1. US Core Data for Interoperability (USCDI): Data Provenance IG
January 2019
Presentation at HL7 Working Group Meeting

2. USCDI History 21st Century Cures Act – Dec 13, 2016
(10) INTEROPERABILITY.—The term ‘interoperability’, with respect to health information technology, means such health information technology that—
‘‘(A) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user;
‘‘(B) allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and
‘‘(C) does not constitute information blocking as defined in section 3022(a).’’.
Draft U.S. Core Data for Interoperability (USCDI) and Proposed Expansion Process – Jan 5, 2018
… “provides ONC’s first draft of the data classes that would be in the USCDI and lays out the process and structure by which the USCDI will be updated and expanded”

3. USCDI Data Classes
“Similarly, understanding the provenance of the data being exchanged was also referenced by stakeholders as a fundamental need to improve the trustworthiness and reliability of the data being shared.” – Draft USCDI page 6

4. October 2018 WGM: Call to Action
Thursday Q2 – Joint Patient Care + Structured Documents
“Provenance” as a component of USCDI discussed with ONC reps
Agreement that there isn’t explicit guidance on how to meet USCDI provenance requirement today
Agreement that HL7 should provide guidance on how to populate data provenance information in C-CDA and FHIR
Key Principles discussed:
Success is being able to track two things:
The last "handshake" who handed you the data
The data "originator" who initially authored the data
If anyone changes the data along the way, they become the new "author" for the changed data.

5. C-CDA Implementation January 2019
Concurred with prior discussion:
Who ‘authored’
Who ‘handed to you’
Additional insight
Data, and metadata for the purposes for trust, traceability and identification of ‘Who’ and ‘When’
Capture at least the last system that provided, if not the full chain of provenance. The full chain can be recreated by asking each system that is ‘one-hop’ prior. The system that provided you the data
It’s not inherently bad to contain the full chain, but that may not be possible
Information contained within a document may have its own "provenance" however, when this information is packaged into a document the document has a separate set of provenance metadata
Consider Performer element in addition to Author as Provenance

6. Prior Data Provenance Efforts
Data Segmentation for Privacy (DS4P)
FHIR Provenance Resource
FHIR Provenance Profile directly in FHIR core
HL7 Version 3 Standard: Privacy and Security Architecture Framework - Volume 3 Provenance, Release 1 (recent ballot)
EHR Functional Model (profile on the FHIR Provenance resource)
IHE set of profiles - MHD profiles, QEDM, RECON profile
ONC Challenge for tracking provenance
ONC S&I Initiative on Data Provenance (led to CDA IG)
HL7 CDA R2 Data Provenance (written by CBCP)
EHR Lifecycle events – how an EHR manages a record over lifecycle events – focused on CRUD (27 lifecycle events)
What other projects have considered Provenance?

7. Data Provenance IG: Vision
Informative Implementation Guide
Functional Guidance
Which data classes should be communicated with provenance info
Clear specification for the use cases for provenance (e.g., create, consume)
Technical Guidance
What constitutes supplying sufficient provenance info for a data class
Reference Standards Scope:
C-CDA 2.1
FHIR, using US Core profiles where applicable
Content Scope:
“Data Classes” listed in draft USCDI
Goal is to support easy, wide implementation

8. Sponsorship Received Security WG (sponsor)
Historical references and guidance on provenance attributes
Patient Care WG (co-sponsor)
Selection of data classes for which provenance is important
Selection of provenance attributes that should be required
Structured Documents WG (co-sponsor)
C-CDA 2.1 technical guidance
EHR FM (co-sponsor)
FHIR technical guidance
CBCP (co-sponsor)
Prior CDA Data Provenance IG owner