United States Core Data for Interoperability (USCDI)
The United States Core Data for Interoperability (USCDI) is a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange. Review the USCDI Fact Sheet to learn more.
A USCDI Data Class is an aggregation of Data Elements by a common theme or use case.
A USCDI Data Element is a piece of data defined in USCDI for access, exchange or use of electronic health information.
USCDI ONC New Data Element & Class (ONDEC) Submission System
With the publication of USCDI v4, ONC is accepting submissions for new data elements. The deadline for USCDI v5 submissions and comments is September 20, 2023 at 11:59 p.m. ET. Submissions received after this date will be considered for USCDI v6.
USCDI V1
Please reference the USCDI version 1 document to the left for applicable standards versions associated with USCDI v1.
Harmful or undesired physiological responses associated with exposure to a substance.
Health professional’s conclusions and working assumptions that will guide treatment of the patient.
Information on a person who participates or is expected to participate in the care of a patient.
Narrative patient data relevant to the context identified by note types.
Desired state to be achieved by a patient.
Health related matter that is of interest, importance, or worry to someone who may be the patient, patient’s family or patient’s health care provider.
Record of vaccine administration.
Analysis of clinical specimens to obtain information about the health of a patient.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
Data used to categorize individuals for identification, records matching, and other purposes.
Activity performed for or on a patient as part of the provision of care.
The metadata, or extra information about data, regarding who created the data and when it was created.
Representing a patient’s smoking behavior.
Unique identifier(s) for a patient's implantable device(s).
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
USCDI V2
The USCDI v2 contains data classes and elements from USCDI v1 and new data classes and elements submitted through the ONDEC system. Please reference the USCDI Version 2 document to the left for applicable vocabulary standards versions associated with USCDI v2 and to the ONC Standards Bulletin 21-3 for more information about the process to develop USCDI v2 and future versions.
Harmful or undesired physiological responses associated with exposure to a substance.
Health professional’s conclusions and working assumptions that will guide treatment of the patient.
Information on a person who participates or is expected to participate in the care of a patient.
Narrative patient data relevant to the context identified by note types.
Non-imaging and non-laboratory tests performed that result in structured or unstructured findings specific to the patient to facilitate the diagnosis and management of conditions.
Tests that result in visual images requiring interpretation by a credentialed professional.
Information related to interactions between healthcare providers and a patient.
Desired state to be achieved by a patient.
Health related matter that is of interest, importance, or worry to someone who may be the patient, patient’s family or patient’s health care provider.
Record of vaccine administration.
Analysis of clinical specimens to obtain information about the health of a patient.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
Data used to categorize individuals for identification, records matching, and other purposes.
Condition, diagnosis, or reason for seeking medical attention.
Activity performed for or on a patient as part of the provision of care.
The metadata, or extra information about data, regarding who created the data and when it was created.
Representing a patient’s smoking behavior.
Unique identifier(s) for a patient's implantable device(s).
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
USCDI V3
USCDI v3 contains data classes and elements from USCDI v2 and new data classes and elements submitted through the ONDEC system. Please reference the USCDI Version 3 document to the left for applicable vocabulary standards versions associated with USCDI v3 and to the ONC Standards Bulletin 22-2 for more information about the process to develop USCDI v3 and future versions.
Harmful or undesired physiological responses associated with exposure to a substance.
Health professional’s conclusions and working assumptions that will guide treatment of the patient.
Information on a person who participates or is expected to participate in the care of a patient.
Narrative patient data relevant to the context identified by note types.
Non-imaging and non-laboratory tests performed that result in structured or unstructured findings specific to the patient to facilitate the diagnosis and management of conditions.
Tests that result in visual images requiring interpretation by a credentialed professional.
Information related to interactions between healthcare providers and a patient.
Desired state to be achieved by a patient.
Data related to an individual’s insurance coverage for health care.
Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.
Record of vaccine administration.
Analysis of clinical specimens to obtain information about the health of a patient.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
Data used to categorize individuals for identification, records matching, and other purposes.
