2026 US Quality Core Implementation Guide
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2026 US Quality Core Implementation Guide - Downloaded Version 0.5.0 See the Directory of published versions

Resource Profile: US Quality Core Communication Not Done

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

Profile of CommunicationNotDone 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

This profile represents a communication event that intentionally did not occur for a medical, patient, or system reason. To represent communication events that did occur, use the US Quality Core Communication 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 C 0..* Communication A record of information transmitted from a sender to a receiver
Constraints: cnd-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... statusReason Σ 1..1 CodeableConcept Reason for current status
Binding: USQualityCore Negation Reason Codes (extensible)
... subject Σ 0..1 Reference(US Quality Core Patient | Group) Focus of message
... topic 1..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
.... Slices for extension Content/Rules for all slices
..... extension:notDoneValueSet 0..1 canonical(ValueSet) Url of a value set of activities not requested or performed
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Communication.status Base required EventStatus 📍4.0.1 FHIR Std.
Communication.statusReason Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cnd-1 error Communication to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()
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 C 0..* Communication A record of information transmitted from a sender to a receiver
Constraints: cnd-1
... Slices for extension Content/Rules for all slices
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... status 1..1 code preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Fixed Value: not-done
... statusReason 1..1 CodeableConcept Reason for current status
Binding: USQualityCore Negation Reason Codes (extensible)
... topic 1..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
.... Slices for extension Content/Rules for all slices
..... extension:notDoneValueSet 0..1 canonical(ValueSet) Url of a value set of activities not requested or performed
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Communication.statusReason Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cnd-1 error Communication to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication C 0..* Communication A record of information transmitted from a sender to a receiver
Constraints: cnd-1
... 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
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... 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 | not-done | on-hold | stopped | completed | entered-in-error | unknown
Binding: EventStatus (required): The status of the communication.
Fixed Value: not-done
... statusReason Σ 1..1 CodeableConcept Reason for current status
Binding: USQualityCore Negation Reason Codes (extensible)
... 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 1..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... extension:notDoneValueSet 0..1 canonical(ValueSet) Url of a value set of activities not requested or performed
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
.... coding Σ 0..* Coding Code defined by a terminology system
.... text Σ 0..1 string Plain text representation of the concept
... 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(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService) Message recipient
... sender 0..1 Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService) 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 EventStatus 📍4.0.1 FHIR Std.
Communication.statusReason Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
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 📦4.0.1 FHIR Std.
Communication.reasonCode Base example SNOMED CT Clinical Findings 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cnd-1 error Communication to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()
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 C 0..* Communication A record of information transmitted from a sender to a receiver
Constraints: cnd-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... statusReason Σ 1..1 CodeableConcept Reason for current status
Binding: USQualityCore Negation Reason Codes (extensible)
... subject Σ 0..1 Reference(US Quality Core Patient | Group) Focus of message
... topic 1..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
.... Slices for extension Content/Rules for all slices
..... extension:notDoneValueSet 0..1 canonical(ValueSet) Url of a value set of activities not requested or performed
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Communication.status Base required EventStatus 📍4.0.1 FHIR Std.
Communication.statusReason Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cnd-1 error Communication to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()
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 C 0..* Communication A record of information transmitted from a sender to a receiver
Constraints: cnd-1
... Slices for extension Content/Rules for all slices
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... status 1..1 code preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Fixed Value: not-done
... statusReason 1..1 CodeableConcept Reason for current status
Binding: USQualityCore Negation Reason Codes (extensible)
... topic 1..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
.... Slices for extension Content/Rules for all slices
..... extension:notDoneValueSet 0..1 canonical(ValueSet) Url of a value set of activities not requested or performed
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Communication.statusReason Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
Communication.topic Base preferred CommunicationTopic 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cnd-1 error Communication to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Communication C 0..* Communication A record of information transmitted from a sender to a receiver
Constraints: cnd-1
... 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
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... 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 | not-done | on-hold | stopped | completed | entered-in-error | unknown
Binding: EventStatus (required): The status of the communication.
Fixed Value: not-done
... statusReason Σ 1..1 CodeableConcept Reason for current status
Binding: USQualityCore Negation Reason Codes (extensible)
... 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 1..1 CodeableConcept Description of the purpose/content
Binding: CommunicationTopic (preferred): Codes describing the purpose or content of the communication.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... extension:notDoneValueSet 0..1 canonical(ValueSet) Url of a value set of activities not requested or performed
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
.... coding Σ 0..* Coding Code defined by a terminology system
.... text Σ 0..1 string Plain text representation of the concept
... 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(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | Group | CareTeam | HealthcareService) Message recipient
... sender 0..1 Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson | HealthcareService) 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 EventStatus 📍4.0.1 FHIR Std.
Communication.statusReason Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
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 📦4.0.1 FHIR Std.
Communication.reasonCode Base example SNOMED CT Clinical Findings 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cnd-1 error Communication to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()
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)

The Communication and CommunicationNotDone profiles represent the positive and negative statements for a communication event.

This example meets measure intent for exclusion as defined in the following illustrative CQL (informational; not part of conformance requirements):

[CommunicationNotDone: "Macular edema absent (finding)"] MacularEdemaAbsentNotCommunicated
  with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
    such that MacularEdemaAbsentNotCommunicated.sent during EncounterDiabeticRetinopathy.period
      and ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
      )

For a more complete discussion of representation of negation within US Quality Core and quality improvement artifacts, see the Negation in US Quality Core topic.