Provenance Profile

Canonical	../StructureDefinition/nexus-emr-core-provenance
Status	draft · 1.26.0
Base	Provenance (constraint)
Source	FSH · JSON

Attribution for AI-mediated and cross-boundary writes: what was produced, when, by which agent (human or non-human), from what inputs, and -- for generated text -- which verbatim source passage each statement rests on. Used standalone against a produced resource, and contained in an AI-suggestion review Task against the suggestion contained alongside it.

Examples

AI-Drafted Note Accepted by a Clinician · AI-Generated Summary With Per-Fact Citations

AI-Generated Summary With Per-Fact Citations

Provenance for an AI-generated pre-visit summary carrying the attributed-fact extension -- every statement backed by verbatim quotes with run-relative chunk labels, one citation resolving to its source entity via the optional source reference

Provenance/prov-avery-previsit-summary-20250409 — claims conformance to Provenance Profile

{
  "resourceType": "Provenance",
  "id": "prov-avery-previsit-summary-20250409",
  "meta": {
    "profile": [
      "../StructureDefinition/nexus-emr-core-provenance"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns='http://www.w3.org/1999/xhtml'><p>Provenance for an AI-generated pre-visit summary, carrying the attributed-fact extension: each factual statement in the summary is backed by at least one verbatim quote from the source material, labelled with the generating run's chunk id. One citation also carries the optional source reference, resolving the chunk to the entity it was drawn from.</p><p>The single non-human author (Device, acting on behalf of the practitioner) contrasts with the AI-drafted-note example's two-agent author/attester shape: a pre-visit summary is machine-generated working material, not attested record content.</p><p>Note which type each identifier names. The <b>target</b> is a Composition: the summary was generated here, so we hold its text, and an authored note is a Composition even when a machine wrote it. The cited consult letter is a <b>DocumentReference</b>, because it arrived as a file from outside. Both appear in this one example on purpose.</p></div>"
  },
  "extension": [
    {
      "url": "../StructureDefinition/nexus-attributed-fact",
      "extension": [
        {
          "url": "statement",
          "valueString": "Cardiology consult of 2025-03-22 recommends continuing warfarin at the current dose."
        },
        {
          "url": "citation",
          "extension": [
            {
              "url": "chunk",
              "valueString": "c2"
            },
            {
              "url": "quote",
              "valueString": "Continue warfarin 5 mg daily at the current dose; INR has been therapeutic for three consecutive checks."
            },
            {
              "url": "source",
              "valueReference": {
                "reference": "DocumentReference/cardio-consult-20250322",
                "display": "Cardiology consult letter, 2025-03-22"
              }
            }
          ]
        }
      ]
    },
    {
      "url": "../StructureDefinition/nexus-attributed-fact",
      "extension": [
        {
          "url": "statement",
          "valueString": "Most recent INR (2025-04-02) was 2.4, within the target range of 2.0 to 3.0."
        },
        {
          "url": "citation",
          "extension": [
            {
              "url": "chunk",
              "valueString": "c5"
            },
            {
              "url": "quote",
              "valueString": "INR 2.4 (target 2.0-3.0)"
            }
          ]
        },
        {
          "url": "citation",
          "extension": [
            {
              "url": "chunk",
              "valueString": "c2"
            },
            {
              "url": "quote",
              "valueString": "INR has been therapeutic for three consecutive checks."
            }
          ]
        }
      ]
    }
  ],
  "target": [
    {
      "reference": "Composition/previsit-summary-avery-20250409",
      "display": "Pre-visit summary, appointment of 2025-04-09"
    }
  ],
  "occurredDateTime": "2025-04-08T18:00:00-06:00",
  "recorded": "2025-04-08T18:00:04-06:00",
  "activity": {
    "text": "AI-generated pre-visit summary with per-fact citations"
  },
  "agent": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code": "author",
            "display": "Author"
          }
        ],
        "text": "Generating agent (non-human)"
      },
      "who": {
        "type": "Device",
        "identifier": {
          "system": "../NamingSystem/nexus-emr-appdevice-identifier",
          "value": "smartdocs-ai-scribe"
        },
        "display": "SmartDocs AI Scribe"
      },
      "onBehalfOf": {
        "reference": "Practitioner/dr-emil-navarro",
        "display": "Dr. Emil Navarro"
      }
    }
  ],
  "entity": [
    {
      "role": "source",
      "what": {
        "reference": "DocumentReference/cardio-consult-20250322",
        "display": "Cardiology consult letter, 2025-03-22"
      }
    },
    {
      "role": "source",
      "what": {
        "reference": "DiagnosticReport/inr-diagnosticreport-20250402",
        "display": "INR result, 2025-04-02"
      }
    }
  ]
}