ONC Standards Bulletin 2022-1 (SB22-1) discusses the latest draft version of the United States Core Data for Interoperability (USCDI) standard and how the community can provide feedback. USCDI is a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange. USCDI Version 1 (v1) was adopted in the ONC Cures Act Final Rule (May 2020). Additionally, as a Condition and Maintenance of Certification requirement established as part of the ONC Cures Act Final Rule, health IT certified to specific certification criteria needs to be updated to conform to USCDI v1 by the end of December 2022.

The ONC Cures Act Final Rule also established the Standards Version Advancement Process (SVAP). SVAP provides the means for newer versions of standards adopted in regulation – such as USCDI – to be approved by the National Coordinator and subsequently made available for use and compliance under the ONC Health IT Certification Program (Certification Program). 

Draft USCDI v3 will be open for public feedback until April 30, 2022, and ONC plans to release the final USCDI v3 in July 2022.

Draft United States Core Data for Interoperability Version 3

During the development of Draft USCDI v3, ONC received over 400 submissions through the ONDEC submission system. ONC considered these submissions and applied established prioritization criteria to select the most mature data elements, including data elements submitted during previous USCDI submission cycles. Based on these considerations, the following new data classes and data elements have been included as part of Draft USCDI v3.

New Data Classes and Elements Added to Draft USCDI v3

Draft USCDI v3 Key Updates

Building upon USCDI v2, Draft USCDI v3 adds data elements in the Health Status, Procedures, Health Insurance, and Patient Demographics data classes.

Draft USCDI v3 includes four data elements in the new data class Health Status. These are: Disability Status, Mental Function (which includes the more specific Cognitive Status), Functional Status, and Pregnancy Status. The Health Status data class provides a broader context than the existing Health Concerns data class, which contains the single general data element Health Concerns. In Draft USCDI v3, the Health Status data class also includes two existing data elements Health Concerns and Smoking Status which were reclassified from their own data classes as found in USCDI v2. The ability to capture and exchange data that represent these more specific health statuses represents a significant advance for health IT to improve care and to address inequities.

Another new data class, Health Insurance Information, provides an opportunity for health IT to capture and exchange key elements of health care insurance coverage. This information can be useful in the care of patients and for price transparency. This data class includes seven new elements: Coverage Status and Relationship to Subscriber; Member, Subscriber, and Group Identifiers; and Coverage Type and Payer Identifier.

To address public health reporting priorities, especially considering the current COVID-19 pandemic, ONC added Specimen Type and Result Status to the Laboratory data class. Occupation, Occupation Industry, and Pregnancy Status also support public health data requirements.

ONC also added Reason for Referral in the Procedures data class, as this data element is already part of the Certification Program requirements for Transitions of Care and is broadly implemented in health IT.

Additional Updates to Draft USCDI v3

To provide clarity and updates based on ongoing standards development, we made improvements and changes to existing data elements. For the data element Discharge Summary Note, we specified additional requirements, including admission and discharge dates and locations, discharge instructions, and reason(s) for hospitalization. These components are already required by the Certification Program in the Transitions of Care and View, Download, and Transmit to 3rd Party criteria, so we expect implementation burdens to be minimal.

Additionally, ONC intends to update the applicable vocabulary standards to their latest published versions when we issue the final USCDI v3. This is consistent with our approach to prior USCDI versions.

Draft USCDI v3 Public Feedback Period

As part of the predictable, transparent, and collaborative process to expand USCDI, Draft USCDI v3 has been made available to the public for feedback via the Draft USCDI v3 website or on individual data class or data element pages through April 30, 2022. You must be registered and logged in to the website to submit feedback. In addition to requesting feedback on the entire Draft USCDI v3 and the specific data elements identified above, ONC is seeking feedback on the following areas:

1. Are there any improvements needed in the data classes or elements included in Draft USCDI v3, including:
   1. Appropriate and meaningful data class and element names and definitions?
   2. Representative examples or value sets used by health IT developers and implementers to fully understand the intent of the data element?
2. Should other data elements classified as Level 2 be added to USCDI v3 instead, or in addition to those included in Draft USCDI v3? If so, why?
3. Are there significant barriers to development, implementation, or use of any of the Draft USCDI v3 data elements that would warrant not including them in USCDI v3?

ONC will work with the Health Information Technology Advisory Committee to provide Draft USCDI v3 recommendations to the National Coordinator for Health Information Technology.

ONC will continue to work with the public and federal agencies to identify areas where more work is needed to inform future versions of USCDI. However, we recognize that there are specific but important use cases that require consistency and alignment on datasets that go beyond USCDI, and we also seek to be responsive to those needs. Accordingly, we launched the USCDI+ initiative in 2021 to work directly with our federal partners to support the identification and establishment of domain or program-specific datasets that can be extensions to USCDI. Please see our USCDI+ blog post for more information.

ONC will consider all feedback submitted through the Draft USCDI v3 website by April 30, 2022, and is targeting release of the final USCDI v3 in July 2022.