Welcome to the US Core Implementation Guide Repository

US Core Implementation Guide (FHIR IG) Publication (Version) History

Authors: Eric Haas, Brett Marquard

Version 4.0.0 STU4 Changes:

The changes in this annual update to US Core have been reviewed and commented upon by the public through the January 2021 HL7 balloting process. The resolution of the community comments has been agreed to and voted on by the members of the sponsoring work group HL7 International Cross-Group Projects.

The key changes are summarized below:

1. New Conformance Expectations page

• Defining different ways to implement and conform to US Core.
• Clarification of the Must Support definitions as it relates to various FHIR elements such a choice datatype and references.

2. Publishing a set US Core Vital Signs independent of the FHIR core profile upon which it is based

• US Core Vital Signs Profile
  • US Core Blood Pressure Profile
  • US Core BMI Profile
  • US Core Head Circumference Profile
  • US Core Body Height Profile
  • US Core Body Weight Profile
  • US Core Body Temperature Profile
  • US Core Heart Rate Profile
  • US Core Respiratory Rate Profile

3. Linking terminology directly to the FHIR® Terminology Service for VSAC Resources (Value Set Authority Center (VSAC) - NIH) where applicable:

US Core Value Set	VSAC Value Set	VSAC OID	extensional?
Detailed ethnicity	Detailed Ethnicity	2.16.840.1.114222.4.11.877	No
OMB Ethnicity Categories	Ethnicity	2.16.840.1.114222.4.11.837	Yes
US Core CareTeam Provider Roles	Care Team Member Function	2.16.840.1.113762.1.4.1099.30	Yes
US Core Medication Codes (RxNorm)	Medication Clinical Drug	2.16.840.1.113762.1.4.1010.4	Yes
US Core Provider Specialty (NUCC)	Healthcare Provider Taxonomy	2.16.840.1.114222.4.11.1066	No
US Core Smoking Status	Smoking Status	2.16.840.1.113883.11.20.9.38	Yes
US Core Vaccine Administered Value Set (CVX)	CVX Vaccines Administered Vaccine Set	2.16.840.1.113762.1.4.1010.6	Yes
US Core Common substances for allergy and intolerance documentation including refutations	Common substances for allergy and intolerance documentation including refutations	2.16.840.1.113762.1.4.1186.8	No

4. Migrating to the standard set of HL7 FHIR IG templates for publishing. Although we strove to minimize the differences between this version and the previous versions of US Core, these changes are notable:

   • Additional Features include:
     • Addition of vocabulary and constraint tables to the profile pages
     • Addition of a summary table and to the profile page introduction
     • Addition of "Snapshot Table (Must Support)" Tab to profile views
   • Due to restrictions on customizable content, the full narrative text summaries of profiles is no longer available.

5. Addressing over 90 January 2021 Ballot related trackers resulting in the followed detailed changes.

Listed below are the resolved trackers for this version:

