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Argonaut vs. IPS: A Compare and Contrast between Two FHIR Implementation Guides

March 2019

 

 

HL7 Work Group White Paper

 

 

Sponsored by:

FHIR Infrastructure Work Group

 

Written by:

Michele Mottini – CareEvolution Inc

 

 

 

NOTE:  This Work Group White Paper (WGWP) has been reviewed and approved by the authoring Work Group listed above.  It has not been balloted or subject to formal review by the full HL7 organization. This WGWP expires five years from the date of publication.

 

 

 

Point of Contact Name and Email: http://www.hl7.org/Special/committees/fiwg/leadership.cfm

Michele Mottini / mimo@careevolution.com

 

 

 

 

 

Instructions: If Work Group does not want to require Copyright, delete the optional section below.

Copyright © 2016 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher.  HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off .


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Following is a non-exhaustive list of third-party terminologies that may require a separate license:

 

Terminology

Owner/Contact

Current Procedures Terminology (CPT) code set

American Medical Association
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-products-services/licensing.page?

SNOMED CT

International Healthcare Terminology Standards Developing Organization (IHTSDO) http://www.ihtsdo.org/snomed-ct/get-snomed-ct or info@ihtsdo.org

Logical Observation Identifiers Names & Codes (LOINC)

Regenstrief Institute

International Classification of Diseases (ICD) codes

World Health Organization (WHO)

NUCC Health Care Provider Taxonomy code set

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Contributor

Affiliation

Michele Mottini

CareEvolution Inc

Lauren Udawari

CareEvolution Inc

 

 

Version

Date

First draft

3/18/2019


1.    Abstract

This white paper describes the main similarities and differences between two implementation guides that detail how to use the FHIR standard to transfer patient data: the US-based Argonaut Data Query implementation guide (Argonaut) and the international-based International Patient summary implementation guide (IPS). This paper includes a detailed list of the differences between the two guides in terms of FHIR resources used, required elements, vocabularies, constraints, REST interactions and operations—and more.

2.    Introduction

FHIR (Fast Healthcare Interoperability Resources) is a standard for exchanging healthcare information electronically. FHIR is being developed by HL7 (Health Level Seven International), an organization dedicated to developing standards for exchanging, integrating, sharing, and retrieving electronic health information in support of its vision: “a world in which everyone can securely access and use the right health data when and where they need it.”

 

Achieving HL7’s global interoperability vision requires using the FHIR standard to transfer patient data between different entities and across jurisdictions—an ability that’s aided by effective implementation guides. This white paper examines the similarities and differences between two prominent FHIR implementation guides:

This detailed compare-and-contrast paper documents key differences between IPS version 0.1.0 and Argonaut 2.0.0 (the most recent published versions that profile FHIR STU3), and IPS version 0.2.0 and Argonaut 2.1.0 (the most recent published versions that profile FHIR R4). This paper explains their differences in terms of goals, must-support elements, restrictiveness, negation, profiled data types, extensions, and more. (These differences are also captured in appendix A and an Excel spreadsheet .)

 

Overall, there are many differences between IPS and Argonaut, many of which can be traced back to their different goals.

3.    Goals: While IPS Is Strictly Clinical , Argonaut Casts a Wider Net

IPS’s goal is specific: “minimal and non-exhaustive patient summary dataset, specialty-agnostic, condition-independent, but readily usable by clinicians for the cross-border unscheduled care of a patient.” Argonaut’s goal is broad: “ minimum conformance requirements for accessing patient data.”

 

This difference in goals is reflected in each guide’s choice of profiled resources: strictly clinical for IPS and both clinical and non-clinical (e.g., care plans) for Argonaut. IPS and Argonaut approach patient data from two different perspectives—their core differences, outlined throughout this paper, stem from these contrasting viewpoints.

4.    Document vs. API Approach to Data Transfer

On one hand, coming from the CDA world, IPS defines a FHIR document structure but doesn’t specify how the resulting documents are exchanged. Argonaut, on the other hand, explicitly defines the actors exchanging the data and specifies how the FHIR REST API can be used to query specific profiled resources.

 

While IPS requires a single document containing all the information (without the option to pick and choose for the recipient), REST-based Argonaut supports transferring specific resources; for example, a client (US core requestor) can request a single observation. The IPS document format lends itself to asynchronous or off-band transfer: email attachments, (S)FTP, and even thumb drives. The Argonaut API approach requires the recipient to have a direct network connection with the data source.

5.    Different Takes on “Must Support” Elements

Both IPS and Argonaut mark certain elements as “must support,” but their definitions are different:

  • IPS’s broad definition : “flag the items that have to be supported to comply with the minimal data set, unconstraining all the others.”
  • Argonaut’s specific definition :
    • US Core Responders SHALL be capable of including the data element as part of the query results as specified by the US Core Server Capability Statement.
    • US Core Requestors SHALL be capable of processing resource instances containing the data elements without generating an error or causing the application to fail. In other words, US Core Requestors SHOULD be capable of displaying the data elements for human use or storing it for other purposes.
    • In situations where information on a particular data element is not present and the reason for absence is unknown, US Core Responders SHALL NOT include the data elements in the resource instance returned as part of the query results.
    • When querying US Core Responders, US Core Requestors SHALL interpret missing data elements within resource instances as data not present in the US Core Responder’s systems.
    • In situations where information on a particular data element is missing and the US Core Responder knows the precise reason for the absence of data, US Core Responders SHALL send the reason for the missing information using values (such as nullFlavors) from the value set where they exist or using the dataAbsentReason extension.
    • US Core Requestors SHALL be able to process resource instances containing data elements asserting missing information

This difference in definitions means that a “must support” element in IPS is somewhere between “optional” and “must support” in Argonaut. “Must support” elements are more likely to be missing or unused in IPS than in Argonaut.

