One important challenge in building high-value solutions in today’s FHIR ecosystem is that needed data elements may not be mapped to standard codes or not available as HL7 FHIR profiles. To take FHIR-based value generation to the next level, more data elements need to be available in a consistent and standardized manner via FHIR. For certain types of data elements, both the available HL7 FHIR profiles and their implementation in practice are highly consistent and available, such as Conditions with ICD or SNOMED CT codes, and MedicationRequests with RxNorm codes. In other areas, such as Observations and Procedures, there are two important challenges: 1) Local codes may not be mapped to standard codes. For example, laboratory results may not be mapped to LOINC codes, other types of observations captured in nursing flowsheets may not be mapped to LOINC codes, and procedures may not be mapped to SNOMED CT or CPT codes. The need to enable such mappings was recently identified as a top priority by the U.S. Health IT Advisory Committee ( https://www.healthit.gov/sites/default/files/facas/2019-10-16_ISP_TF_Draft_Final_Report_508.pdf, p. 8). 2) Important data elements may not be retrievable in a consistent manner through existing FHIR profiles. For example, years smoked, packs-per-day, smoking pack-year history, or the amount of oxygen that a patient was on when oxygen saturation was measured may be captured in structured form, but are generally not available in FHIR implementations. This HL7 project proposal intends to accelerate progress in this area by identifying high-priority data elements in the area of chronic disease management that face these issues, developing an approach to ensuring they are available through FHIR interfaces, and ultimately demonstrating the value of implementing the approach. To maximize value and minimize cost, the proposal aims to: - Focus on those data elements associated with high-value clinical use cases for the management of chronic diseases. - Focus on data elements used by SMART on FHIR apps or CDS Hooks services that can provide immediate value. - Focus on data elements that are already captured in structured form in many EHRs, to avoid the need for additional data collection by end users. - Only once feasibility and value has been established, consider moving on to additional data elements in future years. We propose a phased approach beginning with the submission of a focused project scope statement (PSS) for the identification of existing and/or the specification of new observation profiles for detailed smoking history (should suitable existing profiles not exist). This will be followed by the submission of other PSSs pertaining to data elements relevant to other chronic disease management use cases (e.g., profiles for the management of diabetes). We would like to solicit participation from Patient Care, Orders and Observations, and other interested working groups as contributors or reviewers. We propose that CIMI be the sponsoring working group given its mission, its familiarity with FHIR profile development, and the cross-cutting nature of the proposed work.