Status: Summary:(Jira Issue) Link to Change

1. Applied:Update PractitionerRole.practitioner to )..1 MS (FHIR-29681) See Change Here
2. Applied:Change CareTeam status search parameter compositeOR expectation to SHOULD (FHIR-29768) See Change Here
3. Applied:Provide guidance on the population of narrative (FHIR-29777) See Change Here
4. Applied: Change $docref start and end input parameter types from date to dateTime (FHIR-29825) See Change Here
5. Applied: The history file markdown rendering of the table (FHIR-30100) See Change Here
6. Applied:footnote rendering - pre-applied (FHIR-30101) See Change Here
7. Applied:Random Section Numbering (Reminder for tooling issue) (FHIR-30102) See Change Here
8. Applied:Move section 1.5 US Core Conformance Requirements (FHIR-30103) See Change Here
9. Applied:Make custodian optional on document reference (FHIR-30108) See Change Here
10. Applied:Remove required binding on procedure and condition (FHIR-30109) See Changes:
    • Here
    • Here
    • Here
11. Applied:Update DocumentReference CCD operation (FHIR-30110) See Change Here
12. Applied:Update DocumentReference MustSupport to choice of data or url (FHIR-30111) See Change Here
13. Applied:Reference to 3 new document types - addressing corresponding metadat (FHIR-30112) See Change Here AND See Change Here
14. Applied:Typo (FHIR-30113)
15. Applied:Clarify Must Support of Complex elements (FHIR-30321) See Change Here
16. Applied:Clarify that VSAC FHIR API only retrieves a definition (FHIR-30344) See Change Here
17. Applied:Allergy Intolerance example for UNKNOWN allergy status does not use unknown (FHIR-30345) See Change Here
18. Applied:Corrected allergy intolerance example SNOMED CT code (FHIR-30346) See Change Here
19. Applied:Allergy codes updated to snomed product hierarchy in VSAC(FHIR-30347) See Change Here
20. Applied:Clarify plans to align with Gender Harmony(FHIR-30350) See Change Here
21. Applied:Typos on Conformance Expectations Page (FHIR-30353) See Change Here
22. Applied:clarify use of additional codings (FHIR-30354) See Change Here
23. Applied:Clarify server requirements for Choice of Profile Elements scenario (FHIR-30355) See Change Here
24. Applied:Add all options to Procedure.performed[x] (FHIR-30391) See Change Here
25. Applied:Updated MedicationRequest.authoredOn from mandatory to must support(FHIR-30430) See Change Here
26. Applied:Typo (FHIR-30460) See Change Here
27. Applied: Update Encounter Type CPT Description (FHIR-30470) See Change Here
28. Applied: Clarify Missing Data language for coded data elements with required binding strength (FHIR-30630) See Change Here
29. Applied:Note re language codes(FHIR-30654) See Change Here
30. Applied:Change URL for Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes(FHIR-30655) See Changes Here and Here
31. Applied:Typo (FHIR-30656)
32. Applied: Explain the relationship between US CORE and an evolving USCDI. (FHIR-30657) See Change Here
33. Applied:Correct 2 bullet points in section 1.2. (FHIR-30658) See Change Here
34. Applied:Clarify actors (FHIR-30659) See Change Here
35. Applied:Edit basic provenance (FHIR-30660) See Change Here
36. Applied:Clarify the duplication requirement for scanned documents in DocumentReference and DiagnosticReport. (FHIR-30662) See Change Here
37. Applied:Clarify that clients should retain data visualization between DSTU2 to R4 upgrades. (FHIR-30665) See Change Here
38. Applied:Add provenance to writing/updating guidance? (FHIR-30666) See Change Here
39. Applied:Clarify Code System section and update codesystem table (FHIR-30667) See Change Here
40. Applied: Clarify guidance on implantable medical devices. (FHIR-30669) [See Change Here
41. Applied: Make udi_HRF a Must Support element. (FHIR-30670) See Change Here
42. Applied: Clarify UDI information. (FHIR-30672) See Changes:
    • Here
    • Here
43. Applied:Clarify text (FHIR-30673) See Change Here
44. Applied:Typos (FHIR-30674)
45. Applied:Clarify prohibition on using contained resources. (FHIR-30677) See Change Here
46. Applied:Add guidance on suppressed data. (FHIR-30678) See Change Here
47. Applied:Clarify what is meant by "support the other elements." (FHIR-30680) See Change Here
48. Applied:Typo(FHIR-30681)
49. Applied:Fix typos (FHIR-30683) Various Changes
50. Applied:Update on Guidance on DataAbsentReason for Observations (FHIR-30685) See Change Here
51. Applied:Clarify use of qualifier LOINCs (FHIR-30690) See Change Here
52. Applied: Fix Typo (FHIR-30695) See Change Here
53. Applied: Update on Guidance on DataAbsentReason for Observations (FHIR-30699) See Change Here
54. Applied: Clarify what is intended with "additional observations"(FHIR-30772) See Change Here
55. Applied: Add statement about clinical safety to the security page (FHIR-30776) See Change Here
56. Applied: Added clarification to vitals profile regarding use of additional codings and component observations. (FHIR-30778) See Change Here
57. Applied: Typo grammar. All codes SHALL have an system value. Correction “a value system”. (FHIR-30782) See Change Here
58. Applied: Clarify resource search requirements CapabilityStatements and provide guidance on search for multiple patients using Bulk data (FHIR-30787) See Changes:
    • Here
    • Here
59. Applied: Add MedicationAdministration to the Future Page. (FHIR-30788) See Change Here
60. Applied: Fix text in $docref description (FHIR-30810) See Change Here
61. Applied: Mandate that CapabilityStatement.instantiates refer to US Core (FHIR-30889) See Change Here
62. Applied: Add binding so Vitals will render it in differential view (FHIR-31391) See Change Here
63. Applied: Update to URI from OID for CDT in Procedure Code ValueSet (FHIR-31556) See Change Here
64. Applied: Add DocumentReference.content is under "must have" list (FHIR-31364) See Change Here
65. Applied: Update Must Support Bullet regarding missing data (FHIR-31507) See Change Here
66. Applied: Update use context for Race and Ethnicity extensions (FHIR-31008) See Change Here
67. Applied: Add guidance on "POST based search" (FHIR-31585) See Changes:
    • Here
    • Here
68. Applied: Add reference to Mapping from LOINC scale type to FHIR data type (FHIR-31084) See Change Here
69. Applied: Update Observation.value[x] definition (FHIR-31083) See Change Here
70. Applied: Add LOINC to procedure codes (FHIR-31514) See Change Here
71. Applied: Make PractitionerRole.organization must support and add invariant (FHIR-29680) See Change Here
72. Applied: Fix FHIRPath constraint for provenance-1(FHIR-31020) See Change Here
73. Applied: Add guidance to BMI Profile(FHIR-32658) See Change Here
74. Applied: Write usage note for non-vaccination CVX codes(FHIR-31899) See Change Here
75. Applied: Clarify that Extensible binding can always provide a mapped code(FHIR-32010) See Change Here
76. Applied: Clarify RESTFul requirements(FHIR-31490) See Changes:
    • Here
    • Here
    • Here
    • Here
77. Applied: fix Procedure Example error (FHIR-30106) See Change Here

