ONC Releases Draft Version 4 of USCDI

Jan. 13, 2023
ONC proposes to add 20 data elements across one new (Facility Information) and eight existing data classes

The Office of the National Coordinator for Health IT is seeking input on the newly released draft of Version 4 of the United States Core Data for Interoperability (USCDI).

The USCDI is a standardized set of health data classes and constituent data elements for health information exchange. 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 21st Century Cures Act and is a required part of certain certification criteria and, as a result, certified health IT must be able to exchange USCDI data elements.

The USCDI defines the data elements and, where applicable, associated vocabulary standards that must be used as part of, for example, document-based exchange and via application programming interfaces (APIs).

USCDI is expanding over time as standards mature and requirements evolve. The public participates in theexpansion by submitting data classes and data elements for future versions of the USCDI through the ONC New Data Element and Class (ONDEC) submission system.During the Version 4 submission cycle, which ended Sept. 30, 2022, ONC received approximately 150submissions for new data elements and almost 350 comments on previously submitted data elements.With the publication of Draft USCDI v4, ONC proposes to add 20 data elements across one new (FacilityInformation) and eight existing data classes, which if finalized, would result in a USCDI v4 with 112 dataelements organized in 19 data classes.

Draft USCDI v4 includes data elements that focus on patient care and facilitating patient access while promoting equity, reducing disparities, supporting underserved communities, integrating behavioral health.

The new data class, Facility Information, provide details to patients and providers regarding the physicallocation where care was received, or services were provided (or might be provided in thefuture). Facility Information is valuable when care is received in multiple sites. It may also beused to identify the facility where a laboratory test is performed. Draft USCDI v4 adds threedata elements:Facility Identifier, Facility Type, and Facility Name.

Here are a few other examples of what is new in Draft Version 4:

Encounter InformationIn USCDI v3, ONC included several data elements in a new data class, Encounter Information.Several stakeholders commented that a data element was needed to link data related to an encounter (e.g., diagnosis, medications prescribed, lab tests ordered, consultations sent).Encounter Identifierfits this need and is added to Draft USCDI v4. While there are novocabulary standards associated withEncounter Identifierand each unique value is generatedby the organization involved in the encounter, ONC said it is a useful reference when searching for thisinformation.GoalsOne of ONC’s policy priorities is to advance the needs of underserved communities, includingpatients whose treatment goals and preferences are not well represented in health IT. Expression of goals, preferences, and priorities are key to determining how treatment isdelivered in a person-centered way. The advance care planning process may include expressions of interventions, religious beliefsand overall care experience preferences (e.g., a birth plan developed by the patient to expresstheir preferences for treatment and care experience during labor and delivery). To make thesetypes of preferences available for exchange, ONC added two data elementsTreatmentIntervention PreferenceandCare Experience Preference.This is a first step toward enablingthe use and exchange of these patient perspectives.MedicationsUSCDI users have provided ongoing support for data elements to enable the exchange ofpatient medication information. In USCDI v3, ONC addedMedicationsdata elements to enrichthe information about medication type and dosage, however these data elements did notaddress the extent to which a patient adheres to clinical instructions. Over several USCDIupdate cycles, ONC received a significant number of submissions that addressed differentaspects of this need, including submissions for Medication Administration, Medication List,Reported Medication, Medication Usage, and Medication Adherence. Exchanging medication adherence information can aid medication reconciliation and inform a use and exchange of medication reconciliation data is to add two new data elements: Medication Instructions and Medication Adherence. Medication Adherence includes patient-reported data, further enhancing the patient’s participation in their care.

Draft USCDI v4 is now available for public feedback until April 17, 2023, at 11:59 pm ET. You must be registered and logged in to the website to submit feedback. Health IT expertise is not required to provide comments and ONC welcomes information that identifies the healthcare community’s preferences and priorities for informing further investigation.

In addition, ONC is seeking feedback on the following areas:1. Suggestions for improvement in the data classes or elements in Draft USCDI v4,including:a. Data class and data element definitions,b. Examples of code sets used by health IT developers and implementers tocommunicate data element scope.2. Should other data elements, already classified as Level 2 on the USCDI web pages,be added to USCDI v4 instead, or in addition to those in Draft USCDI v4? If so, why?3. Are there significant barriers to development, implementation, or use for any of thesedata elements that warrant a change in definition, or removal from Draft USCDI v4? ONC will also work with the Health Information Technology Advisory Committee (HITAC) to receiverecommendations on Draft USCDI v4.

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