Publication Build: This will be filled in by the publication tooling
| Page standards status: Informative |
This section provides implementers with important definitions to create and share the Provenance Resource1.
The FHIR Provenance Resource provides a foundation for assessing authenticity, enabling trust, and allowing reproducibility. It is not scoped to a specific use case nor limits the number of Provenance records associated with a Resource. The primary guidance here, and in the IE Core Provenance Profile, focuses on a key subset of elements, the 'last hop', and specific use cases. The guidance here does not preclude more advanced use cases or additional elements.
Full Provenance of a Resource requires details from the original resource creator and all intermediary actors that updated the Resource.
The guidance for Provenance in IE Core focuses on six key elements: Timestamp, the Target Resource, Author, Author Organization, Transmitter, and Transmitter Organization. The Timestamp is the date and time the author created, updated, or deleted the data. The Target Resource is the Resource the Provenance record supports. The Author represents the person(s) responsible for the information. The Author Organization defines the organization the author is associated with when they created, updated, or deleted the data. The Transmitter represents the system responsible for transmitting the information. Finally, the Transmitter Organization defines the organization responsible for the transmission.
Key Provenance elements:
| Element | Required | Must Support | Optional | FHIR Element |
|---|---|---|---|---|
| Target | Resource Provenance record supports |
Provenance.target |
||
| Timestamp | Date | Time with timezone offset | Provenance.recorded |
|
| Author | Name Identifier |
NPI recommended, additional identifiers allowed | Provenance.agent.who |
|
| Author Organization | Name Identifier |
NPI recommended, additional identifiers allowed | Provenance.agent.onBehalfOf |
|
| Transmitter | Name Identifier |
NPI recommended, additional identifiers allowed | Provenance.agent.who |
|
| Transmitter Organization | Name Identifier |
NPI recommended, additional identifiers allowed | Provenance.agent.onBehalfOf |
The HL7 Basic Provenance Informative implementation guide outlines four use cases: Fax, Health Information Exchange (HIE) redistribution, HIE transformation, and Clinical Information Reconciliation and Incorporation (CIRI). While these use cases may have FHIR implications in the future, CIRI and HIE are the key use cases and are covered in detail here.
Clinical Information Reconciliation and Incorporation (CIRI) is when a user reviews and updates or accepts information into their system. The data could come from a Health Information Exchange (HIE), a 3rd-party FHIR server, or a patient providing information. Figure 1 represents information from Good Health and Sunshine Health Organization. Dr. Reconciled reviews the data in Figure 1, updates the reaction to hives, and stores it in the Future Health Organization system. When a mobile app requests the information, it receives Dr. Reconciled as the Author and Future Health as the organization. This type of authorship change is only relevant for data suitable for reconciliation, such as medications, allergies, and problems. If Dr. Accepted had saved other clinical content into his EHR that is not reconciled but stored, such as clinical notes, that content must retain its original author.
Dr. Reconciled is the latest author after updating the reaction on 5/15/2019 and accepting it to the local data store. By accepting the information, Dr. Reconciled is taking over the responsibility.
GET /AllergyIntolerance?patient=[ID]&_revinclude=Provenance:target
Good Health Organization Provenance
Request:
Get “all allergies” for a patient and all corresponding Provenance records.
iEHR
GET [base]/AllergyIntolerance?patient=12345&_revinclude=Provenance:target
Response:
A Server returns a search Bundle resource containing all the Allergies for the patient and corresponding Provenance records.
HTTP/1.1 200 OK
[other headers]
{
"resourceType": "Bundle",
"id": "c887e62f-6166-419f-8268-b5ecd6c7b901",
"meta": {
"lastUpdated": "2019-07-09T18:49:01.235+00:00"
},
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://hapi.fhir.org/baseR4/AllergyIntolerance?patient=Examples&_revinclude=Provenance:target"
}
],
"entry": [
{
"fullUrl": "http://hapi.fhir.org/baseR4/AllergyIntolerance/79613",
"resource": {
"resourceType": "AllergyIntolerance",
"id": "79613",
"meta": {
"versionId": "1",
"lastUpdated": "2019-07-09T15:26:23.217+00:00",
"profile": [
"http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-allergyintolerance"
]
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
"code": "active",
"display": "Active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
"code": "confirmed",
"display": "Confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "762952008",
"display": "Peanuts"
}
],
"text": "Peanuts"
},
"category": [
"medication"
],
"criticality": "high",
"patient": {
"reference": "Patient/example"
},
"onsetDateTime": "2018-01",
"reaction": [
{
"manifestation": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "247472004",
"display": "Hives"
}
]
}
],
"onset": "2018-01"
}
]
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://hapi.fhir.org/baseR4/Provenance/79614",
"resource": {
"resourceType": "Provenance",
"id": "79614",
"meta": {
"versionId": "1",
"lastUpdated": "2019-07-09T15:26:23.217+00:00",
"profile": [
"http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-provenance"
]
},
"target": [
{
"reference": "AllergyIntolerance/79613"
}
],
"recorded": "2018-02T15:26:23.217+00:00",
"agent": [
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code": "author",
"display": "Author"
}
]
}
],
"who": {
"reference": "Practitioner/Dr-Jones-12345"
},
"onBehalfOf": {
"reference": "Organization/good-health-54321"
}
}
]},
"search": {
"mode": "include"
}
}
] }
Sunshine Health Organization Provenance
Request:
Get “all allergies” for a patient and all corresponding Provenance records.