6.    Restrictiveness

In general, IPS is more restrictive than Argonaut: elements that are required in IPS are often only “must support” or outright optional in Argonaut; for example, AllergyIntolerance.onsetDateTime, Condition.clinicalStatus, Condition.onsetDateTime, and Organization.type are all required in IPS but optional or “must support” in Argonaut.

This is not always the case, however; for example, Patient.identifier is optional in IPS but required in Argonaut. IPS also prohibits some elements, whereas Argonaut does not.

 

It is more likely that IPS-conformant data also conforms with Argonaut than vice versa—but there are no guarantees that this will be the case.

7.    Negation

IPS defines a way to specify that the patient does not have something:

Argonaut does not spell out how to express negation, but being a REST API, it typically will not return any resources in the “unknown” cases. It can use the SNOMED codes for “no known allergy,” “no known problems,” and “no known procedures,” and the CVX code for “no vaccine administered” to express negation for these resources.

 

Although IPS and Argonaut are more different than alike, they do share some similarities regarding main value sets.

8.    Main Value Sets

In both IPS and Argonaut, allergies and conditions are coded using SNOMED (as described in the previous section, IPS uses a custom value set to express negation).

 

In IPS, procedures are coded using SNOMED (IPS uses a custom value set to express negation). In Argonaut, procedures are coded using either SNOMED or CPT .

 

In both IPS and Argonaut, observations are coded using LOINC .

 

In IPS, immunizations (vaccines) and medications are coded according to the identification of medicinal products (IDMP) standard and the WHO ATC classification (using different coding elements for the various IDMP sub-standards and the WHO classification), plus a custom value set to express negation. In Argonaut, immunizations are coded using CVX and medications are coded using RxNorm .

 

There are a few additional notable differences between Argonaut and IPS:

  • The patient name and identifier are optional in IPS but required in Argonaut.
  • MedicationStatement can express the medication as a reference or CodeableConcept in Argonaut, but only as a reference in IPS (unless it’s a negation [unknown or no medication] case).
  • The Reference.identifier element is generally prohibited in IPS but optional in Argonaut.
  • IPS profiles Observation to convey pregnancy-related data (expected delivery date, status, outcome); there is no equivalent profiling in Argonaut, which can represent the same data with either Condition or Observation.
  • IPS profiles Observation to describe patient alcohol use; there is no equivalent profiling in Argonaut.

9.    Profiled Data Types

IPS profiles CodeableConcept and coding , explicitly specifying the translation extension for Coding.display. It is a standard extension, so Argonaut implementations can use it as well. IPS also profiles Narrative , adding an IPS-specific extension specifying translations for the narrative. This profiled narrative is used for Composition.section.text, for which there is no Argonaut correspondent.

 

IPS profiles Quantity , Range , and Ratio , requiring that a measurement unit is specified and uses UCUM units. Argonaut uses UCUM as well, but specifies it as an invariant, only for quantity and only if a measurement unit system is specified (i.e., not having a system is valid in Argonaut, but not in IPS).

 

Argonaut does not explicitly profile any data type but does define one extension that applies to the ContactPoint data type.

 

When it comes to extensions, there are differences between Argonaut and IPS.

10.          Extensions

Argonaut defines the following extensions, each with no IPS equivalent:

  • us-core- race and us-core- ethnicity , specifying a patient’s race and ethnicity respectively—two very US-centric pieces of data.
  • us-core- birthsex , specifying a patient’s sex at birth as opposed to the administrative gender specified by the standard Patient.gender element .
  • us-core-direct , specifying whether an email in Patient.telecom, Practitioner.telecom, or Organization.telecom (all ContactPoint ) is a direct address.

IPS defines the following extensions, each with no Argonaut equivalent:

11.          Resources Profiled in Argonaut, but Not IPS

There are several FHIR resources that are profiled in Argonaut, but not IPS:

  • CarePlan , CareTeam , Goal , Encounter , Location , and PractitionerRole : Since they aren’t strictly clinical data, they’re out of scope for IPS.
  • DocumentReference —US Core DocumentReference Profile: Since this isn’t relevant in a summary, especially one that is delivered as a document, it’s out of scope for IPS.
  • DocumentReference New US Core DocumentReference Profile (clinical notes): IPS can use observation to represent clinical notes.
  • MedicationRequest : IPS uses MedicationStatement , which conveys the same information (medication used by the patient) within a summary.
  • DiagnosticReport —US Core Diagnostic Report Profile: IPS uses observation with children for the same purpose of grouping lab results.
  • DiagnosticReport New US Core Diagnostic Report Profile for Report and Note exchange : IPS uses observation and ImagingStudy to represent textual and imaging reports.

12.          Resources Profiled in IPS, but Not Argonaut

There are several resources that are profiled in IPS, but not Argonaut:

  • DeviceUseStatement (only for FHIR STU3): IPS makes the distinction between the statement that a device is being used and the device description itself (device resource). Argonaut only uses the device description.
  • Composition : This does not apply to Argonaut because it is API-based.
  • ImagingStudy : Argonaut represents imaging data using DiagnosticReport in FHIR R4; it does not profile imaging data for FHIR STU3.
  • Specimen : this data is not profiled in Argonaut.