Condition, diagnosis, or reason for seeking medical attention.
Activity performed for or on a patient as part of the provision of care.
The metadata, or extra information about data, regarding who created the data and when it was created.
Unique identifier(s) for a patient's implantable device(s).
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
USCDI V4
USCDI v4 added 20 data elements and one data class to USCDI v3. Please reference the USCDI v4 standard document and the ONC Standards Bulletin 23-2 for details. To review the prioritization criteria ONC used to select the USCDI v4 data elements, refer to the ONC Standards Bulletin 22-2. ONC is accepting submissions for new data elements through the ONDEC system and feedback on existing data elements until Wednesday, September 20, 2023 at 11:59 p.m. ET.
Harmful or undesired physiological responses associated with exposure to a substance.
Information on a person who participates or is expected to participate in the care of a patient.
Narrative patient data relevant to the context identified by note types.
Non-imaging and non-laboratory tests performed that result in structured or unstructured findings specific to the patient to facilitate the diagnosis and management of conditions.
Tests that result in visual images requiring interpretation by a credentialed professional.
Information related to interactions between healthcare providers and a patient.
Physical place of available services or resources.
Desired state to be achieved by a person or a person’s elections to guide care.
Data related to an individual’s insurance coverage for health care.
Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.
Record of vaccine administration.
Analysis of clinical specimens to obtain information about the health of a patient.
An instrument, machine, appliance, implant, software or other article intended to be used for a medical purpose.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
Data used to categorize individuals for identification, records matching, and other purposes.
Conclusions and working assumptions that will guide treatment of the patient, and recommendations for future treatment.
Condition, diagnosis, or reason for seeking medical attention.
Activity performed for or on a patient as part of the provision of care.
The metadata, or extra information about data, regarding who created the data and when it was created.
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
- Represented by a terminology standard or SDO-balloted technical specification or implementation guide.
- Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
- Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
- Use cases apply to most care settings or specialties.
Level 2
Harmful or undesired physiological responses associated with exposure to a substance.
Material substance originating from a biological entity intended to be transplanted or infused into another (possibly the same) biological entity.
Narrative patient data relevant to the context identified by note types.
Tests that result in visual images requiring interpretation by a credentialed professional.
Physical place of available services or resources.
Data related to an individual’s insurance coverage for health care.
Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.
Record of vaccine administration.
Analysis of clinical specimens to obtain information about the health of a patient.
An instrument, machine, appliance, implant, software or other article intended to be used for a medical purpose.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
Data used to categorize individuals for identification, records matching, and other purposes.
Conclusions and working assumptions that will guide treatment of the patient, and recommendations for future treatment.
Condition, diagnosis, or reason for seeking medical attention.
Activity performed for or on a patient as part of the provision of care.
The metadata, or extra information about data, regarding who created the data and when it was created.
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
- Represented by a terminology standard or SDO-balloted technical specification or implementation guide.
- Data element is captured, stored, or accessed in at least one production EHR or HIT module.
- Data element is electronically exchanged between two production EHRs or other HIT modules using available interoperability standards.
- Use cases apply to several care settings or specialties.
Level 1
Material substance originating from a biological entity intended to be transplanted or infused into another (possibly the same) biological entity.
Narrative patient data relevant to the context identified by note types.
Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.
Analysis of clinical specimens to obtain information about the health of a patient.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
Data used to categorize individuals for identification, records matching, and other purposes.
The metadata, or extra information about data, regarding who created the data and when it was created.
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
- Not represented by a terminology standard or SDO-balloted technical specification or implementation guide.
- Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
- Data element is electronically exchanged in limited environments, such as connectathons or pilots.
- Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Level 0
Material substance originating from a biological entity intended to be transplanted or infused into another (possibly the same) biological entity.
Information on a person who participates or is expected to participate in the care of a patient.
Narrative patient data relevant to the context identified by note types.
Non-imaging and non-laboratory tests performed that result in structured or unstructured findings specific to the patient to facilitate the diagnosis and management of conditions.
Tests that result in visual images requiring interpretation by a credentialed professional.
Information related to interactions between healthcare providers and a patient.
Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.
Desired state to be achieved by a patient.
Desired state to be achieved by a person or a person’s elections to guide care.
Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.
Record of vaccine administration.
Analysis of clinical specimens to obtain information about the health of a patient.
An instrument, machine, appliance, implant, software or other article intended to be used for a medical purpose.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
Data used to categorize individuals for identification, records matching, and other purposes.
Conclusions and working assumptions that will guide treatment of the patient, and recommendations for future treatment.
Condition, diagnosis, or reason for seeking medical attention.
Activity performed for or on a patient as part of the provision of care.
The metadata, or extra information about data, regarding who created the data and when it was created.
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
For data class description and applicable standards supporting data elements, click to view the USCDI Version 1 (July 2020 errata) in PDF format below.
The USCDI ONC New Data Element and Class (ONDEC) Submission System supports a predictable, transparent, and collaborative process, allowing health IT stakeholders to submit new data elements and classes for future versions of USCDI. Click here for more information and to submit new data elements.
The USCDI standard will follow the Standards Version Advancement Process described in the Cures rule to allow health IT developers to update their systems to newer version of USCDI and provide these updates to their customers.
Comment
Submitted by brianscarpelli on 2023-09-21
‘Vital sign results: date and timestamps' promotion from Level 2
The Connected Health Initiative appreciates the opportunity to provide public comment in support of promoting ‘Vital sign results: date and timestamps’ from Level 2 to the draft USCDI v5.
In the Standards Bulletin, July 2023, ONC noted the need of for additional information related to average blood pressure: "ONC received significant input and support for Average Blood Pressure over several USCDI version update cycles. Average Blood Pressure is recognized as an independent risk factor in many diseases and health conditions... The time period, number of readings, and specific protocols may be needed to interpret an Average Blood Pressure value." (Source: ONC Health IT Standards Bulletin, July 2023. https://www.healthit.gov/sites/default/files/page/2023-07/Standards_Bulletin_2023-2.pdf)
Rather than suggesting new data elements specific only to average blood pressure and to reduce the burden on certified health IT companies, the vital sign results: date and timestamps data element could be utilized to provide context for a documented average blood pressure.
Several others have previously commented on the usefulness of vital sign results: date and timestamps specifically related to average blood pressure. They note that in order for average blood pressure to be useful it must include all the metadata to provide the context for interpretation.
The Connected Health Initiative requests that ONC promote Vital sign results: date and timestamps and include it in the draft USCDI v5.
Submitted by mmoen48 on 2023-09-21
Recommendations for USCDI v5
We appreciate the opportunity to submit comments on the standardized health data classes and constituent data elements eligible for promotion to version 5 of the USCDI. As we look to version 5 of USCDI and those items that will enable individuals to express the things that will allow them to ensure systems make the information available across care settings that are most impactful to their healthcare experience, ADVault strongly recommends that the following health data classes and constituent data elements, including clarifications to their naming convention, be included.
Submitted by tomalley on 2023-09-21
Advancing Quality of Life Priorities to USCDI V5
I'm writing in support of advancing the Quality of Life (QoL) Priorities data class within Goals and Preferences for inclusion in USCDI V5. A person’s quality of life priorities are based on their personal values for what is important to them to have a good quality of life. When first introduced two years ago, Quality of Life (QoL) Priorities were not emphasized for decisions regarding care and treatment. Care Experience Preference and Treatment Intervention Preference were called out in USCDI V4 while QoL Priorities were relegated to Level 1.
Several developments over the past two years have established that QoL Priorities have significant impact on clinical decisions, and together with Care Experience Preference and Treatment Intervention Preference give a complete picture of an individual’s goals,preferences, and priorities (GPPs). Adding this data element to USCDI V5 would establish a full suite of GPP data elements to describe more accurately what matters most to the individual.
Among these developments is the work of the Moving Forward Coalition established in 2022 following the NASEM Committee report on the Imperative to Improve Nursing Home Care. (Home - Moving Forward Coalition). Three committees are working to create a taxonomy of goals, preferences, and priorities to guide care plans, establish quality measures, and serve as the foundation for an HIT-enabled process to gather granular GPPs. This work involves more than 1000 individuals including 90 nursing home residents from across the country. The framework for this taxonomy is preferences for treatment, preferences for care, and priorities for quality of life. The participating nursing home residents have uniformly requested Quality of Life Priorities to be added to preferences for Treatment and Care. Several residents have had experience in a Greenhouse Home (Research - Green House Project (thegreenhouseproject.org) which emphasizes quality of life.
A focus group of residents lead by Barbara Bowers, Chair, Advancing Excellence in Long Term Care Collaborative, produced a list of sixty items which represented ways in which nursing homes could improve the care of residents. Their comments fell into several domains including “Control of the Care Process” and “Role in Decision Making” which closely align with the preferences for care and treatment. However, most items were more closely related to QoL including Quality of Food, Quality of Life, Privacy, Personal Dignity and Respect, and Resident Assistance/Protection. These domains represent important aspects of nursing home life which reflect QoL rather than preferences for care or treatment.
Quality of Life Priorities are particularly important for nursing home residents, but also for anyone living in situations where quality of life choices are constrained, and if addressed, would significantly change their care and treatment. It is probably fair to say that for any of us, quality of life choices impact our choices for care and treatment. There are approximately 1.2 million nursing home residents in the US, however, this data element is relevant to a much larger population.
One of the Moving Forward committees has analyzed 4500 anonymous advance directive records made available by ADVault. Text comments from these records in response to questions such as “what gives you joy?, “What makes you smile?” were analyzed using Natural Language Processing and resulted in 17 categories of responses all of which addressed QoL issues. This is further indication of the importance of QoL issues for the general public
The PACIO Project has recently launched a new workgroup to establish a standardized data set for Long-Term and Post-Acute Care Transitions of Care. Standardized GPPs will be an essential part of the data required at transfer and will be based on QoL Priorities and Preferences for Care and Treatment.
Finally, it should be noted that CMS has collected QoL data as part of MDS (Section F800) for years. These items have associated LOINC codes:
A Choosing clothes to wear
B Caring for personal belongings
C Receiving tub bath
D Receiving shower
E Receiving bed bath
F Receiving sponge bath
G Snacks between meals
H Staying up past 8:00 p.m.
I Family or significant other involvement in care discussions
J Use of phone in private
K Place to lock personal belongings
L Reading books, newspapers, or magazines
M Listening to music
N Being around animals such as pets
O Keeping up with the news
P Doing things with groups of people
Q Participating in favorite activities
R Spending time away from the nursing home
S Spending time outdoors
T Participating in religious activities or practice
Quality of Life Priorities are important, widely applicable, and collected as part of long-established assessments. Advancing Quality of Life Priorities to USCDI V5 would represent a significant advance in person centered care.
Submitted by Karen_Hagerty on 2023-09-20
ASCO Comments
Please see attached for comments from the American Society of Clinical Oncology.
Submitted by Solarf3050 on 2023-09-20
HL7 Comments on USCDI Version 5
Please see attached Health Level Seven (HL7) International's comments on ONC’s Draft United States Core Data for Interoperability (USCDI) Version 5 and related data classes standards and elements.
Submitted by Guntepe1 on 2023-09-20
USCDIv5 Comments
USCDIv5 Comments
Federal Electronic Health Record Modernization (FEHRM)
Mr. Charles Gabrial
On behalf of the Federal Electronic Health Modernization (FERHM), I am writing in response to ONC's request for comments on USCDIv5. We appreciate ONC's continued efforts to reach out to the military to gain unique unique perspectives and to facilitate progress toward standardizing data elements in pursuit of enhanced interoperability. Please see our comments below.
Exposures:
The FEHRM continues to advocate for the addition of "Exposures" as a new data class within the USCDI. The VA and DoD represent millions of veterans, service members and beneficiaries and the VA/DOD/FERHM recently requested SNOMED codes for commonly occurring exposures. Honoring our PACT Act (PACT Act 2022) was passed by Congress and required the collection and reporting of data on Service Member Exposure of hazardous substances. In response to the law, DoD/VA/FEHRM is developing systems to capture relevant data elements for treatment and reporting purposes. The FEHRM has received approval for new codes from SNOMED that correspond to the Level 2 Exposure data elements. The newly approved HL7 Toxic Exposure Project will develop a list of standards data elements for exposure, and we want you to be aware of the group through the Exposure comments.
Care Team Location/Care Team Member
The definition of Care Team Location which is "Place where care is delivered by a care team member". Also, the definition of a care team member is: Information on a person who participates or is expected to participate in the care of a patient. If the care team member includes family members and/or a personal representative, then the definition requires changing since there could be a care team member who is not involved in care delivery and serves solely in the role of care coordination/contact.
Provenance: Author
The FEHRM supports the addition of the author data element to Provenance data class. AI generated content should be attributed to an individual within the organization.
Laboratory Values/Results Documented
Findings of a tested specimen including structured and unstructured components.
a. APPLICABLE VOCABULARY STANDARD(S) lists SNOMED, making it required, which does not take into account numeric or text results. Not all lab values are encoded.
b. The FEHRM suggests the addition of “specimen collection datetime” to the list, as this is the observation date/time for the test.
Care Team Member Location
Place where care is delivered by a care team member.
a. Please consider the use of the CDC’s National Healthcare Safety Network check-digited location codes for the Healthcare Acquired Infections reporting in HL7.
b. The CDC and National Health Care Safety Network (NHSN) codes could also be used at Encounter Location Place where a patient’s care is delivered.
Submitted by fiehnr on 2023-09-20
American Dental Association Comments on USCDI v 5
Attached please see the American Dental Association's comments on ONC's USCDI v5. We appreciate the opportunity to comment.
Submitted by NCQA on 2023-09-20
NCQA Recommendations for USCDI v5
The National Committee for Quality Assurance (NCQA) thanks ONC for the opportunity to provide recommendations for USCDI version 5.
NCQA is a private, 501(c)(3) not-for-profit, independent organization dedicated to improving health care quality through our Accreditation and measurement programs. We are a national leader in quality oversight and a pioneer in quality measurement. Leveraging our strengths as a trusted third party, we are committed to helping organizations navigate the challenges associated with moving toward an equitable health care system. Our mission to improve the quality of health for all Americans, with a focus on health equity and support for meaningful value-based payment models, propels our daily work.
NCQA is pleased to provide the following recommendations for USCDI version 5, outlined below and detailed on each Data Class-specific ONDEC page.
Recommend adding the following elements to USCDI:
- Health Insurance Information: Coverage Period
- Referrals: Referral Code, Referral Category, reclassify Reason for Referral
- Health Status Assessment: Pain Assessment
- Health Status Assessment: Depression Screening
- Context-Specified Sex Parameter for Clinical Use elements
- Provenance: Signature
- Patient Demographics/Information: Pronouns
Recommend modifications to the following existing elements:
- Health Insurance Information: Coverage Type
- Health Status Assessment: Smoking Status
- Diagnostic Imaging: Diagnostic Imaging Test
- Vital Signs: Average Blood Pressure
Thank you again for the opportunity to comment. We remain committed to improving the nation’s health care system and look forward to continued collaboration on USCDI and USCDI+ Quality.
Submitted by Robert Hussey on 2023-09-20
Comments from Wolters Kluwer
Attached are comments from Wolters Kluwer on USCDI version 5. Thanks for allowing us to provide this preliminary feedback.
WK Comments to ONC on USCDI Version 5 September 2023 Final.pdf
Submitted by brianscarpelli on 2023-09-21
Comments of the Connected Health Initiative
See attached for comments of the Connected Health Initiative.
CHI Comments re v5 USCDI (20 Sept 2023).pdf