USCDI: Supporting Interoperability Requirements of the Cures Act

By David Navarro, Sr. Director of Data Science, Harmony Healthcare IT
Twitter: @HarmonyHIT

What is the USCDI?

United States Core Data for Interoperability (USCDI) is a standardized set of health data classes (categories) and constituent data elements for interoperable health information exchange. USCDI serves as a minimum guide for provider organizations on what data classes and elements will be stored and made interoperable, prescribing specific concepts like LOINC, SNOMED, CPT, and ICD10 that should be utilized to store patient observations.

The Office of the National Coordinator (ONC) adopted USCDI as the content standard for 21st Century Cures Act. Certified health IT developers must support the USCDI v1 by the end of 2022, which includes 15 Data Classes:

  1. Assessment and Plan of Treatment
  2. Care Team Members
  3. Clinical Notes
  4. Goals
  5. Health Concerns
  6. Immunizations
  7. Laboratory
  8. Medications
  9. Patient Demographics
  10. Problems
  11. Procedures
  12. Provenance
  13. Smoking Status
  14. Unique Device Identifier for a Patient’s Implantable Devices
  15. Vital Signs

How is the USCDI updated?

The USCDI is constantly under review. In fact, the ONC has a process for health IT stakeholders to follow to suggest updates. This can mean the addition of new data classes, like those listed above, or data elements that could be added to an existing class. For example, in moving forward from USCDI v1 to USCDI v2, there were more than 600 data classes and elements submitted by the health IT community during the version 2 development cycle. The result was three new data class additions and 22 data element updates.

The process to suggest an update includes submitting new data elements and classes to the USCDI ONDEC (ONC New Data Element and Class) Submission System.

The submission for a proposed change should include:

  • Use case information
  • Applicable standards and technical specifications
  • Existing industry use and exchange
  • Potential challenges of incorporating proposed data elements

Then, the ONC evaluates the proposed data elements and assigns them one of the following levels:

  • Comment – Data may not have a well-defined use case or value to potential users
  • Level 1 – Limited existing use in electronic systems, limited exchange between systems
  • Level 2 – Extensive existing use in systems, and exchange between systems, would improve nationwide interoperability

Next, the ONC publishes data elements to the USCDI page for comments by health IT stakeholders. Updates and comments can be made for consideration of moving proposed data elements into the next version of the USCDI standard. Submissions achieving Level 2 will then be considered for incorporation into the new USCDI version of the standard.

While there may be a long list of suggested updates, the ONC is taking a judicious approach about how much to add to subsequent USCDI versions because of the USCDI’s broad applicability to certified healthcare technology, interoperability transactions, and its potential effect on user experience and workflow.

How are new versions of the USCDI incorporated into initiatives such as the 21st Century Cures Act?

While, to date, only version 1 is required to meet the Cures Act requirements, the ONC has established a voluntary Standards Version Advancement Process (SVAP) to enable health IT developers to incorporate newer versions of the standards and implementation specifications as part of the “Real World Testing” Condition and Maintenance of Certification requirement of the Cures Act. This means that using SVAP, certified health IT developers are permitted to use a more advanced version of the USCDI standards than currently in widespread use.

The impact of USCDI is not limited to just health IT products certified under the ONC Health IT Certification Program.

The USCDI also is used to align interoperability requirements and national priorities for health IT and health care broadly across industry initiatives. In fact, CMS and other federal, state, local, and tribal partners reference the USCDI for a range of health information exchange purposes.

This article was originally published on the Harmony Healthcare IT blog and is republished here with permission.