13.          IPS Resource Profiles with No Argonaut Correspondent

There are also many IPS resource profiles without a corresponding Argonaut profile:

14.          Conclusion

IPS and Argonaut have the same broad objective—to support sharing healthcare data—but as things currently stand, their contrasting architecture and goals make them very different and incompatible. In particular, their document versus API approaches, dissimilar use of resources (e.g., Observation versus DiagnosticReport), and vocabulary differences (e.g., IDPM versus RxNorm) make interoperability between systems supporting the two implementation guides challenging.


15.          Appendix A: IPS vs. A rgonaut Spreadsheet

 

STU3

IPS

Argonaut

 

Resource

Profile

Profile

 

AllergyIntolerance

AllergyIntolerance-uv-ips

US Core AllergyIntolerance Profile

CarePlan

 

US Core CarePlan Profile

 

CareTeam

 

US Core CareTeam Profile

 

Composition

Composition-uv-ips

 

 

Condition

Condition-uv-ips  

US Core Condition (a.k.a Problem) Profile

Device

device-uv-ips

US Core Device Profile

 

Device-observer-uv-ips

 

 

DeviceUseStatement

DeviceUseStatement-uv-ips

 

 

DiagnosticReport

 

US Core DiagnosticReport Profile

 

DocumentReference

 

US Core DocumentReference Profile

 

Encounter

 

US Core Encounter Profile

 

Goal

 

US Core Goal Profile

 

ImagingStudy

ImagingStudy-uv-ips

 

 

Immunization

Immunization-uv-ips

US Core Immunization Profile

Location

 

US Core Location Profile

 

Medication

Medication-uv-ips

US Core Medication Profile

MedicationRequest

 

US Core MedicationRequest Profile

 

MedicationStatement

MedicationStatement-uv-ips  

US Core MedicationStatement Profile

Observation

Observation-attachment-uv-ips  

 

 

 

Observation-uv-ips

Vitals Signs Profile

 

Observation-laboratory-uv-ips

US Core Results Profile

 

Observation-member-pathology-uv-ips  

 

 

 

Observation-member-laboratory-uv-ips  

 

 

 

Observation-pathology-uv-ips

 

 

 

Observation-alcoholUse-uv-ips  

 

 

 

Observation-imaging-uv-ips

 

 

 

Observation-member-imaging-uv-ips  

 

 

 

Observation-pregnancy-edd-uv-ips

 

 

 

Observation-pregnancy-outcome-uv-ips  

 

 

 

Observation-pregnancy-status-uv-ips

 

 

 

Observation-tobaccoUse-uv-ips  

US Core Smoking Status Profile

Organization

organization-laboratory-uv-ips

US Core Organization Profile

 

Organization-observation-uv-ips

 

 

Patient

Patient-uv-ips

US Core Patient Profile

Practitioner

Practitioner-uv-ips

US Core Practitioner Profile

PractitionerRole

 

US Core PractitionerRole Profile

 

Procedure

Procedure-uv-ips

US Core Procedure Profile

Specimen

specimen-uv-ips

 

 

 

AllergyIntolerance - STU3

 

IPS

Argonaut

clinicalStatus

Required

MustSupport

type

MustSupport

Optional

criticality

MustSupport

Optional

code

preferred: allergy-intolerance-substance-condition-uv-ips

extensible: us-core-substance

codeableconcept-uv-ips

CodeableConcept

    .coding

required: absent-or-unknown-allergies-uv-ips

extensible: us-core-substance

Required

Optional

One

Many

        .system

Required

Optional

        .code

Required

Optional

patient.identifier

Prohibited

Optional

onsetDateTime

Required

Optional

recorder.identifier

Prohibited

Optional

asserter.identifier

Prohibited

Optional

reaction.manifestation

codeableconcept-uv-ips

CodeableConcept

preferred: allergy-reaction-uv-ips

example: clinical-findings

    .severity

MustSupport

Optional

extension: abatement-datetime-uv-ips

Optional

N/A

 

Condition - STU3

 

IPS

Argonaut

identifier

One

Many

clinicalStatus

Required

MustSupport

category

codeableconcept-uv-ips

CodeableConcept

MustSupport

Required

One

Many

required: problem-type-uv-ips

preferred: us-core-condition-category

severity

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

Many

One

preferred: condition-severity-uv-ips

preferred: condition-severity

code

preferred: core-problem-list-disorders-uv-ips

extensible: us-core-problem

codeableconcept-uv-ips

CodeableConcept

    .coding

required: absent-or-unknown-problems-uv-ips

extensible: us-core-problem

Required

Optional

One

Many

        .system

Required

Optional

        .code

Required

Optional

bodySite

codeableconcept-uv-ips

CodeableConcept

preferred: body-site

example: body-site

subject.identifier

Prohibited

Optional

onsetDateTime

Required

Optional

abatement[x]

MustSupport

Optional

asserter.identifier

Prohibited

Optional

 

Device - STU3

 

