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

With the publication of USCDI v3, ONC is accepting submissions for new data elements through the ONDEC system and comments on existing data elements until September 30, 2022. ONC plans on releasing Draft USCDI v4 in January 2023.

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.

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.

Condition, diagnosis, or reason for seeking medical attention.

Activity performed for or on a patient as part of the provision of care.

Metadata, or data that describes other data.

Representing a patient’s smoking behavior.

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. (e.g., electrocardiogram (ECG), visual acuity exam, macular exam, or graded exercise testing (GXT))

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.

Condition, diagnosis, or reason for seeking medical attention.

Activity performed for or on a patient as part of the provision of care.

Metadata, or data that describes other data.

Representing a patient’s smoking behavior.

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. (e.g., electrocardiogram (ECG), visual acuity exam, macular exam, or graded exercise testing (GXT))

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.

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.

Condition, diagnosis, or reason for seeking medical attention.

Activity performed for or on a patient as part of the provision of care.

Metadata, or data that describes other data.

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. Data elements listed below with the new data element indicate these data elements were added to recently released Draft USCDI v3. ONC is accepting public feedback on these new data elements until April 30, 2022.

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.

Information on a person who participates or is expected to participate in the care of a patient.

Data related to an individual’s insurance coverage for health care.

Condition, diagnosis, or reason for seeking medical attention.

Activity performed for or on a patient as part of the provision of care.

Metadata, or data that describes other data.

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

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.

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.

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.

Metadata, or data that describes other data.

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

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.

Comment

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.

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.

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. (e.g., electrocardiogram (ECG), visual acuity exam, macular exam, or graded exercise testing (GXT))

Tests that result in visual images requiring interpretation by a credentialed professional.

Desired state to be achieved by a patient.

Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.

Condition, diagnosis, or reason for seeking medical attention.

Activity performed for or on a patient as part of the provision of care.

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

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.

Comment

Advance Directives data class at Level 2, but missing from page

The Advance Directives data class is at Level 2, but is missing from the Level 2 USCDI page.  It appears on the Level 1 USCDI Page with data elements that are at Level 1, and there the Advance Directives data class is clearly labeled as being at Level 2.  This is confusing.     Recommendation: Update the Level 2 page to include an empty box (no Advance Directives data elements at Level 2), but shows that the data class itself is at Level 2.

DREDF Comments on USCDI v3

Please see attached the comments of Disability Rights Education and Defense Fund (DREDF) on USCDI v3.   Thank you, Silvia Yee

DREDF Comments_USCDI v3_4-30-22_0.docx

This field is for general…

This field is for general comments on the USCDI. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC

DREDF Comments_USCDI v3_4-30-22.docx

HL7 Patient Empowerment PCD feedback on USCDI v3 and provenance

USCDI consists of categories of data elements representing information captured from different systems as well as by individuals. However, attribution of information created or supplied by an individual, as a patient or other role, is not reflected within the Provenance data class in the latest USCDI draft version 3 consisting of the following two (2) data elements: Author Time Stamp and Author Organization. We suggest at minimum the Author data element classified as Level 2 be added to USCDI v3.    In addition to USCDI v3 Provenance not specifying Author, the data class is not fully inclusive of information created outside an organization (or changes to information such as updates). To better understand the origin and changes to data that can occur with or without exchange, and improve Provenance with context that identifies the type of actor or system creating or updating data, we recommend two (2) additional data elements: 
  1. Author Role to clarify the type of actor, such as patient, especially where information is contributed by individuals. Author should also accommodate device-generated data such as wearables. 
  2. Updates to understand whether data has changed either from the point of creation or in exchange
  We also suggest ONC reframe Author Organization to be location-agnostic or account for environments outside an organization which may include a personal device or system.   COVID-19 pushed care delivery outside organizations with a boom of consumer-facing technologies to enable remote care and support emergent public health priorities. The pandemic also highlighted the need to understand factors outside of healthcare settings that have a large effect on health status (and outcomes). However, the current USCDI does not explicitly represent health and other data that might be contributed by individuals outside health care organizations, in spite of introducing new data classes and elements often dependent on individual/patient input. Several current or potential future data clases contain elements often asserted or informed by the patient including (but not limited to):   
  • Demographics (include identity, race and ethnicity, sexual orientation and gender identity, and other data)
  • Health Insurance Information
  • Goals (Patient and SDOH)
  • Problems (includes SDOH Problems/Health Concerns and dates from diagnosis and resolution)
  • Health Status (Includes Health Concerns, Functional Status, Disability Status, Mental Function, and Smoking Status)
  • Clinical Tests (currently only reflects those performed in lab though perhaps could be expanded to include self-administered at-home tests)
  • Observations
  • Assessments and Plan of Treatment (includes SDOH assessment)
  • Advance Directives (not in USCDI v3)
  • Vital signs (e.g. where capture from remote sensing devices)
  We see patient contributed data which is person-generated or self-reported as equivalent to clinical and administrative data recorded by health care professionals or systems. Therefore supporting provenance that captures the most granular metadata associated with data creation in USCDI is foundational for all information contributed by patients to be recognized and trusted.    As ONC continues to prioritize health equity and patient engagement, the importance of data provenance will only increase as USCDI evolves and information used to identify, assess, treat, coordinate, and measure care increasingly relies on patient generated or contributed information. Updating the USCDI to ensure instances where data originate or are reported by individuals are appropriately attributed is a first step in ensuring PCD is recognized, represented, and leveraged to improve patient engagement, promote equity, and support broader national health care and interoperability goals.   Thank you for considering HL7 Patient Contributed Data (PCD) Committee (Sub-Workgroup of the HL7 Patient Empowerment Workgroup) comments in finalizing the USCDI v3.  

