Introduction

Provenance of a resource is a record that describes entities and processes involved in producing and delivering or otherwise influencing that resource. Provenance provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility. Provenance assertions are a form of contextual metadata and can themselves become important records with their own provenance. Provenance statement indicates clinical significance in terms of confidence in authenticity, reliability, and trustworthiness, integrity, and stage in lifecycle (e.g. Document Completion - has the artifact been legally authenticated), all of which may impact security, privacy, and trust policies.

Scope and Usage

In scope of the eHealth Infrastructure, Provenance resources are used for a number of different purposes. Some of these purposes are purely internal to the infrastructure, whereas others are of relevance to clients of the infrastructure.

The details of different usages of Provenance resources relevant to clients are described in the following sections together with the resources and operations they are supporting.

Reuse of measurements

When a client submits measurements in the form of Observation, QuestionnaireResponse and/or Media, the client can submit one or more of these as reused resources, provided that reuse requirements have been met. For each resource where data is reused, the client must construct a Provenance that:

• identifies the resource containing reused data through the target element
• identifies the resource from where data was reused through the entity[0].what element
• identifies a policy which states reuse

Each such Provenance must be submitted along with the resources containing reused data.

See eHealth-observation for further details.

Tracking measurements submitted in the same bundle

Provenance resources are created internally by the eHealth infrastructure to link correlated resources which are submitted together in one bundle:

See eHealth-observation for further details.

Stating legal frameworks and data privacy regulations for episodes of care

Provenance resources are submitted by a client for creation when an EpisodeOfCare (in profile ehealth-episodeofcare) is created using the create-episode-of-care operation.

Some of these provenance resources hold information about which legal frame the EpisodeOfCare is created under through the Provenance element policy. This could be for instance the health law (in Danish: “Sundhedsloven”) or other relevant legal frameworks.

Other of these provenance resources define which data privacy regulations are applicable to data concerning patient, practitioners, and suppliers under the episode of care. This, too, is captured in policy.

See create-episode-of-care for further details.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Provenance

Name	Flags	Card.	Type	Description & Constraints
Provenance			Provenance
policy		1..*	uri	Policy or plan the activity was defined by Binding: Policies for provenances (required)
agent
who		1..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who participated
onBehalfOf		0..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who the agent is representing
entity
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
dateTimeOfReusedEntity		0..1	dateTime, Period	Contains date and time of Reused Entity URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-provenance-dateTimeOfReusedEntity
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Provenance.policy	required	Policies for provenances http://ehealth.sundhed.dk/vs/ehealth-provenance-policies from this IG

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	Provenance	Who, What, When for a set of resources
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
target	Σ	1..*	Reference(Resource)	Target Reference(s) (usually version specific)
recorded	Σ	1..1	instant	When the activity was recorded / updated
policy		1..*	uri	Policy or plan the activity was defined by Binding: Policies for provenances (required)
agent		1..*	BackboneElement	Actor involved
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
who	Σ	1..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who participated
onBehalfOf		0..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who the agent is representing
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Provenance.policy	required	Policies for provenances http://ehealth.sundhed.dk/vs/ehealth-provenance-policies from this IG

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	Provenance	Who, What, When for a set of resources
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 Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
target	Σ	1..*	Reference(Resource)	Target Reference(s) (usually version specific)
occurred[x]		0..1		When the activity occurred
occurredPeriod			Period
occurredDateTime			dateTime
recorded	Σ	1..1	instant	When the activity was recorded / updated
policy		1..*	uri	Policy or plan the activity was defined by Binding: Policies for provenances (required)
location		0..1	Reference(Location)	Where the activity occurred, if relevant
reason		0..*	CodeableConcept	Reason the activity is occurring Binding: PurposeOfUse (extensible): The reason the activity took place.
activity		0..1	CodeableConcept	Activity that occurred Binding: ProvenanceActivityType (extensible): The activity that took place.
agent		1..*	BackboneElement	Actor involved
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
type	Σ	0..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	Σ	1..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who participated
onBehalfOf		0..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who the agent is representing
entity		0..*	BackboneElement	An entity used in this activity
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
dateTimeOfReusedEntity		0..1	dateTime, Period	Contains date and time of Reused Entity URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-provenance-dateTimeOfReusedEntity
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
role	Σ	1..1	code	derivation | revision | quotation | source | removal Binding: ProvenanceEntityRole (required): How an entity was used in an activity.
what	Σ	1..1	Reference(Resource)	Identity of entity
agent		0..*	See agent (Provenance)	Entity is attributed to this agent
signature		0..*	Signature	Signature on target
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Provenance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Provenance.policy	required	Policies for provenances http://ehealth.sundhed.dk/vs/ehealth-provenance-policies from this IG
Provenance.reason	extensible	PurposeOfUse http://terminology.hl7.org/ValueSet/v3-PurposeOfUse
Provenance.activity	extensible	ProvenanceActivityType http://hl7.org/fhir/ValueSet/provenance-activity-type from the FHIR Standard
Provenance.agent.type	extensible	ProvenanceParticipantType http://hl7.org/fhir/ValueSet/provenance-agent-type from the FHIR Standard
Provenance.agent.role	example	SecurityRoleType http://hl7.org/fhir/ValueSet/security-role-type from the FHIR Standard
Provenance.entity.role	required	ProvenanceEntityRole http://hl7.org/fhir/ValueSet/provenance-entity-role|4.0.1 from the FHIR Standard