IPS

Argonaut

identifier

One

Many

    .use

Prohibited

Optional

    .type.coding.system

Prohibited

Optional

            .version

Prohibited

Optional

            .userSelected

Prohibited

Optional

        .text

Prohibited

Optional

    .system

Prohibited

Optional

    .period

Prohibited

Optional

    .assigner

Prohibited

Optional

type

Optional

Required

example: medical-devices-uv-ips

extensible: device-kind

    .coding

coding-uv-ips

Coding

type

Optional

Required

required: medical-devices-uv-ips

extensible: device-kind

type

Optional

Required

preferred: medical-devices-uv-ips

extensible: device-kind

owner

Prohibited

Optional

contact

Prohibited

Optional

location

Prohibited

Optional

url

Prohibited

Optional

note

Prohibited

Optional

safety

Prohibited

Optional

udi

Optional

Required

 

Immunization - STU3

 

IPS

Argonaut

vaccineCode

example: vaccine-code

extensible: us-core-cvx

    .coding

coding-uv-ips

Coding

        .system

Fixed Value:   http://hl7.org/fhir/sid/phpid-l1

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

        .system

Fixed Value:   http://hl7.org/fhir/sid/phpid-l2

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

        .system

Fixed Value:   http://hl7.org/fhir/sid/phpid-l3

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

        .system

Fixed Value:   http://hl7.org/fhir/sid/phpid-l4

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

MustSupport

Optional

        .system

Fixed Value:   http://hl7.org/fhir/sid/mpid

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

MustSupport

Optional

        .system

Fixed Value:   http://hl7.org/fhir/sid/pcid

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed Value:   http://www.whocc.no/atc

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

MustSupport

Optional

One

Many

        .system

Fixed value: absent-or-unknown-immunization-uv-ips

Optional

        .code

Required

Optional

    .text

MustSupport

Optional

patient.reference

MustSupport

Optional

    .identifier

Prohibited

Optional

manufacturer.identifier

Prohibited

Optional

site.coding

coding-uv-ips

Coding

preferred: target-site-uv-ips

 

route

required: medicine-route-of-administration

example: immunization-route

    .coding

coding-uv-ips

Coding

required: medicine-route-of-administration

 

practitioner

MustSupport

Optional

One

Many

    .actor.reference

MustSupport

Optional

        .identifier

Prohibited

Optional

explanation.reasonNotGiven

One

Many

        .coding

coding-uv-ips

Coding

vaccinationProtocol

Prohibited

Optional

extension: statement-uv-ips

Optional

N/A

extension: targetdiseases-immunization-uv-ips

MustSupport

N/A

 

Medication - STU3

 

IPS

Argonaut

code

codeableconcept-uv-ips

CodeableConcept

MustSupport

Required

example: medication-codes

extensible: us-core-medication-codes

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed Value: http://hl7.org/fhir/sid/phpid-l1

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed Value:   http://hl7.org/fhir/sid/phpid-l2

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed Value:   http://hl7.org/fhir/sid/phpid-l3

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed Value:   http://hl7.org/fhir/sid/phpid-l4

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed Value:   http://hl7.org/fhir/sid/mpid

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed Value:   http://hl7.org/fhir/sid/pcid

Optional

        .code

Required

Optional

    .coding

coding-uv-ips

Coding

One

Many

extensible: whoatc-uv-ips

 

        .system

Fixed Value:   http://www.whocc.no/atc

Optional

        .code

Required

Optional

    .text

MustSupport

Optional

status

Prohibited

Optional

isBrand

Prohibited

Optional

isOverTheCounter

Prohibited

Optional

manufacturer

Prohibited

Optional

form

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

Many

One

example: medicine-doseform

example: medication-form-codes

    .coding.system

Optional

N/A

ingredient

MustSupport

Optional

    .itemCodeableConcept

Optional

Optional

        .coding

MustSupport

Optional

        .text

MustSupport

Optional

    .isActive

Prohibited

Optional

    .amount

ratio-uv-ips

Ratio

MustSupport

Optional

Many

One

package

Prohibited

Optional

 

 

MedicationStatement - STU3

 

IPS

Argonaut

basedOn.identifier

Prohibited

Optional

partOf.identifier

Prohibited

Optional

context.identifier

Prohibited

Optional

category

codeableconcept-uv-ips

CodeableConcept

Many

One

medicationCodeableConcept

codeableconcept-uv-ips

CodeableConcept

required: absent-or-unknown-medication-uv-ips

extensible: us-core-medication-codes

informationSource.identifier

Prohibited

Optional

subject.identifier

Prohibited

Optional

derivedFrom

Optional

MustSupport

    .identifier

Prohibited

Optional

reasonNotTaken

codeableconcept-uv-ips

CodeableConcept

reasonCode

codeableconcept-uv-ips

CodeableConcept

reasonReference.identifier

Prohibited

Optional

dosage

MustSupport

Optional

    .text

MustSupport

Optional

    .additionalInstruction

codeableconcept-uv-ips

CodeableConcept

    .patientInstruction

MustSupport

Optional

    .timing

MustSupport

Optional

        .repeat.bounds[x]

Duration, Range-uv-ips, Period

Duration, Range, Period

        .code

codeableconcept-uv-ips

CodeableConcept

example: valueset-event-timing

preferred: TimingAbbreviation

    .site

codeableconcept-uv-ips

CodeableConcept

Many

One

    .route

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

 

Many

One

    .method

codeableconcept-uv-ips

CodeableConcept

Many

One

    .maxDosePerPeriod

Prohibited

Optional

    .maxDosePerAdministration

quantity-uv-ips

SimpleQuantity

Prohibited

Optional

        .comparator

Prohibited

Optional

    .maxDosePerLifetime

quantity-uv-ips

SimpleQuantity

Prohibited

Optional

        .comparator

Prohibited

Optional

    .rateQuantity

Prohibited

Optional

dateAsserted

Optional

Required

extension: data-absent-reason

MustSupport

N/A

 

