xDev Asia

Analyze US Core Implementation Guide, International Patient Summary (IPS), AU Core (Australia), UK Core, lessons from actual implementation, compare countries, apply to Vietnam.

HL7 FHIR - Basic to Advanced Healthcare Data Standard

Part 7: Production, Scale and Future

xdev.asia

1. US Core Implementation Guide

US Core is the official US IG, required for all EHR systems certified under ONC (21st Century Cures Act). This is the most important reference IG in the world.

Main US Core Profiles

Profile	Base Resource	Featured request
US Core Patients	Patient	Race, ethnicity extensions; MRN identifier
US Core Conditions	Condition	SNOMED CT + ICD-10-CM; Clinical status required
US Core Observation	Observation	Vital Signs, Lab Results, Social History
US Core MedicationRequest	MedicationRequest	RxNorm coding required
US Core Encounter	Encounter	Class, type, participant required
US Core Procedures	Procedure	CPT/SNOMED CT coding
US Core AllergyIntolerance	AllergyIntolerance	Clinical status + reaction
US Core DocumentReference	DocumentReference	Clinical Notes (C-CDA on FHIR)

US Core Patient — Example

{
  "resourceType": "Patient",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
    ]
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
      "extension": [
        {
          "url": "ombCategory",
          "valueCoding": {
            "system": "urn:oid:2.16.840.1.113883.6.238",
            "code": "2106-3",
            "display": "White"
          }
        },
        {"url": "text", "valueString": "White"}
      ]
    },
    {
      "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
      "extension": [
        {
          "url": "ombCategory",
          "valueCoding": {
            "system": "urn:oid:2.16.840.1.113883.6.238",
            "code": "2186-5",
            "display": "Not Hispanic or Latino"
          }
        }
      ]
    }
  ],
  "identifier": [
    {
      "system": "http://hospital.example.org/mrn",
      "value": "MRN123456"
    }
  ],
  "name": [
    {"family": "Smith", "given": ["John", "A."]}
  ],
  "gender": "male",
  "birthDate": "1985-03-15"
}

Lessons from US Core

Standard Mandate — ONC rule (2020) requires EHR vendors to implement US Core
USCDI — US Core Data for Interoperability defines minimal data elements
Terminology binding — Required SNOMED CT, LOINC, RxNorm
$everything operation — Patient Access API for patient portals
Bulk Data — Payer-to-Payer data exchange

2. International Patient Summary (IPS)

IPS is a summary of cross-border health records — minimally, regardless of jurisdiction. ISO 27269:2021.

IPS Sections required

Section	FHIR Resource	Content
Medication Summary	MedicationStatement	Medicines in use
Allergies and Intolerances	AllergyIntolerance	Allergy, BDR medication
Problem List	Condition	Disease under treatment
Immunizations	Immunization	Vaccination
Procedures History	Procedure	Surgery and procedures performed

IPS Document Bundle

{
  "resourceType": "Bundle",
  "type": "document",
  "entry": [
    {
      "resource": {
        "resourceType": "Composition",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/uv/ips/StructureDefinition/Composition-uv-ips"
          ]
        },
        "type": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "60591-5",
              "display": "Patient summary Document"
            }
          ]
        },
        "subject": {"reference": "Patient/patient-001"},
        "date": "2025-01-15",
        "author": [{"reference": "Practitioner/practitioner-001"}],
        "title": "International Patient Summary",
        "section": [
          {
            "title": "Active Problems",
            "code": {"coding": [{"system": "http://loinc.org", "code": "11450-4"}]},
            "entry": [{"reference": "Condition/cond-001"}]
          },
          {
            "title": "Medication Summary",
            "code": {"coding": [{"system": "http://loinc.org", "code": "10160-0"}]},
            "entry": [{"reference": "MedicationStatement/med-001"}]
          },
          {
            "title": "Allergies and Intolerances",
            "code": {"coding": [{"system": "http://loinc.org", "code": "48765-2"}]},
            "entry": [{"reference": "AllergyIntolerance/allergy-001"}]
          }
        ]
      }
    }
  ]
}

Use case IPS for Vietnam

Medical tourism — Japanese/Korean patients coming to Vietnam bring IPS
Foreign workers — Vietnamese workers in Japan/Korea need IPS
International hospital transfer — FV Hospital, Vinmec International

3. AU Core (Australia)

Characteristics	AU Core	Lessons for Vietnam
Identifier	IHI (Individual Healthcare Identifier)	Similar to CCCD/health insurance
Indigenous status	Aboriginal/Torres Strait Islander extension	Similar to Ethnic Vietnam extension
Healthcare providers	HPI-I (identifier for BS)	Practicing certificate code
Organization	HPI-O (identifier for organizations)	Medical facility code
Terminology	SNOMED CT-AU, PBS, AMT	ICD-10 VN, Health insurance drugs

4. UK Core

Characteristics	UK Core	Lessons for Vietnam
NHS Number	10-digit unique ID for each citizen	CCCD 12 numbers
Ethnicity	ONS 2011 Census categories	54 Vietnamese ethnic groups
GP Practice	ODS code for every GP	Initial medical facility code
dm+d	NHS Dictionary of Medicines	List of drugs under health insurance
SNOMED CT UK	UK clinical terms	ICD-10 VN

5. Compare Implementation Guides

Criteria	US Core	AU Core	UK Core	VN Core (recommended)
FHIR Version	R4	R4	R4	R5
Patient ID	MRN/SSN	IHI	NHS Number	CCCD
Insurance	Coverage	Medicare	NHS	Health insurance
Diagnosis code	ICD-10-CM	ICD-10-AM	SNOMED CT	ICD-10 VN
Drug code	RxNorm	AMT	dm+d	Health insurance medicine
Lab code	LOINC	LOINC	LOINC	LOINC
Mandate	ONC Rule	ADHA	NHS Digital	MOH (future)

6. Lessons from actual implementation

Start small — US Core starts with 15 profiles, gradually expanding
Government mandate — Need legal regulations (ONC Rule, ADHA) to promote adoption
Terminology first — Build CodeSystems/ValueSets (ICD-10 VN, Health Insurance Drugs) before profiles
Testing infrastructure — US has Touchstone, Inferno for conformance testing
Community — Connectathon, IG balloting, community feedback
Backward compatibility — US Core keeps R4 because of its large ecosystem; VN can start R5
Must Support — Clearly define must-support semantics for vendors

7. Summary

US Core — Largest reference IG, required by ONC, using SNOMED CT + LOINC + RxNorm
IPS — Summary of cross-border records, ISO 27269, 5 sections required
AU/UK Core — Each country customizes its own identifier, terminology, and legislation
VN Core — Need to build on international lessons, starting from terminology + Patient profile

Lesson 24: Case Studies — US Core, IPS and Practical Implementation