2026 US Quality Core Implementation Guide
0.5.0 - release United States of America flag

This page is part of the US Quality Core (v0.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: US Quality Core Communication

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-communication Version: 0.5.0
Active as of 2026-06-05 Computable Name: USQualityCoreCommunication

Profile of Communication for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

USCDI+ Quality Element Support Expectations

This profile does not include USCDI+ Quality flagged elements and is not in scope for USCDI+ Quality V1 conformance requirements in this guide. See the USCDI+ Quality page for the list of profiles and elements that are in scope for USCDI+ Quality V1.

This profile is inherited from QI-Core v6.0.0 and is included to ease adoption for systems that currently support QI-Core. Refer to the Formal Views section for the formal summary, definitions, terminology requirements, and mandatory element requirements.

Profile Specific Implementation Guidance

To represent that a communication event intentionally did not occur for a medical, patient, or system reason, use the US Quality Core Communication Not Done profile.

Additional informational guidance for authoring CQL using this profile is provided in the CQL Authoring Usage (Informational) section of this page.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication 0..* Communication A record of information transmitted from a sender to a receiver
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown
Binding: Non-Negative Event Status (required)
... topic 0..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred)
... sent 0..1 dateTime When sent
... received 0..1 dateTime When received
... recipient 0..* Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) Message recipient
... sender 0..1 Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) Message sender

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Communication.status Base required Non-Negative Event Status 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦1.0.1 THO v7.1

Constraints

Id Grade Path(s) Description Expression
dom-2 error Communication If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Communication If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Communication If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Communication If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Communication A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication 0..* Communication A record of information transmitted from a sender to a receiver
... status 1..1 code preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown
Binding: Non-Negative Event Status (required)
... subject 0..1 Reference(US Quality Core Patient | Group) Focus of message
... topic 0..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred)
... received 0..1 dateTime When received
... recipient 0..* Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) Message recipient
... sender 0..1 Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) Message sender

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Communication.status Base required Non-Negative Event Status 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦1.0.1 THO v7.1
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication 0..* Communication A record of information transmitted from a sender to a receiver
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Unique identifier
... instantiatesCanonical Σ 0..* canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(Resource) Request fulfilled by this communication
... partOf Σ 0..* Reference(Resource) Part of this action
... inResponseTo 0..* Reference(Communication) Reply to
... status ?!Σ 1..1 code preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown
Binding: Non-Negative Event Status (required)
... statusReason Σ 0..1 CodeableConcept Reason for current status
Binding: CommunicationNotDoneReason (example): Codes for the reason why a communication did not happen.
... category 0..* CodeableConcept Message category
Binding: CommunicationCategory (example): Codes for general categories of communications such as alerts, instructions, etc.
... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Codes indicating the relative importance of a communication.
... medium 0..* CodeableConcept A channel of communication
Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
... subject Σ 0..1 Reference(US Quality Core Patient | Group) Focus of message
... topic 0..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred)
... about 0..* Reference(Resource) Resources that pertain to this communication
... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
... sent 0..1 dateTime When sent
... received 0..1 dateTime When received
... recipient 0..* Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) Message recipient
... sender 0..1 Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) Message sender
... reasonCode Σ 0..* CodeableConcept Indication for message
Binding: SNOMEDCTClinicalFindings (example): Codes for describing reasons for the occurrence of a communication.
... reasonReference Σ 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why was communication done?
... payload 0..* BackboneElement Message payload
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... content[x] 1..1 Message part content
..... contentString string
..... contentAttachment Attachment
..... contentReference Reference(Resource)
... note 0..* Annotation Comments made about the communication

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Communication.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Communication.status Base required Non-Negative Event Status 📦0.5.0 This IG
Communication.statusReason Base example CommunicationNotDoneReason 📍4.0.1 FHIR Std.
Communication.category Base example CommunicationCategory 📍4.0.1 FHIR Std.
Communication.priority Base required Request priority 📍4.0.1 FHIR Std.
Communication.medium Base example v3 Code System ParticipationMode 📦2018-08-12 FHIR Std.
Communication.topic Base preferred CommunicationTopic 📦1.0.1 THO v7.1
Communication.reasonCode Base example SNOMED CT Clinical Findings 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Communication If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Communication If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Communication If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Communication If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Communication A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication 0..* Communication A record of information transmitted from a sender to a receiver
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!Σ 1..1 code preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown
Binding: Non-Negative Event Status (required)
... topic 0..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred)
... sent 0..1 dateTime When sent
... received 0..1 dateTime When received
... recipient 0..* Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) Message recipient
... sender 0..1 Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) Message sender