Observation (labs) - STU3

 

IPS

Argonaut

basedOn

Prohibited

Optional

category

codeableconcept-uv-ips

CodeableConcept

One

Many

code

codeableconcept-uv-ips

CodeableConcept

 

extensible: laboratory-tests-and-panels-uv-ips

extensible: LOINC

subject.identifier

Prohibited

Optional

context.identifier

Prohibited

Optional

effective[x]

Required

MustSupport

performer

Required

Optional

One

Many

    .identifier

Prohibited

Optional

value[x]

string,   Range,   Ratio,   time,   dateTime,   Period,   CodeableConcept-uv-ips - extensible: lab-result-coded-value-uv-ips,   quantity-uv-ips

string, Range, Ratio, time, dateTime, Period, CodeableConcept - preferred: SNOMED-CT, Quantity - required: UCUM units, boolean, SampledData Attachment

dataAbsentReason

Prohibited

MustSupport

interpretation.coding

coding-uv-ips

Coding

bodySite

Prohibited

Optional

method.coding

coding-uv-ips

Coding

specimen.identifier

Prohibited

Optional

device.identifier

Prohibited

Optional

referenceRange.type

codeableconcept-uv-ips

CodeableConcept

Required

Optional

related

Optional

Optional

     .type

Fixed Value: has-member

Optional

    .target.identifier

Prohibited

Optional

    .type

Fixed Value: derived-from

Optional

    .target.identifier

Prohibited

Optional

component

Prohibited

Optional

 

 

Observation (smoking) - STU3

 

IPS

Argonaut

code

codeableconcept-uv-ips

CodeableConcept

subject.identifier

Prohibited

Optional

effective[x]

Required

Optional

valueCodeableConcept

codeableconcept-uv-ips

CodeableConcept

MustSupport

Required

Many

One

required: current-smoking-status-uv-ips

extensible: us-core-observation-ccdasmokingstatus

    .coding

coding-uv-ips

Coding

MustSupport

Optional

issued

Optional

Required

 

Observation (general  / vitals) - STU3

 

IPS

Argonaut

identifier

MustSupport

Optional

category

Optional

Required

code

example: observation-codes

extensible: observation-vitalsignresult

subject

Optional

Required

effective[x]

Optional

Required

value[x]

Quantity,   CodeableConcept,   string,   boolean,   Range,   Ratio,   SampledData,   Attachment,   time,   dateTime,   Period

Quantity - required: UCUM units

Optional

MustSupport

    .value

Optional

Required

    .unit

Optional

Required

    .system

Optional

Required

    .code

Optional

Required

dataAbsentReason

Optional

MustSupport

related

Optional

MustSupport

    .type

Optional

Required

component

Optional

MustSupport

    .code

example: observation-codes

extensible: observation-vitalsignresult

    .valueQuantity

Optional

MustSupport

        .value

Optional

Required

        .unit

Optional

Required

        .system

Optional

Required

        .code

Optional

Required

    .dataAbsentReason

Optional

MustSupport

 

Organization - STU3

 

IPS

Argonaut

active

Prohibited

Required

type

Required

Optional

One

Many

    .coding

coding-uv-ips

Coding

Required

Optional

One

Many

extensible: performing-organization-type

 

alias

Prohibited

Optional

One

Many

partOf

Prohibited

Optional

endpoint

Prohibited

MustSupport

One

Many

identifier

Optional

Required

    .system

Optional

Required

telecom

Optional

Required

address

Optional

Required

    .line

Optional

MustSupport

    .city

Optional

MustSupport

    .state

Optional

MustSupport

 

required: usps-state

    .postalCode

Optional

MustSupport

 

Patient - STU3

 

IPS

Argonaut

identifier

Optional

Required

    .system

Optional

Required

    .value

Optional

Required

name

MustSupport

Required

    .given

One

Many

telecom

MustSupport

Optional

birthDate

Required

MustSupport

address

MustSupport

Optional

    .line

MustSupport

Optional

    .city

MustSupport

Optional

    .state

MustSupport

Optional

    .postalCode

MustSupport

Optional

    .country

MustSupport

Optional

contact

MustSupport

Optional

    .relationship

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

required: personal-relationship-uv-ips

extensible: v2-0131

    .name

MustSupport

Optional

        .family

MustSupport

Optional

        .given

MustSupport

Optional

    .telecom

MustSupport

Optional

    .address

MustSupport

Optional

        .line

MustSupport

Optional

        .city

MustSupport

Optional

        .state

MustSupport

Optional

        .country

MustSupport

Optional

    .organization

MustSupport

Optional

        .identifier

Prohibited

Optional

    .language

extensible: languages

extensible: simple-language

generalPractitioner

MustSupport

Optional

    .identifier

Prohibited

Optional

extension: us-core-race

N/A

MustSupport

extension: us-core-ethnicity

N/A

MustSupport

extension: us-core-birthsex

N/A

MustSupport

 

Practitioner - STU3

 