American Occupational Therapy Association's Comment on USCDI v3

The American Occupational Therapy Association (AOTA) appreciates the opportunity to comment on draft version 3 of the US Core Data for Interoperability (USCDI). AOTA is the national professional association representing the interests of more than 220,000 occupational therapists, students of occupational therapy (OT), and occupational therapy assistants. Occupational therapy defines “occupations” as any meaningful or purposeful activity, which can describe activities of daily living (ADLs), instrumental activities of daily living (IADLs), work, school, hobbies, and social participation. The practice of occupational therapy is person-centered, evidence-based, and enables people of all ages to live life to its fullest by promoting health and purposeful activity. AOTA believes that understanding a person’s whole health, including function, environment, and context is crucial.  AOTA is pleased to see the addition of Health Status as a data class. We support the inclusion of health concerns, functional status, disability status, mental function, pregnancy status, and smoking status as key components of health status. AOTA encourages these items to also be aligned with social determinants of health as these factors can have a significant impact on an individual’s status.  We also support the utilization of the International Classification of Function (ICF) when establishing a framework for health data exchange in regards to function, cognition, and mobility. The Occupational Therapy Practice Framework: Domain and Process –4th edition (OTPF4) was developed based on concepts and terminology from the ICF in an effort to promote standardized interdisciplinary communication.     Please see attached for full comments from AOTA

2022 USCID Final Comments.pdf

Comments on USCDI v3

Please see attached comments from the American Medical Informatics Association.

USCDIv3 final submitted GPJ.pdf

Legal Action Center's comments on USCDI v. 3

The Legal Action Center (“LAC”) is the only non-profit law and policy organization in the United States whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, and to advocate for sound public policies in these areas. LAC appreciates the opportunity to submit the attached comments on the ONC’s draft United States Core Data for Interoperability, Version 3. 

USCDI v3 - LAC comments - 4-30-2022 submission.pdf

Phreesia comments on USCDI v3

Thank you for the opportunity to provide comments on the USCDI Draft v3. Please see comments from Phreesia attached.

Phreesia Comments on ONC USCDI v3_vF_0.pdf

NASL Comments on USCDI v3

The National Association for the Support of Long Term Care (NASL) is pleased to offer our attached comments on the Draft USCDI v3. NASL is a national trade association representing providers of ancillary care and services operating in the long term and post-acute care (LTPAC) sector, to include the health IT developers/vendors who serve the majority of LTPAC providers. NASL and its members welcome the opportunity to work with ONC in further developing and expanding the standardized set of health data classes and data elements contained in the USCDI.

NASL Comments USCDI v3 FINAL 043022_0.pdf

OCHIN Comments on USCDI Draft Version 3 and Process

Thank you for the opportunity to provide comments on USCDI Draft Version 3.  Please see OCHIN's full comment letter included. Thank you. 

OCHIN comments on USCDI V3.pdf