GET [base]/AllergyIntolerance?patient=1234599&_revinclude=Provenance:target
Response:
A Server returns a search Bundle resource containing all the Allergies for the patient and corresponding Provenance records.
HTTP/1.1 200 OK
[other headers]
{
"resourceType": "Bundle",
"id": "c887e62f-6166-419f-8268-b5ecd6c7b901",
"meta": {
"lastUpdated": "2019-07-09T18:49:01.235+00:00"
},
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://hapi.fhir.org/baseR4/AllergyIntolerance?patient=Examples99&_revinclude=Provenance:target"
}
],
"entry": [
{
"fullUrl": "http://hapi.fhir.org/baseR4/AllergyIntolerance/7961399",
"resource": {
"resourceType": "AllergyIntolerance",
"id": "7961399",
"meta": {
"versionId": "1",
"lastUpdated": "2019-07-09T15:26:23.217+00:00",
"profile": [
"http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-allergyintolerance"
]
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
"code": "active",
"display": "Active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
"code": "confirmed",
"display": "Confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "762952008",
"display": "Peanuts"
}
],
"text": "Peanuts"
},
"category": [
"medication"
],
"criticality": "high",
"patient": {
"reference": "Patient/example"
},
"onsetDateTime": "2017-09",
"reaction": [
{
"manifestation": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Unknown"
}
]
}
],
"onset": "2017-09"
}
]
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://hapi.fhir.org/baseR4/Provenance/7961499",
"resource": {
"resourceType": "Provenance",
"id": "7961499",
"meta": {
"versionId": "1",
"lastUpdated": "2019-07-09T15:26:23.217+00:00",
"profile": [
"http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-provenance"
]
},
"target": [
{
"reference": "AllergyIntolerance/7961399"
}
],
"recorded": "2017-09T15:26:23.217+00:00",
"agent": [
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code": "author",
"display": "Author"
}
]
}
],
"who": {
"reference": "Practitioner/Dr-Smith-1234599"
},
"onBehalfOf": {
"reference": "Organization/sunshine-health-5432199"
}
}
]},
"search": {
"mode": "include"
}
}
] }
After reconciliation, the Future Health Organization Provenance contains the latest information.
Request:
Get “all allergies” for a patient and all corresponding Provenance records.
GET [base]/AllergyIntolerance?patient=123459988&_revinclude=Provenance:target
Response:
A Server returns a search Bundle resource containing all the Allergies for the patient and corresponding Provenance records.
HTTP/1.1 200 OK
[other headers]
{
"resourceType": "Bundle",
"id": "94d5d5ac-6645-41dc-8282-1870b71e840a",
"meta": {
"lastUpdated": "2019-07-20T18:49:01.235+00:00"
},
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://hapi.fhir.org/baseR4/AllergyIntolerance?patient=Examples9988&_revinclude=Provenance:target"
}
],
"entry": [
{
"fullUrl": "http://hapi.fhir.org/baseR4/AllergyIntolerance/796139988",
"resource": {
"resourceType": "AllergyIntolerance",
"id": "796139988",
"meta": {
"versionId": "1",
"lastUpdated": "2019-07-09T15:26:23.217+00:00",
"profile": [
"http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-allergyintolerance"
]
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
"code": "active",
"display": "Active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
"code": "confirmed",
"display": "Confirmed"
}
]
},
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "762952008",
"display": "Peanuts"
}
],
"text": "Peanuts"
},
"category": [
"medication"
],
"criticality": "high",
"patient": {
"reference": "Patient/example"
},
"onsetDateTime": "2017-09",
"reaction": [
{
"manifestation": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "247472004",
"display": "Hives"
}
]
}
],
"onset": "2017-09"
}
]
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://hapi.fhir.org/baseR4/Provenance/796149988",
"resource": {
"resourceType": "Provenance",
"id": "796149988",
"meta": {
"versionId": "1",
"lastUpdated": "2019-07-09T15:26:23.217+00:00",
"profile": [
"http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-provenance"
]
},
"target": [
{
"reference": "AllergyIntolerance/796139988"
}
],
"recorded": "2019-05-15T15:26:23.217+00:00",
"agent": [
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code": "author",
"display": "Author"
}
]
}
],
"who": {
"reference": "Practitioner/dr-reconciled-123459988"
},
"onBehalfOf": {
"reference": "Organization/future-health-543219988"
}
}
]},
"search": {
"mode": "include"
}
}
] }
Dr. Accepted is the latest author after verifying the problem on 5/2018 and accepting the problem data into their local data store since it went through an interactive reconciliation process.
