USCDI Version 3 Adds Health Status, Insurance Data Classes

July 19, 2022
ONC’s United States Core Data for Interoperability has expanded from 52 data elements in 16 data classes in Version 1 to 94 data elements in 19 data classes in Version 3

The Office of the National Coordinator for Health IT has released the United States Core Data for Interoperability Version 3, which includes new data classes involving health status and health insurance information.

The USCDI was established to create a foundation for the access, exchange and use of electronic health information to support patient care. The USCDI also is used by federal agencies, hospitals, physician offices, and software developers and is updated annually to keep pace with medical, technology, and policy changes. 

The USCDI has expanded from 52 data elements in 16 data classes in v1 to 94 data elements in 19 data classes in v3.

Health Status/Assessments Data Elements: The draft of v3 included a new data class, Health Status. In response to stakeholder input to make the description/scope of this data class clearer and more representative of the types of data that could be included, USCDI v3 refers to this data class as Health Status/Assessments. This new data class represents assessments of health-related matters performed during care that could identify a need or problem. The new data elements in this data class are Disability Status, Mental/Cognitive Status (Mental Status in Draft v3), Functional Status, and Pregnancy Status. ONC said Pregnancy Status is of particular importance to those who provide care for persons who may be or seek to become pregnant. It is also a substantive data element for lab testing and public health reporting, as noted by ONC’s prior federal advisory committees. The Health Status/Assessments data class provides a broader context than the USCDI v2 Health Concerns data class; therefore, ONC also moved Health Concerns into this new data class.

Health Insurance Information Data Elements: USCDI v3 also includes a new data class called Health Insurance Information, which provides an opportunity for health IT (not just electronic health record systems) to capture and exchange key health care insurance coverage information in a consistent and standardized way. This information can be useful for patient care, and to identify healthcare disparities related to insurance coverage. This data class includes seven new elements: Coverage Status, Relationship to Subscriber, Member Identifier, Subscriber Identifier, Payer Identifier, Group Identifier, and Coverage Type. (ONC received feedback that Coverage Type may be based on the setting and type of care provided, and it is calling on stakeholders to identify an applicable vocabulary standard.

Other Updates Within USCDI v3: To address the need for flexibility in the way certain data elements are represented in health IT, and the rapidly changing terminology landscape around these data elements, ONC removed the references to specific value sets and codes. Instead, where appropriate, it replaced these value sets and codes with applicable vocabulary standards and will continue to use the Interoperability Standards Advisory to identify value sets or code sets that may be helpful for developers and implementers.

ONC also updated the applicable vocabulary standards for data elements to their latest published versions and clarified the definitions and scope of many data elements to assist with implementation.

Based on ongoing standards development, ONC made updates to the definition for Discharge Summary Note to include admission and discharge dates and locations, discharge instructions, and reason(s) for admission. It says it expects the implementation burden to be minimal because this data is required in the Transitions of Care, and View, Download and Transmit to 3rd Party Certification Criteria.

ONC is now accepting new submissions for data classes and data elements to be considered for inclusion in the next version of USCDI, Version 4 (USCDI v4). The submission period for USCDI v4 ends Friday, Sept. 30, 2022, at 11:59pm ET.

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