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Agenda Item


Decision Link(if not child)

C-CDA Companion Guide

Review latest CDA design and background integrated into the C-CDA Companion Guide

Basic Provenance ballot submission in September.

Brett presented C-CDA design at Security WG meeting June 17, 2019, and SG Security WG requested the design to be included in the C-CDA Companion Guide ballot for comment. The template includes new constraints for author participation for CDA header (body section). Please review that ballot. Structured rules in Appendix C, plus some guidance in the main body.

Brett continued that Argonaut is working on provenance and created draft profile (Argo R4 Implementation Guide CI Build v3.1.0). No firm date for US Core update, and Argonaut does not immediately ballot through HL7. HL7 will be earlier than Argonaut (U.S. Core) update, and this project may copy the profile or reference it as coming in the future.

Background: includes author name and identifier and guidance on last hop (one hop back).

Use cases: clinical information reconciliation and incorporation (CIRI), FAX, HIE.

Argonaut Provenance Design

Draft Argonaut Provenance design is online.

Argonaut profile: Draft profile (online) requires agent (with a type of author), plus who, plus on behalf of (organization).   

Aligns with author, author org, and time stamp.

Kathleen: the current FHIR resource works well.

The group discussed agent, organization, and onBehalfOf.


  1. Should we have an invariant that if who = Practitioner, there SHALL be an ‘onBehalfOf’ with an organization present? Brett: leaning yes.

Should we have an invariant that if who = PractitionerRole, there SHALL be an ‘onBehalfOf’ with an organization present? Maybe PractitionerRole should not be allowed in ‘who’. [Brett will ask Argonaut about ACTUAL use of PactitionerRole]

  1. If an Organization is in the ‘who’ do we want to allow Organization in ‘onBehalfOf’? Yes. HIE acting on behalf of another organization.

Some use cases will need accountability split between two organizations, so ‘onBehalfOf’ is needed.

Most EHR vendors do not split concept of practitioner and practitionerRole, which works for inward-facing EHRs, but is problematic across organizations.

Most vendors have not implemented revInclude. It may not be possible to include all required provenance information in a single data call. But a ‘get’ [base] provenance call can include required information. Brett will review and streamline the data call structure.

Organization profile: originally built for provider directory and contains more information than needed for provenance. The group discussed using Core instead of US Core. The project is a US Realm project to write an informative implementation guide with a set of use cases and how to apply provenance to CDA and FHIR for those use cases. For CDA, we will reference the template that is created in the CDA Companion Guide. For FHIR, had Argonaut not taken this on with plans for US Core, we would have created our own profile. The plan is to point to the profile in the informative guide with expectation that it all folds into US Core.

Project Scope Statement is realm specific (US Realm).

Argonaut submission will be balloted as an update to US Core. HL7 will have an opportunity to comment on and influence this submission.

Additional Argonaut Use Cases
  1. Serving a FHIR resource from a CCD/CDA which may have been transformed and aggregated through an HIE [no guidance is written on how to aggregate data]
  2. Does any state support FHIR based immunization registries? None are known in US because of v2, but it exists internationally.

HL7 CDA R2 IGC-CDA Templates for Clinical Notes STU Companion Guide, Release 2. Appendix C: Provenance – Author Participation. This group reviewed the information which is now in the companion guide. Open for ballot now and formal comments are required to make changes.
Next Agenda

Review draft content.

Deeper review of use cases agreed upon in Apr-May 2019

Call ended4:00 PM eastern time