IPS

Argonaut

identifier

Optional

Required

    .system

Optional

Required

    .value

Optional

Required

active

Prohibited

Optional

name

Optional

Required

Many

One

    .family

Optional

Required

    .text

Prohibited

Optional

    .period

Prohibited

Optional

telecom.period

Prohibited

Optional

address.period

Prohibited

Optional

gender

Prohibited

Optional

birthDate

Prohibited

Optional

photo

Prohibited

Optional

One

Many

qualification

Prohibited

Optional

One

Many

communication

Prohibited

Optional

One

Many

 

 

Procedure - STU3

 

IPS

Argonaut

code

preferred: procedures-uv-ips

extensible: us-core-procedure-code

codeableconcept-uv-ips

CodeableConcept

code

required: absent-or-unknown-procedures-uv-ips

extensible: us-core-procedure-code

codeableconcept-uv-ips

CodeableConcept

subject.identifier

Prohibited

Optional

performer.actor

device-observer-uv-ips

Reference

bodySite

MustSupport

Optional

example: target-site-uv-ips

example: body-site

extension: statement-uv-ips

Optional

N/A

    .extension

Prohibited

Optional

 

R4

IPS

Argonaut

 

Resource

Profile

Profile

 

AllergyIntolerance

Allergy Intolerance

US Core AllergyIntolerance Profile

CarePlan

 

US Core CarePlan Profile

 

CareTeam

 

US Core CareTeam Profile

 

Composition

Composition (IPS)

 

 

Condition

Condition

US Core Condition Profile

Device

Device

US Core Device Profile

 

Device (use statement)

 

 

 

Device-observer-uv-ips  

 

 

DiagnosticReport

 

US Core DiagnosticReport Profile

 

 

 

New US Core Diagnostic Report Profile for Report and Note exchange

 

DocumentReference

 

US Core DocumentReference Profile

 

 

 

New US Core DocumentReference Profile

 

Encounter

 

US Core Encounter Profile

 

Goal

 

US Core Goal Profile

 

ImagingStudy

ImagingStudy-uv-ips

 

 

Immunization

Immunization

US Core Immunization Profile

Location

 

US Core Location Profile

 

Medication

Medication

US Core Medication Profile

MedicationRequest

 

US Core MedicationRequest Profile

 

MedicationStatement

Medication Statement

US Core MedicationStatement Profile

Observation

Observation (generic result)

Vital Signs Profile

 

Observation (laboratory result)

US Core Result Observation Profile

 

Observation (media)

 

 

 

Observation (member pathology)

 

 

 

Observation (member)

 

 

 

Observation (pathology result)

 

 

 

Observation-alcoholUse-uv-ips

 

 

 

Observation-imaging-uv-ips

 

 

 

Observation-member-imaging-uv-ips

 

 

 

Observation-pregnancy-edd-uv-ips

 

 

 

Observation-pregnancy-outcome-uv-ips

 

 

 

Observation-pregnancy-status-uv-ips

 

 

 

Observation-tobaccoUse-uv-ips

US Core Smoking Status Observation Profile

Organization

Organization (laboratory)

US Core Organization Profile

 

Organization-observation-uv-ips

 

 

Patient

Patient-uv-ips

US Core Patient Profile

Practitioner

Practitioner-uv-ips

US Core Practitioner Profile

PractitionerRole

 

US Core PractitionerRole Profile

 

Procedure

Procedure-uv-ips

US Core Procedure Profile

Specimen

Specimen

 

 

 

AllergyIntolerance - R4

 

IPS

Argonaut

verificationStatus

MustSupport

Required

type

MustSupport

Optional

criticality

MustSupport

Optional

code

preferred: allergy-intolerance-substance-condition-uv-ips

extensible: 2.16.840.1.113762.1.4.1186.8

    .coding

Required

Optional

coding-uv-ips

Coding

required: absent-or-unknown-allergies-uv-ips

 

        .system

Required

Optional

        .code

Required

Optional

patient.identifier

Prohibited

Optional

onsetDateTime

Required

Optional

reaction

MustSupport

Optional

    .manifestation

codeableconcept-uv-ips

CodeableConcept

preferred: allergy-reaction-uv-ips

example: clinical-findings

    .severity

MustSupport

Optional

extension: abatement-datetime-uv-ips

Optional

N/A

 

Condition - R4

 

IPS

Argonaut

identifier

One

Many

clinicalStatus

Required

MustSupport

category

codeableconcept-uv-ips

CodeableConcept

MustSupport

Required

One

Many

required: problem-type-uv-ips

preferred: us-core-condition-category

severity

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

preferred: condition-severity-uv-ips

preferred: condition-severity

code

preferred: core-problem-list-disorders-uv-ips

extensible: us-core-problem

    .coding

coding-uv-ips

Coding

Required

Optional

One

Many

required: absent-or-unknown-problems-uv-ips

 

bodySite

codeableconcept-uv-ips

CodeableConcept

subject.identifier

Prohibited

Optional

onsetDateTime

Required

Optional

abatement[x]

MustSupport

Optional

asserter.identifier

Prohibited

Optional

 

Device - R4

 

IPS

Argonaut

identifier

One

Many

    .use

Prohibited

Optional

    .type.coding.text

Prohibited

Optional

    .system

Prohibited

Optional

    .period

Prohibited

Optional

    .assigner

Prohibited

Optional

type

Optional

Required

preferred: medical-devices-uv-ips

extensible: device-kind

    .coding

coding-uv-ips

Coding

required: medical-devices-uv-ips

 

        .system

Required

Optional

        .code

Required

Optional

owner

Prohibited

Optional

contact

Prohibited

Optional

location

Prohibited

Optional

url

Prohibited

Optional

note

Prohibited

Optional

safety

Prohibited

Optional

udiCarrier

Optional

Required

 

