During an April 15 meeting, an advisory committee to the Office of the National Coordinator for Health IT approved sending ONC a task force’s recommendations to add nine data elements to the United States Core Data for Interoperability (USCDI) version 2, including social determinant of health data.
In January 20201, ONC released a draft of version 2 of USCDI, which defines a standardized set of health data classes and data elements for health information exchange. Version 2 introduces incremental and modest changes, including nine new data elements and two new data classes.
The USCDI establishes a baseline set of data that can be commonly exchanged across care settings for a wide range of uses. Version 1 was adopted as a standard in the ONC Cures Act Final Rule published May 1, 2020. The standard was included as a required part of certain certification criteria in the 2015 Edition Cures Update and is also referenced in the context of information blocking. The final iteration of version 2 is expected to be published on July 1, 2021.
During the April 15 meeting of the ONC Health Information Technology Advisory Committee (HITAC), Steven Lane, M.D., M.P.H, clinical informatics director for privacy, information security & interoperability for California-based Sutter Health, gave a briefing on the USCDI task force’s recommendations. He serves as task force co-chair. In the ONC draft version 2, there were two new data classes that were introduced for diagnostic imaging and encounter information and a handful of new data elements. “Really, it was a modest advancement, I think, based on the challenges in the context of the pandemic,” Lane said, “and a lot of public comment has come back that perhaps this was right on, that they hit it right on the mark, and then there was other public comment that suggested that maybe this was too conservative in terms of the demands and the needs of the industry to advance USCDI, and we've had a lot of that conversation at the task force as well.”
He said that while the task force members appreciated the work that ONC did to narrow things down in their draft version 2, “there was a general feeling that we should be more inclusive, that there were more data elements that really were important to include in version 2.”
As well as asking ONC to clarify language about several of the data types required, the task force recommended adding nine data elements to version 2, some of them contingent on HL7 being able to complete implementation guides within the same timeline.
Among the data elements they recommend be added was care team members, because it supports communication and coordination between care team members and automates information routing. Another recommendation involves diagnostic studies and exams with results, including colonoscopies, echocardiograms, electrocardiograms, and pulmonary function tests. Diagnostic studies represents a significant gap area in USCDI version 1 and draft version 2, Lane explained. “All the systems that deal with Medicare and Medicaid patients certainly have the ability to capture these,” he said, “so they are in broad use, and we thought that they should be included in version 2.”
Other elements the task force would like to see added include encounter disposition, encounter location, Medicare beneficiary ID, and discharge medications, as well as types of orders for medical care or services. The task force noted that interoperability of orders would add needed flexibility to patients and providers, allowing orders to move more easily between organizations, facilitating patient choice and greater value.
The task force also wants version 2 to include Gender Identity/Sexual Orientation in patient demographics, which it says is fundamental to patient safety, care and equity. Lane mentioned that this recommendation is contingent on HL7 finalizing an implementation guide in time.
Last but not least, Lane explained that social determinant of health data elements should be included if the HL7 implementation guide can be finalized in time. “We're all well aware of the importance of social determinants of health in determining health outcomes, and how important these have been in the context of the pandemic,” he said. Several data element implementation guides are well along the path to finalization by HL7, he noted.
Looking ahead to future USCDI versions, the task force wants to look at adding orders related to end-of-life care such as Portable Medical Orders for Life-Sustaining Treatments (POLST/MOLST).
