The fourth version of the U.S. Core Data for Interoperability (USCDI) standard published Thursday includes a new iteration of more health classes and elements that are improving exchange of electronic health information for better equity across the health care ecosystem.
The Office of the National Coordinator for Health IT (ONC) adopted the standard in May 2020 through the 21st Century Cures Act. Since then, ONC continues to update and expand its data elements and classes annually.
"In order to make USCDI data interoperable, it has to be exchanged using a couple of different required exchange methods in our certification program,” Al Taylor, ONC's medical informatics officer, told GovCIO Media & Research. “That includes exchanges using the consolidated clinical data architecture documents, [clinical document architecture] for a variety of different ways of exchanging documents, along with using FHIR resources to exchange data that's in USCDI.”
"We are using these data elements because we want to have the information, not the anecdotal evidence, but the actual heart, understanding and knowledge of what root causes are, and then how best to solve them through technology and interoperability," said ONC Deputy Director of the Office of Technology Ryan Argentieri at the HIMSS conference in Chicago in April.
What's New in USCDI Version 4?
ONC collected over 600 comments over the draft's public comment period to incorporate into the fourth version, which includes 20 new data elements and one new data class, including facility information.
"We went through every single comment, every single recommendation on data elements that were in draft before or data elements that were in prior versions of USCDI," Taylor said. "We made a lot of adjustments to those data elements to better reflect the needs that were included in those comments."
Some of the highlighted updates include:
- "Substance (non-medication)" added to the allergies and intolerances data class to incorporate common allergens such as latex, peanuts and pollen.
- "Encounter identifier" added to last year's new "encounter information" data class to link data related to an encounter.
- New "facility information" data classes added to provide details to patients and providers regarding physical location of the services provided.
- Six data elements added to the "laboratory" data class to support ongoing public health reporting needs.
Other updates included those to goals and preferences, health status assessments, medications, procedures and vital signs. Additionally, ONC implemented some changes to definitions and applicable vocabulary standards.
USCDI Supports Health Equity
Overall, the updated version continues to focus on patient-centered data and quality measurement to further health equity goals.
“One of the things it does is it continues, an effort that we've made over the last several versions of USCDI, to add data elements that address certain policy priorities like health equity disparities, underserved communities, behavioral health, behavioral health integration and public health data requirements,” Taylor said.
Taylor highlighted that one of the new data elements represents goals and preferences. This means providers will be able to document a patient's expression of their goals and preferences to be part of their care and treatment plans, such as patient desires for whether and when lifesaving interventions are performed, or a birth plan, for example.
In the prior third version released in 2022, ONC added new data classes that focused on insurance information and health status.
“In addition to expanding the USCDI data classes and elements to address patient access and care needs, many of the added elements are also meant to mitigate health and health care inequities and disparities, address the needs of underserved communities, and support public health interoperability needs of reporting, investigation and emergency response,” spokespersons from ONC's Standards Division told GovCIO Media & Research in July 2022.
In April, the Centers for Medicare and Medicaid Services (CMS) and the Center for Disease Control and Prevention (CDC) adopted USCDI standards as they aim to reach public health equity goals and improve public health reporting and response.
With data standardization top of mind, the agencies collaborated in CDC's reorganization that spurred a new office focusing on public health data and interoperability.
“As we stand up the new office, one of our divisions will be dedicated to data policy and standards work. Working across public health, across CDC, but most importantly with our health care and with our federal partners to really accelerate the work will be the incorporation of standards and interoperability particularly across our core data systems,” said the office’s Acting Director Jennifer Layden on panel at the HIMSS conference in April.
With the new version published, the agency is now seeking comments for existing data elements and new elements for its upcoming fifth version through Sept. 20.
“With each change and with each new data element that we add, we recognize that there may be certain amount of burden to not only develop the health IT that is able to handle the new data or ensure that it's captured and exchanged,” Taylor said. “We feel like the number of data elements and the complexity of the data elements in aggregate are a reasonable additional lift for all potential users of USCDI version four in the future.”
The agency anticipates a fifth draft to release January 2024.