Many

One

 

Immunization - R4

 

IPS

Argonaut

vaccineCode

preferred: vaccines-uv-ips

extensible: us-core-cvx

    .coding

coding-uv-ips

Coding

MustSupport

Optional

    .coding

coding-uv-ips

Coding

example: phpid-lvl1-uv-ips

extensible: us-core-cvx

    .coding

coding-uv-ips

Coding

example: phpid-lvl2-uv-ips

extensible: us-core-cvx

    .coding

coding-uv-ips

Coding

example: phpid-lvl3-uv-ips

extensible: us-core-cvx

    .coding

coding-uv-ips

Coding

example: phpid-lvl4-uv-ips

extensible: us-core-cvx

        .display

MustSupport

Optional

    .coding

coding-uv-ips

Coding

MustSupport

Optional

example: mpid-uv-ips

extensible: us-core-cvx

    .coding

coding-uv-ips

Coding

MustSupport

Optional

example: pcid-uv-ips

extensible: us-core-cvx

    .coding

coding-uv-ips

Coding

        .system

Fixed value: whoatc-uv-ips

Optional

        .display

MustSupport

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed value: absent-or-unknown-immunization-uv-ips

Optional

        .code

Required

Optional

    .text

MustSupport

Optional

patient.reference

MustSupport

Optional

site.coding

coding-uv-ips

Coding

preferred: target-site-uv-ips

example: immunization-site

route.coding

coding-uv-ips

Coding

required: medicine-route-of-administration

example: immunization-route

performer

MustSupport

Optional

One

Many

    .actor.reference

MustSupport

Optional

statusReason

Optional

MustSupport

primarySource

Optional

Required

extension: statement-uv-ips

Optional

N/A

 

Medication - R4

 

IPS

Argonaut

code

codeableconcept-uv-ips

CodeableConcept

MustSupport

Required

example: medication-codes

extensible: us-core-medication-codes

    .coding

coding-uv-ips

Coding

example: phpid-lvl1-uv-ips

extensible: us-core-medication-codes

    .coding

coding-uv-ips

Coding

example: phpid-lvl2-uv-ips

extensible: us-core-medication-codes

    .coding

coding-uv-ips

Coding

example: phpid-lvl3-uv-ips

extensible: us-core-medication-codes

    .coding

coding-uv-ips

Coding

example: phpid-lvl4-uv-ips

extensible: us-core-medication-codes

        .display

MustSupport

Optional

    .coding

coding-uv-ips

Coding

MustSupport

Optional

example: mpid-uv-ips

extensible: us-core-medication-codes

    .coding

coding-uv-ips

Coding

MustSupport

Optional

example: pcid-uv-ips

extensible: us-core-medication-codes

        .display

MustSupport

Optional

    .coding

coding-uv-ips

Coding

One

Many

        .system

Fixed value: whoatc-uv-ips

Optional

        .code

Required

Optional

    .text

MustSupport

Optional

status

Prohibited

Optional

manufacturer

Prohibited

Optional

form

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

example: medicine-doseform

example: medication-form-codes

ingredient

MustSupport

Optional

    .itemCodeableConcept

Required

Optional

        .coding

MustSupport

Optional

        .text

MustSupport

Optional

    .isActive

Prohibited

Optional

    .amount

MustSupport

Optional

 

MedicationStatement - R4

 

IPS

Argonaut

basedOn.identifier

Prohibited

Optional

partOf.identifier

Prohibited

Optional

category

codeableconcept-uv-ips

CodeableConcept

medicationCodeableConcept

codeableconcept-uv-ips

CodeableConcept

required: absent-or-unknown-medication-uv-ips

extensible: us-core-medication-codes

subject.identifier

Prohibited

Optional

context.identifier

Prohibited

Optional

informationSource.identifier

Prohibited

Optional

derivedFrom

Optional

MustSupport

    .identifier

Prohibited

Optional

reasonCode

codeableconcept-uv-ips

CodeableConcept

reasonReference.identifier

Prohibited

Optional

dosage

MustSupport

Optional

    .text

MustSupport

Optional

    .additionalInstruction

codeableconcept-uv-ips

CodeableConcept

    .patientInstruction

MustSupport

Optional

    .timing

MustSupport

Optional

    .site

codeableconcept-uv-ips

CodeableConcept

    .route

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

    .method

codeableconcept-uv-ips

CodeableConcept

    .doseAndRate.rateQuantity

Prohibited

Optional

    .maxDosePerPeriod

Prohibited

Optional

    .maxDosePerAdministration

quantity-uv-ips

SimpleQuantity

Prohibited

Optional

        .comparator

Prohibited

Optional

    .maxDosePerLifetime

quantity-uv-ips

SimpleQuantity

Prohibited

Optional

        .comparator

Prohibited

Optional

dateAsserted

Optional

Required

extension: data-absent-reason

MustSupport

N/A

 

Observation (labs) - R4

 

IPS

Argonaut

basedOn

Prohibited

Optional

category

codeableconcept-uv-ips

CodeableConcept

One

Many

code

codeableconcept-uv-ips

CodeableConcept

 

extensible: laboratory-tests-and-panels-uv-ips

extensible: LOINC

subject.identifier

Prohibited

Optional

encounter.identifier

Prohibited

Optional

effective[x]