A Health Information Exchange (HIE) is an organization and technology that facilitates information exchange between one and many partners. In specific HIE scenarios, they only redistribute information, while in others, they store, transform, and redistribute information. The HIE must maintain the clinical content fidelity (original author, author organization, and timestamp). In addition, the HIE must keep track of who sent them the information for auditing; however, they are not required to include the original transmitter when redistributing content.
Since no clinical content is changed in the HIE redistribution, the best scenario is a Provenance Record with:
Provenance.agent.type = author
Provenance.agent.who set to the practitioner who authored the content (i.e., not the HIE)Provenance.agent.onBehalfOf set to the organization that the author acted on behalf of before sharing with the HIEProvenance.agent.type = transmitter
Provenance.agent.who set to the HIE organizationThe timestamp and pointer (i.e., target) to the appropriate Resource are required in all cases and must be included. This IG would note these as SHALL constraints if systems always had the Author and Author Organizations available. Participants in the development of this guide reported that the Author information provided to HIEs needs to be more consistent and reliable.
Unlike Use Case 3 - HIE Redistribution, Use Case 4 includes data transformation. Information is received (e.g., v2 lab, other CDs), transformed by a HIE, stored, and passed in a new format (e.g., CCD or FHIR).
Transformation of data from one format to another MAY change the authorship of the information, where the HIE is the author/author organization. The HIE must maintain the original data source. An agent.type="assembler", agent.type="transmitter", or other agents from Provenance Agent Type value set MAY also be included. Due to insufficient implementer guidance, the Basic Provenance guidance here does not specify how to assign authorship for this use case. HL7 plans to gather additional input and include it in the HL7 Basic Provenance Informative guide for C-CDA and FHIR.
This section is informative and not a requirement for systems conforming to the IE Core Provenance Profile.
Using the FHIR Extension Target Element, Provenance can target a particular element or set of elements. For example, to document how and who supplied patient demographic data such as Race and Ethnicity (R/E), gender identity, and sexual orientation.
Example:
In this IE Core Patient Profile example, the patient demographic data such as Race and Ethnicity (R/E), gender identity, etc., have individual element ids within a resource for internal and external referencing:
{
"resourceType" : "Patient",
"id" : "example-targeted-provenance",
"meta" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/instance-name",
"valueString" : "Targeted Provenance Patient Example"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/instance-description",
"valueMarkdown" : "This is a patient example for the *IE Core Patient Profile* to demonstrate how Provenance can be used to document the source of individual elements such as Race and Ethnicity (R/E), gender identity."
}],
"profile" : ["http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-patient"]
},
"extension" : [{
"id" : "genderIdentity",
"url" : "http://iehr.ai/fhir/ie/core/StructureDefinition/ie-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" : "1 234 5678"
}],
"gender" : "female",
"_gender" : {
"id" : "gender"
},
"birthDate" : "1987-02-20",
"address" : [{
"line" : ["183 MOUNTAIN VIEW ST"],
"city" : "Sandyford",
"state" : "Galway",
"postalCode" : "H91 CV48"
}]
}
This IE 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 ids within the Patient resource:
{
"resourceType" : "Provenance",
"id" : "example-targeted-provenance",
"meta" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/instance-name",
"valueString" : "Targeted Provenance Example"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/instance-description",
"valueMarkdown" : "This is a provenance example for the *IE Core Provenance Profile* to demonstrate how Provenance can be used to document the source of individual elements such as Race and Ethnicity (R/E), gender identity."
}],
"profile" : ["http://iehr.ai/fhir/ie/core/StructureDefinition/ie-core-provenance"]
},
"target" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/targetElement",
"valueUri" : "ethnicity"
}],
"reference" : "Patient/example-targeted-provenance"
}],
"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"
}
}]
}
Footnotes
This Basic Provenance guidance and IE Core Provenance Profile are provisional and may change in future releases. Although it is based on feedback from the HL7 community, there was only preliminary testing of this approach before publication. ↩