United States Core Data for Interoperability (USCDI)

How should ONDEC submitters flag Required vs Preferred?

Submissions will be going to USCDI ONDEC system: https://healthit.gov/ONDEC How does HHS ONC recommend submitters flag existing FHIR fields for elements, e.g. clinicalStatus for Allergy Intolerance, as recommending a field to be required, rather than preferred? For this Example, see AllergyIntolerance resource and FHIR, and FHIR coding for clinicalStatus: https://www.hl7.org/fhir/allergyintolerance.html http://hl7.org/fhir/R4/valueset-allergyintolerance-clinical.html In this example, active = Active, inactive = Inactive, resolved = Resolved. For example, clinically, a significant number of patient labelled as 'penicillin allergic' are not truly allergic to the drug.  As a result, these antibiotics can be withheld unnecessarily.  (ref: https://www.pharmaceutical-journal.com/learning/learning-article/penicillin-allergy-identification-and-management/20069170.article ) Thank you. Henry Wei MD Google

USCDI to FHIR Resource Mapping Guide

Hi. Will there be a data spec/map be published to show how data elements are mapped to FHIR resources? 

Proposal for precise modeling of entities in the USCDI

The USCDI V1 is a landmark specification of core clinical data for nationwide exchange. Recognizing USCDI's significant promise for directing future interoperability efforts, we seek to improve its foundation for continued expansion. In particular, we believe that improving the clarity of USCDI entity definitions (e.g. Data Class, Data Element) are necessary for the industry to interpret them consistently. We seek to add precision to their specifications to enable a principled approach for users to understand, implement, extend, and refine them with future submissions for new USCDI content. To that end, we submit these recommendations, which includes a proposed model that is described in the accompanying appendix.

Proposal for precise modeling of entities in the U.S. Core Data for Interoperability - Version 1.0.pdf

UCSF Center for Digital Health Innovation's Comment on USCDI

Dear Dr. Rucker: The University of California, San Francisco’s Center for Digital Health Innovation provides the attached comments on new data classes and elements for version 2 of the U.S. Core Data for Interoperability.  We appreciate the considerable work that ONC has devoted to the Common Clinical Data Set (CCDS) and its next evolution, the U.S. Core Data for Interoperability version 1.  Version 1, however, was only a “modest expansion” of the Common Clinical Data Set.   As a health care provider, we urge ONC to add numerous additional data elements now so that they, too, become available for better health care, for key national use cases such as COVID-19 and virtual care, and for the nationwide learning health system we need.  According to ONC, technical specifications are already available for 46 of 50 data classes ONC listed for candidate and emerging status, and all 50 are “critical to achieving nationwide interoperability.” To illustrate the importance of adding the missing data elements now, we tested them against two COVID-19 use cases and asked which missing structured data elements are necessary or important now for health care in the midst of the COVID-19 pandemic.  Not surprisingly, most were necessary or important. If you or your staff have any thoughts or questions about these comments, please feel free to contact me at Mark.Savage@ucsf.edu. Yours truly,   Mark Savage   Mark Savage Director, Health Policy Center for Digital Health Innovation University of California, San Francisco   E. Mark.Savage@ucsf.edu C. 415.225.1676 W. www.CenterforDigitalHealthInnovation.org

Support for the Gravity Project's submission on SDOH

Please see the attached letter for Providence St. Joseph Health's support to the Gravity Project's submission for two approaches for including social determinants of health data in the USCDI.

PSJH Gravity support USCDI 10-23-20.pdf

NYeC Support for Gravity Project Submission

The New York eHealth Collaborative (NYeC) supports the inclusion of key social determinants of health (SDOH) data elements as submitted by the Gravity Project in the U.S. Core Data for Interoperability (USCDI) Version 2. New York State has been a leader in requiring interventions and data collection to address SDOH in Value-Based Payment as part of the Medicaid program, which underscores the importance of this work. The Gravity Project’s submissions would add critical domains such as food insecurity, housing instability, transportation insecurity, social isolation, and stress to the USCDI, integrated with core clinical activities such as assessments, diagnoses, interventions, and outcomes. Widespread capturing of standardized SDOH data is critical to understanding and addressing health disparities and improving health outcomes for individuals and communities.