Known issues:

We're working to fix these issues that may come up when using US CORE. We will correct them in a future version of the guide

Publishing

• Resolved - change required:Confusing for commercial vendor. Reads very confusing. (FHIR-30783) proposal is to make the differential tab the default view, see publishing plans here timeline unknown.
• Resolved - change required:In most of the data elements – “Binding is from base FHIR and US Core Vital Signs” Need this to be one single combined listing (FHIR-30780) proposal is to limit the terminology and invariants to view shown. see Zulip chat timeline unknown.
• Resolved - change required:Why are there separate codes for USCoreVitalSigns and the Systolic.value and the diastolic value? (FHIR-30779) proposal is to work with publishing to "clean up" terminology and invariants to view shown. see: see Zulip chat timeline unknown.

Terminology

• Resolved - change required: valueset-simple-language.xml QA error "Error from server: Language valuesets cannot be expanded as they are based on a grammar" (FHIR-30107) this error is still extant from prior version of US Core and has yet to be resolved. Work with publishing to fix and created STU note. see Zulip chat
• Resolved - change required: Patient Examples QA Errors: CDCREC code system in VSAC Patient (FHIR-30105) CDCREC codes and code system value not aligned with VSAC. Workaround is to publish the CDCREC code system and valuesets in USCore until this content is moved to HL7 Terminology Add an STU Note. Zulip chat1 and Zulip chat2 and Zulip chat3
• Resolved - change required:imm-1.json NDC/CVX codes QA Error (FHIR-30104) Work with terminology server team to correct. see Zulip chat
• Resolved - change required:Pulse Ox Example: observation-satO2-fiO2 (FHIR-27845) Proposed Jira ticket to resolve in base made an STU note that is technically not conformant with the base FHIR vital profile. See Zulip chat

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