specific variances from US-PCS to IPS are further detailed in the US Variance to IPS section of this guide.

When US-PCS documents are created and used to inform care outside the United States, the inclusion of the terminology translation to IPS will be important since domestic vocabularies from US Core do not always match global expectations. Guidance on terminology differences are included in this guide and details specific differences by clinical resource. The US-PCS shares guidance and requirements for narrative content as the IPS. Having a human-readable view of US-PCS contents remains important when summaries are shared outside the United States where patients may receive care in different languages and coding expectations differ from the United States.

When receiving patient summaries that conform to the IPS from other national jurisdictions, systems will generally not be able to assume that the shared summaries have the same coding and data requirements as US-PCS summaries (i.e. resources may not conform to the US Core Implementation Guide). In this circumstance, being able to display the narrative contents of IPS documents remains important for informing care. Reference to the US-PCS terminology guidance may assist with terminology translation from non-US IPS documents.