Highmark Health Letter of Support for Gravity Project Submission

This letter is written in support of The Gravity Project’s submission to the Office of the National Coordinator to advocate for the inclusion of Social Determinants of Health (SDOH) in the U.S. Core Data for Interoperability.   As one of the nation’s largest integrated healthcare delivery systems, Highmark Health believes this integration is critical to improve the health and well-being of those we serve.    Public health professionals have long known that social and environmental determinants of health explain most of a person’s and population’s health status.  The health care delivery sector is now understanding that the delivery of traditional health care accounts for only 20% of one’s health.  The COVID-19 pandemic has highlighted this reality daily across the nation.  The Gravity Project’s submissions would add critical domains such as food insecurity, housing instability, transportation insecurity, social isolation, and stress to the USCDI, integrated with core clinical activities such as assessments, diagnoses, interventions, and outcomes.  The need for inclusion of SDOH as a new data class in USCDI is a requisite to capturing social risk and supports a focus on and prioritization of use cases with a high impact on the triple aim, the widely accepted policy objective of HHS that refers to improving the experience of care, improving the health of populations, and reducing per capita costs of health care.  The fact that SDOH accounts for 80 percent of health status at a population level and that there is no consistent method to document and communicate these factors during a health care encounter emphasizes the urgency of a national standard approach across the health care system.  The implementation of these standards is necessary to drive reductions in missed appointments, cost savings from preventable health events, culturally competent care, increased care plan compliance, reduced administrative burden, promoting effective investment in community health programs, and leveraging critical data to improve patient outcomes. Health care’s transition from a fee-for-service model to value-based care adds an additional imperative for SDOH, since these elements will become increasingly necessary to establish appropriate and equitable reimbursement of health care service providers and advance reimbursement models for community based organizations.  Without standards and code sets, health plans will be challenged to evolve their value based reimbursement programs to include social risk. Please accept this recommendation on behalf of Highmark, for The Gravity Project’s submission to the USCDI.  Should you have any questions or need additional insight please don’t hesitate to contact me at (412) 721-6800 or via email at Deborah.donovan@highmarkhealth.org.

Letter of support 12 4 20 DJD Highmark Health. FINAL.pdf

Division of Vital Statistics Support for Death and Birth items

The Division of Vital Statistics (DVS) within CDC’s National Center for Health Statistics (NCHS) supports inclusion of submitted mortality and natality data elements into USCDIv2.  The mortality data elements include Cause of Death Information, Autopsy Performed, and Date and Time pronounced dead.  These mortality data elements requested not only support multiple public health use cases, but they also support the clinical information reported on death certificates. This will inform mortality reporting about public health challenges, determine life expectancy and compare death trends with other countries. The natality data elements include Clinical Notes for Newborn, Pregnancy History, Apgar Score, Estimated Date of Delivery, Gestational Age at Birth, Last Menstrual Period (LMP), Number of Fetal Deaths This Delivery, and Patient Birth Place. Currently there are natality elements that have progressed to level 2, and to compliment the reporting of natality holistically are a reason these Comment Level items should also be included within the Level 2 inclusion.  These data elements track health trends that includes pregnancy risk factors and preterm births. The inclusion of these elements in USCDIv2 would have a significant impact on mortality and natality reporting by reducing the burden of duplicative data entry and streamlining the process flow.  The primary objective is to improve the timeliness, quality, and sustainability of vital statistics reporting.  The inclusion of these elements would not only support national level reporting but also benefit State partners who are the first line of receiving these data and clinical providers who are on the first line of sending these data. DVS has been working with State partners and their electronic registration systems as part of modernization efforts. Inclusion of these elements would support interoperability among the vital statistics ecosystem.  DVS and State partners have been focusing working towards using the HL7 FHIR standards that adhere to the US Core resources within their implementation guides when possible.