Differential View

This structure is derived from Provenance

Name	Flags	Card.	Type	Description & Constraints
Provenance			Provenance
policy		1..*	uri	Policy or plan the activity was defined by Binding: Policies for provenances (required)
agent
who		1..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who participated
onBehalfOf		0..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who the agent is representing
entity
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
dateTimeOfReusedEntity		0..1	dateTime, Period	Contains date and time of Reused Entity URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-provenance-dateTimeOfReusedEntity
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Provenance.policy	required	Policies for provenances http://ehealth.sundhed.dk/vs/ehealth-provenance-policies from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	Provenance	Who, What, When for a set of resources
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
target	Σ	1..*	Reference(Resource)	Target Reference(s) (usually version specific)
recorded	Σ	1..1	instant	When the activity was recorded / updated
policy		1..*	uri	Policy or plan the activity was defined by Binding: Policies for provenances (required)
agent		1..*	BackboneElement	Actor involved
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
who	Σ	1..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who participated
onBehalfOf		0..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who the agent is representing
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Provenance.policy	required	Policies for provenances http://ehealth.sundhed.dk/vs/ehealth-provenance-policies from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Provenance		0..*	Provenance	Who, What, When for a set of resources
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 Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
target	Σ	1..*	Reference(Resource)	Target Reference(s) (usually version specific)
occurred[x]		0..1		When the activity occurred
occurredPeriod			Period
occurredDateTime			dateTime
recorded	Σ	1..1	instant	When the activity was recorded / updated
policy		1..*	uri	Policy or plan the activity was defined by Binding: Policies for provenances (required)
location		0..1	Reference(Location)	Where the activity occurred, if relevant
reason		0..*	CodeableConcept	Reason the activity is occurring Binding: PurposeOfUse (extensible): The reason the activity took place.
activity		0..1	CodeableConcept	Activity that occurred Binding: ProvenanceActivityType (extensible): The activity that took place.
agent		1..*	BackboneElement	Actor involved
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
type	Σ	0..1	CodeableConcept	How the agent participated Binding: ProvenanceParticipantType (extensible): The type of participation that a provenance agent played with respect to the activity.
role		0..*	CodeableConcept	What the agents role was Binding: SecurityRoleType (example): The role that a provenance agent played with respect to the activity.
who	Σ	1..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who participated
onBehalfOf		0..1	Reference(ehealth-practitioner | ehealth-relatedperson | ehealth-patient | ehealth-device | ehealth-organization)	Who the agent is representing
entity		0..*	BackboneElement	An entity used in this activity
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
dateTimeOfReusedEntity		0..1	dateTime, Period	Contains date and time of Reused Entity URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-provenance-dateTimeOfReusedEntity
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
role	Σ	1..1	code	derivation | revision | quotation | source | removal Binding: ProvenanceEntityRole (required): How an entity was used in an activity.
what	Σ	1..1	Reference(Resource)	Identity of entity
agent		0..*	See agent (Provenance)	Entity is attributed to this agent
signature		0..*	Signature	Signature on target
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Provenance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Provenance.policy	required	Policies for provenances http://ehealth.sundhed.dk/vs/ehealth-provenance-policies from this IG
Provenance.reason	extensible	PurposeOfUse http://terminology.hl7.org/ValueSet/v3-PurposeOfUse
Provenance.activity	extensible	ProvenanceActivityType http://hl7.org/fhir/ValueSet/provenance-activity-type from the FHIR Standard
Provenance.agent.type	extensible	ProvenanceParticipantType http://hl7.org/fhir/ValueSet/provenance-agent-type from the FHIR Standard
Provenance.agent.role	example	SecurityRoleType http://hl7.org/fhir/ValueSet/security-role-type from the FHIR Standard
Provenance.entity.role	required	ProvenanceEntityRole http://hl7.org/fhir/ValueSet/provenance-entity-role|4.0.1 from the FHIR Standard

This structure is derived from Provenance

Summary

Mandatory: 1 element

Structures

This structure refers to these other structures:

• ehealth-practitioner (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-practitioner)
• ehealth-relatedperson (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-relatedperson)
• ehealth-patient (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-patient)
• ehealth-device (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-device)
• ehealth-organization (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-organization)

Extensions

This structure refers to these extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-provenance-dateTimeOfReusedEntity