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Communication.status Base required Non-Negative Event Status 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦1.0.1 THO v7.1

Constraints

Id Grade Path(s) Description Expression
dom-2 error Communication If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Communication If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Communication If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Communication If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Communication A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication 0..* Communication A record of information transmitted from a sender to a receiver
... status 1..1 code preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown
Binding: Non-Negative Event Status (required)
... subject 0..1 Reference(US Quality Core Patient | Group) Focus of message
... topic 0..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred)
... received 0..1 dateTime When received
... recipient 0..* Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) Message recipient
... sender 0..1 Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) Message sender

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Communication.status Base required Non-Negative Event Status 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦1.0.1 THO v7.1

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication 0..* Communication A record of information transmitted from a sender to a receiver
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Unique identifier
... instantiatesCanonical Σ 0..* canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(Resource) Request fulfilled by this communication
... partOf Σ 0..* Reference(Resource) Part of this action
... inResponseTo 0..* Reference(Communication) Reply to
... status ?!Σ 1..1 code preparation | in-progress | on-hold | stopped | completed | entered-in-error | unknown
Binding: Non-Negative Event Status (required)
... statusReason Σ 0..1 CodeableConcept Reason for current status
Binding: CommunicationNotDoneReason (example): Codes for the reason why a communication did not happen.
... category 0..* CodeableConcept Message category
Binding: CommunicationCategory (example): Codes for general categories of communications such as alerts, instructions, etc.
... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Codes indicating the relative importance of a communication.
... medium 0..* CodeableConcept A channel of communication
Binding: v3 Code System ParticipationMode (example): Codes for communication mediums such as phone, fax, email, in person, etc.
... subject Σ 0..1 Reference(US Quality Core Patient | Group) Focus of message
... topic 0..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred)
... about 0..* Reference(Resource) Resources that pertain to this communication
... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
... sent 0..1 dateTime When sent
... received 0..1 dateTime When received
... recipient 0..* Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson | Group) Message recipient
... sender 0..1 Reference(US Quality Core Device | US Core Implantable Device Profile(6.1.0) | US Quality Core Organization | US Quality Core Patient | US Quality Core Practitioner | US Quality Core RelatedPerson) Message sender
... reasonCode Σ 0..* CodeableConcept Indication for message
Binding: SNOMEDCTClinicalFindings (example): Codes for describing reasons for the occurrence of a communication.
... reasonReference Σ 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why was communication done?
... payload 0..* BackboneElement Message payload
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... content[x] 1..1 Message part content
..... contentString string
..... contentAttachment Attachment
..... contentReference Reference(Resource)
... note 0..* Annotation Comments made about the communication

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Communication.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Communication.status Base required Non-Negative Event Status 📦0.5.0 This IG
Communication.statusReason Base example CommunicationNotDoneReason 📍4.0.1 FHIR Std.
Communication.category Base example CommunicationCategory 📍4.0.1 FHIR Std.
Communication.priority Base required Request priority 📍4.0.1 FHIR Std.
Communication.medium Base example v3 Code System ParticipationMode 📦2018-08-12 FHIR Std.
Communication.topic Base preferred CommunicationTopic 📦1.0.1 THO v7.1
Communication.reasonCode Base example SNOMED CT Clinical Findings 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Communication If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Communication If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Communication If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Communication If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Communication A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

CQL Authoring Usage (Informational)

To create an expression specifically requesting information that a communication intentionally did not occur for a medical, patient or system reason, use the profile USQualityCore-communicationnotdone.

The Communication and CommunicationNotDone profiles represent the positive and negative statements for a communication event. To ensure instances retrieved meet positive intent, applications should check the status as illustrated in this example:

define Communication:
  [Communication] C
    where C.status in { 'preparation', 'in-progress', 'on-hold', 'completed' }