Required

MustSupport

performer

Required

Optional

One

Many

    .identifier

Prohibited

Optional

value[x]

string,   Range,   Ratio,   time,   dateTime,   Period,   CodeableConcept-uv-ips - extensible: lab-result-coded-value-uv-ips,   quantity-uv-ips

string, Range, Ratio, time, dateTime, Period, CodeableConcept - preferred: SNOMED-CT, Quantity - required: UCUM units, boolean, SampledData Attachment

extensible: lab-result-coded-value-uv-ips

 

dataAbsentReason

Prohibited

MustSupport

interpretation.coding

coding-uv-ips

Coding

bodySite

Prohibited

Optional

method.coding

coding-uv-ips

Coding

specimen.identifier

Prohibited

Optional

device.identifier

Prohibited

Optional

referenceRange.type

codeableconcept-uv-ips

CodeableConcept

Required

Optional

hasMember

MustSupport

Optional

    .identifier

Prohibited

Optional

derivedFrom.identifier

Prohibited

Optional

component

Prohibited

Optional

 

Observation (smoking) - R4

 

IPS

Argonaut

code

codeableconcept-uv-ips

CodeableConcept

effective[x]

Required

Optional

valueCodeableConcept

codeableconcept-uv-ips

CodeableConcept

MustSupport

Required

required: current-smoking-status-uv-ips

extensible: us-core-observation-ccdasmokingstatus

issued

Optional

Required

 

Observation (general / vitals) - R4

 

IPS

Argonaut

identifier

MustSupport

Optional

basedOn

Prohibited

Optional

One

Many

status

required: observation-status

required: observation-status|4.0.0

category

codeableconcept-uv-ips

CodeableConcept

One

Many

code

codeableconcept-uv-ips

CodeableConcept

example: observation-codes

extensible: observation-vitalsignresult

performer

Required

Optional

One

Many

value[x]

string,   boolean, Range,   Ratio,   time,   dateTime,   Period,   CodeableConcept-uv-ips,   quantity-uv-ips

Quantity - required: UCUM units

dataAbsentReason

Prohibited

MustSupport

interpretation

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

bodySite

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

method

codeableconcept-uv-ips

CodeableConcept

specimen

Prohibited

Optional

device

Prohibited

Optional

referenceRange

MustSupport

Optional

    .type.coding

coding-uv-ips

Coding

    .appliesTo

Prohibited

Optional

One

Many

    .age

Prohibited

Optional

category.coding

Optional

Required

        .system

Optional

Required

        .code

Optional

Required

component

Optional

MustSupport

    .code

example: observation-codes

extensible: observation-vitalsignresult

    .value[x]

Optional

MustSupport

 

required: ucum-vitals-common|4.0.0

    .dataAbsentReason

Optional

MustSupport

 

 

Organization - R4

 

IPS

Argonaut

type

Required

Optional

One

Many

    .coding

coding-uv-ips

Coding

Required

Optional

One

Many

extensible: performing-organization-type

example: organization-type

identifier

Optional

Required

    .system

Optional

Required

active

Optional

Required

telecom

Optional

Required

address

Optional

Required

    .line

Optional

MustSupport

    .city

Optional

MustSupport

    .state

Optional

MustSupport

 

required: us-core-usps-state

    .postalCode

Optional

MustSupport

endpoint

Optional

MustSupport

 

Patient - R4

 

IPS

Argonaut

identifier

Optional

Required

    .system

Optional

Required

    .value

Optional

Required

name

MustSupport

Required

    .given

One

Many

telecom

MustSupport

Optional

birthDate

Required

MustSupport

address

MustSupport

Optional

    .line

MustSupport

Optional

    .city

MustSupport

Optional

    .state

MustSupport

Optional

    .postalCode

MustSupport

Optional

    .country

MustSupport

Optional

contact

MustSupport

Optional

    .relationship

codeableconcept-uv-ips

CodeableConcept

MustSupport

Optional

required: personal-relationship-uv-ips

extensible: patient-contactrelationship

    .name

MustSupport

Optional

        .family

MustSupport

Optional

        .given

MustSupport

Optional

    .telecom

MustSupport

Optional

    .address

MustSupport

Optional

        .line

MustSupport

Optional

        .city

MustSupport

Optional

        .state

MustSupport

Optional

        .country

MustSupport

Optional

    .organization

MustSupport

Optional

        .identifier

Prohibited

Optional

communication.language

preferred: languages

extensible: simple-language

generalPractitioner

MustSupport

Optional

    .identifier

Prohibited

Optional

extension: us-core-race

N/A

MustSupport

extension: us-core-ethnicity

N/A

MustSupport

extension: us-core-birthsex

N/A

MustSupport

 

Practitioner - R4

 

IPS

Argonaut

identifier

Optional

Required

    .system

Optional

Required

    .value

Optional

Required

name

Many

One

    .text

Prohibited

Optional

    .family

MustSupport

Required

    .given

MustSupport

Optional

telecom

MustSupport

Optional

address

MustSupport

Optional

 

Procedure - R4

 

IPS

Argonaut

code

MustSupport

Required

preferred: procedures-uv-ips

extensible: us-core-procedure-code

    .coding

Required

Optional

coding-uv-ips

Coding

required: absent-or-unknown-procedures-uv-ips

 

subject.identifier

Prohibited

Optional

bodySite

MustSupport

Optional

example: target-site-uv-ips

example: body-site

extension: statement-uv-ips

Optional

N/A