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  1. FHIR Specification Feedback
  2. FHIR-44561

Profiles based on US Core 3.1.1 don't leverage latest post-acute care additions

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Electronic Long-Term Services & Supports (ELTSS) (FHIR)
    • 2.0.0-ballot [deprecated]
    • Human and Social Services
    • All Eltss Careplan
    • Artifacts Summary
    • Profiles
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      BACKGROUND:
      HT-1 will come into effect Jan 2026. We have been investigating HT-1 and its effects on our stakeholders.

      ONC’s stance is to use US Core 4.0.0 as the base level ( for USCDI v1) and then approve the latest SVAP version aligned with the latest version of USCDI.

      See the SVAP link below, for ONC’s published requirements for US Core : https://www.healthit.gov/topic/standards-version-advancement-process-svap
      The link contains the text that displays the stance that ONC will allow USCORE 4.0.0 version for certification to USCDI v1 ( and not 3.1.1)

      "Additionally, the SVAP approved standard of HL7® FHIR® US Core Implementation Guide STU 4.0.0, June 2021 will continue to remain available for certification via SVAP while the United States Core Data for Interoperability (USCDI), Version 1, July 2020 Errata remains available for use in the Certification Program as a standard adopted in regulation."

      USCORE 3.1.1 is still allowed for certification because it is in the cures regulations until HTI-1 becomes the regulatory floor. But ONC have kept the 4.0.0 version in SVAP to align with USCDi v1 since 3.1.1 had issues. The issues are with differences in terminology bindings.

      ACTION: We are looking to see if we can adopt USCORE 4.0 or USCORE 6.1.1 in the STU2 version.
      There should be a minimal direct effect on data covered directly by the IG as the IG was made compatible with USCORE 7 before the ballot. There are accessory features in later USCORE versions that touch on items beyond the eLTSS IG Update's scope of the eLTSS DAM data elements, such as the US Core Observation Occupation Profile.

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      BACKGROUND: HT-1 will come into effect Jan 2026. We have been investigating HT-1 and its effects on our stakeholders. ONC’s stance is to use US Core 4.0.0 as the base level ( for USCDI v1) and then approve the latest SVAP version aligned with the latest version of USCDI. See the SVAP link below, for ONC’s published requirements for US Core : https://www.healthit.gov/topic/standards-version-advancement-process-svap The link contains the text that displays the stance that ONC will allow USCORE 4.0.0 version for certification to USCDI v1 ( and not 3.1.1) "Additionally, the SVAP approved standard of HL7® FHIR® US Core Implementation Guide STU 4.0.0, June 2021 will continue to remain available for certification via SVAP while the United States Core Data for Interoperability (USCDI), Version 1, July 2020 Errata remains available for use in the Certification Program as a standard adopted in regulation." USCORE 3.1.1 is still allowed for certification because it is in the cures regulations until HTI-1 becomes the regulatory floor. But ONC have kept the 4.0.0 version in SVAP to align with USCDi v1 since 3.1.1 had issues. The issues are with differences in terminology bindings. ACTION: We are looking to see if we can adopt USCORE 4.0 or USCORE 6.1.1 in the STU2 version. There should be a minimal direct effect on data covered directly by the IG as the IG was made compatible with USCORE 7 before the ballot. There are accessory features in later USCORE versions that touch on items beyond the eLTSS IG Update's scope of the eLTSS DAM data elements, such as the US Core Observation Occupation Profile.
    • Bret Heale / Brian Handspicker : 7 - 0 - 0
    • Enhancement
    • Compatible, substantive

    Description

      The 2.0.0-ballot eLTSS IG defines a number of profiles base on US Core 3.1.1.  US Core 3.1.1 is quite old now and lacks many of the data elements that have been added for post-acute care from more recent releases of USCDI.  eLTSS is designed to exchange long-term care plans, so this is an issue for PACIO, which is designing IGs to leverage the many additions (e.g., Functional Status, Mental Status, Advance Directives, etc.) in US Core 6.1.0 that have been added since 3.1.1.

      The balloted eLTSS IG has many specific references to eLTSS profiles (it actually creates quite a web of these references).  The PACIO Personal Functioning and Engagement IG, for STU2 development, is adding Condition, ServiceRequest, and other profiles beyond just the Observation focus in STU1, similar to what was done for the published SDOH-CC and Physical Activity IGs.

      The web of references between eLTSS profiles based on US Core 3.1.1 makes it very difficult for PACIO to integrate (or anyone else wanting to leverage the newer US Core profiles) with the eLTSS IG and take advantage of the new data elements in US Core.  Indeed, PACIO had to get a waiver from using a US Core 3.1.1 profile since it did not cover our needs.  That has since been fixed in subsequent US Core releases.

      All of this will also impact implementations and potentially raise a lot of confusion.  Mismatched US Core lineages would be an issue, but creating duplicate sets of profiles in various places (like in PACIO) beyond what is defined in eLTSS to leverage the latest additions in US Core doesn’t seem like a great solution either.

      eLTSS should consider at least the following alternatives:

      1) If sticking with US Core 3.1.1, relax references to not just refer to eLTSS profiles.  If they wish, they could still promote the use of their profiles, but add a slice that also references base FHIR resources so that other profiles based on newer US Core releases to be used as well.  This is similar to what the SDOH-CC and Physical Activity IGs did with references in the “addresses” data element within their Goal profiles.

      2) Base eLTSS profiles off of a newer version of US Core (e.g., 6.1.0).

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            bheale Bret Heale
            dwhill David Hill
            David Hill
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              Updated:
              Resolved: