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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 various Data Elements by a common theme or use case.

A USCDI “Data Element” is the most granular level at which a piece of data is exchanged.

For example, Date of Birth is a Data Element rather than its component Day, Month, or Year, because Date of Birth is the unit of exchange.

USCDI ONC New Data Element & Class (ONDEC) Submission System

To view applicable standards supporting data elements, click the data element name below.

Allergies and Intolerance Allergies and Intolerances Represents harmful or undesirable physiological response associated with exposure to a substance.

Assessment and Plan of Treatment Assessment and Plan of Treatment Represents a health professional’s conclusions and working assumptions that will guide treatment of the patient.

Care Team Member(s) Care Team Member(s) The specific person(s) who participate or are expected to participate in the care team.

Clinical Notes Clinical Notes Composed of both structured (i.e. obtained via pick-list and/or check the box) and unstructured (free text) data. A clinical note may include the history, Review of Systems (ROS), physical data, assessment, diagnosis, plan of care and evaluation of plan, patient teaching and other relevant data points.

Goals Goals An expressed desired health state to be achieved by a subject of care (or family/group) over a period of time or at a specific point of time

Health Concerns Health Concerns 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.

Immunizations Immunizations Record of an administration of a vaccination or a record of a vaccination as reported by a patient, a clinician, or another party.

Laboratory Laboratory

Medication Medications

Patient Demographics Patient Demographics

Problems Problems Information about a condition, diagnosis, or other event, situation, issue, or clinical concept that is documented.

Procedures Procedures An activity that is performed with or on a patient as part of the provision of care.

Provenance Provenance The metadata, or extra information about data, that can help answer questions such as when and who created the data.

Smoking Status Smoking Status Classification of a patient’s smoking behavior.

Unique Device Identifier Unique Device Identifier(s) for a Patient’s Implantable Device(s) A unique numeric or alphanumeric code that consists of a device identifier (DI) and a production identifier (PI).

Vital Signs Vital Signs Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.

The USCDI V2 Draft will be prepared for public comment by early 2021. Level 2 data classes/elements will be considered for USCDI V2 Draft based on ONC assessment of a number of factors, including impacts for potential users, maturity of data and technical standards/implementation specifications, burden for implementation, etc.
In addition to “Comment” and “Level 1” criteria, Level 2 data elements demonstrate extensive existing use in systems and exchange between systems, and use cases that show significant value to current and potential users. These data elements would clearly improve nationwide interoperability. Any burdens or challenges would be reasonable to overcome relative to the overall impact of the data elements.

There are not yet any data classes with data elements assigned to this level.

In addition to “Comment” level criteria, Level 1 data elements demonstrate limited existing use in electronic systems, limited exchange between systems and more well-defined use cases and value to potential users. There may still be some burdens associated with development and implementation.

There are not yet any data classes with data elements assigned to this level.

A data element designated as "Comment" level is represented by health care standard terminology such as SNOMED CT® or implementation specifications such as HL7® FHIR® 4. It may not have a well-defined use case or value to potential users. There may be significant or unknown burdens associated with development or implementation.

Ophthalmic data

For data class description and applicable standards supporting data elements, click to view the USCDI Version 1 (July 2020 errata) in PDF format below. 

Click to View

Previous USCDI Versions

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.

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