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 MAY impact security, privacy, and trust policies.

Some parties may MAY be duplicated between the target resource and its provenance. For instance, the prescriber is usually (but not always) the author of the prescription resource. This resource is defined with close consideration for W3C Provenance.

The Reference(s) that were generated or updated by the activity described in this resource. A provenance can point to more than one target if multiple resources were created/updated by the same activity.

Target references are usually version specific, but might not be, if a version has not been assigned or if the provenance information is part of the set of resources being maintained (i.e. a document). When using the RESTful API, the identity of the resource might not be known (especially not the version specific one); the client may MAY either submit the resource first, and then the provenance, or it may MAY submit both using a single transaction. See the notes on transaction for further discussion.

The period during which the activity occurred.

The period can be a little arbitrary; where possible, the time should SHOULD correspond to human assessment of the activity time.

The instant of date and time at which the activity provenance information was recorded. recorded / updated, whether in the FHIR Provenance resource or in some other form that is later communicated in the FHIR Provenance.

This can be a little different from the time stamp lastUpdated on the Provenance resource if there is a delay between recording the event and updating the provenance and target resource.

Policy or plan the activity was defined by. Typically, a single activity may MAY have multiple applicable policy documents, such as patient consent, guarantor funding, etc.

For example: Where an OAuth token authorizes, the unique identifier from the OAuth token is placed into the policy element Where a policy engine (e.g. XACML) holds policy logic, the unique policy identifier is placed into the policy element.

Where the activity occurred, if relevant. occurred.

The reason authorization (e.g., PurposeOfUse) that the activity was taking place. used during the event being recorded.

Record of any relevant security context, not restricted to purposeOfUse valueSet. May include security compartments, refrain, obligation, or other security tags.

Describes why the event recorded in this provenenace occurred in textual form.

An activity is something that occurs over a period of time and acts upon or with entities; it may MAY include consuming, processing, transforming, modifying, relocating, using, or generating entities.

A plan, proposal or order that is fulfilled in whole or in part by this provenance.

Allows tracing of authorization for the provenance and tracking whether proposals/recommendations were acted upon.

The patient element is available to enable deterministic tracking of activities that involve the patient as the subject of the data used in an activity.

When the .patient is populated it SHALL be accurate to the subject of the target data. The .patient SHALL NOT be populated when the target data created/updated (.target) by the activity does not involve a subject. Note that when the patient is an agent, they will be recorded as an agent. When the Patient resource is Created, Updated, or Deleted it will be recorded as an entity. May also affect access control.

This will typically be the encounter the event occurred, but some events MAY be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).

Links the provenance to the Encounter context. May also affect access control.

This will typically be the encounter the provenance was created during, but some provenances MAY be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission lab tests).

An actor taking a role in an activity for which it can be assigned some degree of responsibility for the activity taking place.

An agent can be a person, an organization, software, device, or other entities that may MAY be ascribed responsibility.

Several agents may MAY be associated (i.e. has some responsibility for an activity) with an activity and vice-versa.

The participation Functional Role of the agent had with respect to the activity.

Functional roles reflect functional aspects of relationships between entities. Functional roles are bound to the realization/performance of acts, where actions might be concatenated to an activity or even to a process. This element will hold the functional role that the agent played in the activity that is the focus of this Provenance. Where an agent played multiple functional roles, they will be listed as multiple .agent elements representing each functional participation. See ISO 21298:2018 - Health Informatics - Functional and structural roles, and ISO 22600-2:2014 - Health Informatics - Privilege Management and Access Control - Part 2: formal models.

For example: assembler, author, performer, enterer, attester, prescriber, signer, investigator, etc.

The function structural roles of the agent with respect to indicating the activity. agent's competency. The security role enabling the agent with respect to the activity.

Structural roles reflect the structural aspects of relationships between entities. Structural roles describe prerequisites, feasibilities, or competences for acts. Functional roles reflect functional aspects of relationships between entities. Functional roles are bound to the realization/performance of acts, where actions might be concatenated to an activity or even to a process. See ISO 21298:2018 - Health Informatics - Functional and structural roles, and ISO 22600-2:2014 - Health Informatics - Privilege Management and Access Control - Part 2: formal models..

For example: doctor, nurse, clerk, Chief-of-Radiology, Nurse, Physician, Medical-Student, etc.

The individual, device Indicates who or organization that participated what performed in the event.

The individual, device, or organization for whom agent that delegated authority to perform the change was made. activity performed by the agent.who element.

An entity used in this activity.

How the entity was used during the activity.

Identity of the Entity used. May be a logical or physical uri and maybe absolute or relative.

whatIdentity should The what.identifier SHOULD be used for entities that are not a Resource type.

The entity is attributed to an agent to express the agent's responsibility for that entity, possibly along with other agents. This description can be understood as shorthand for saying that the agent was responsible for the activity which generated used the entity.

A usecase where one Provenance.entity.agent is used where the Entity that was used in the creation/updating of the Target, is not in the context of the same custodianship as the Target, and thus the meaning of Provenance.entity.agent is to say that the entity referenced is managed elsewhere and that this Agent provided access to it. This would be similar to where the Entity being referenced is managed outside FHIR, such as through HL7 v2, V2, v3, or XDS. This might be where the Entity being referenced is managed in another FHIR resource server. Thus it explains the Provenance of that Entity's use in the context of this Provenance activity.

A digital signature on the target Reference(s). The signer should SHOULD match a Provenance.agent. The purpose of the signature is indicated.