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
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.
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.
Draft USCDI V5
Draft USCDI v5 includes 13 new data elements and two new data classes. Please reference the Draft USCDI v5 standard document and the Standards Bulletin 2024-1 for details. ONC is accepting feedback on the proposed new data elements on the Draft USCDI v5 website until Monday, April 15, 2024 at 11:59 p.m. ET. Feedback will be considered as ONC develops the final version of USCDI v5, which we anticipate publishing in July 2024.
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.
Findings or other clinical data collected about a patient during care.
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.
Findings or other clinical data collected about a patient during care.
Provider-authored directive for the delivery of patient care services.
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.
Findings or other clinical data collected about a patient during care.
Provider-authored directive for the delivery of patient care services.
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 jfrench@himss.org on
HIMSS on USCDI v5 / Inclusion of Maternal SDOH Note
Dear Dr. Tripathi:
On behalf of the Healthcare Information and Management Systems Society (HIMSS), we are pleased to provide public comments on the United States Core Data for Interoperability Draft Version 5 release.
HIMSS is a global advisor and thought leader and member-based society committed to reforming the global health ecosystem through the power of information and technology. As a mission-driven non-profit, HIMSS offers a unique depth and breadth of expertise in health innovation, public policy, workforce development, research, and analytics to advise global leaders, stakeholders, and influencers on best practices in health information and technology driven by health equity. Through our innovation engine, HIMSS delivers key insights, education and engaging events to healthcare providers, governments, and market suppliers, ensuring they have the right information at the point of decision. HIMSS serves the global health information and technology communities with focused operations across North America, Europe, the United Kingdom, the Middle East, and Asia Pacific. Our members include more than 125,000 individuals, 480 provider organizations, 470 non-profit partners, and 650 health services organizations. Our global headquarters is in Rotterdam, The Netherlands and our Americas headquarters is in Chicago, Illinois.
HIMSS supports regulatory frameworks that facilitate the seamless, secure, and ubiquitous data access and interoperable health information exchange to ensure the right people have the right access to the right health information in a usable format at the right time. Such a framework facilitates that all stakeholders, including patients, caregivers, and healthcare providers can find, store, use, reuse, send, and receive electronic health information in a manner that is appropriate, secure, timely and reliable to support health and wellness efforts for individual patients and population health. HIMSS believes the proposed USCDI v5 data elements will help to achieve the goals of interoperable health information exchange.
Clinical Data Notes: Inclusion of Maternal Social Determinants of Health Note
To address ONC’s priority for health data needs for providing equitable care for underserved communities, HIMSS recommends ONC add the Maternal Social Determinants of Health Note data element to the Clinical Notes data class as part of the USCDI v5 data element package.
Existing clinical notes do not specify data needs, specifically capturing critical information related to maternal health to support safe and effective maternal and child health. The US maternal mortality rate is the highest of any developed nation with African American and Alaskan Native/Indigenous American women more likely to die from pregnancy related causes. Inclusion of “Maternal Social Determinants of Health Note” as a data element under the Clinical Notes data class in USCDI v5 aligns with ONC's priority to advance health data needs for providing equitable care to underserved communities while addressing a national crisis. Inclusion of this data element supports the White House's Blueprint for Addressing the Maternal Health Crisis by ensuring intentional capture of data essential information to support maternal and child health. This supports several bipartisan bills under the Black Maternal Health Momibus Act.
In addition, HIMSS recommends ONC explore the presentation of data elements in USCDI specific to maternal health considering the high priority of addressing maternal mortality. This exploration could focus on the development of a new data class (e.g. maternal and newborn health) to identify and/or display the data elements in USCDI that are essential for maternal and newborn care.
HIMSS recognizes that maternal health data is highly sensitive, particularly in the current political climate. HIMSS believes it is critical to protect the confidentiality, integrity, and availability of patient information and other sensitive information and assets of stakeholders while ensuring the continued and effective delivery of patient care and coordination of care. Without appropriate privacy mechanisms, sensitive data elements could trigger unwarranted engagement with other entities.
To facilitate the inclusion of these maternal health data elements, ONC policy must identify a method to ensure the safe exchange of potentially sensitive personal health information in a manner compliant with HIPAA, using a rule based, standardized approach that eliminates manual and costly data segmentation exercises.
HIMSS recommends ONC convene the industry through connectathons and other consensus driven methods to develop prioritized use cases, and a rules-based method for segmenting data to ensure patient privacy while minimizing the costly burden manual data segmentation of patients requesting restrictions places on the industry
Immunization Lot Numbers
HIMSS supports the inclusion of vaccine lot number as part of USCDI v5. A sizable number of immunization errors and data rejections result from inaccurate and/or incomplete HL7 messages generated by electronic health records and submitted to jurisdictional immunization information systems (IIS). While not the most frequent cause for errors and rejections, consistent inclusion of lot numbers for administered doses would improve accuracy and completeness. We would encourage clarification, however, that lot numbers would not necessarily be expected for historical dose reporting. In addition to lot number, we strongly encourage the inclusion of vaccine administration date, vaccine event record type, patient identifier (MRN and other IDs), and mother’s maiden name – these are all level 2 data elements which further support immunization data quality. Incorporation of lot number and these additional data elements as USCDI national standards could encourage states and other jurisdictions to initiate work to align with national standards for successful data submission.
Timeline to Implement USDCI v5 requirements.
HIMSS received a clear message from our membership following the release of HTI-1 that a timeline of less than two years from the date of finalizing the requirement for certification is unreasonable for implementing a new version of USCDI. Extensive work is required to implement and test these certification changes across the healthcare ecosystem, while ensuring quality, safety, and patient privacy are not compromised.
HIMSS strongly recommends that the implementation deadline for USCDI v5 should be two years following the publication of these changes in a final rulemaking. This will allow providers and health systems to incorporate any required process changes into their daily workflows to ensure that quality, safety, and patient privacy are not negatively impacted in their organization. A two-year timeline also facilitates appropriate levels of vendor support, so critical access hospitals, federally qualified health centers, and other organizations which care for underserved communities do not get left behind.
We look forward to discussing these issues in more depth. Please feel free to contact Jonathan French, Senior Director of Public Policy and Content Development, at Jonathan.French@HIMSS.org with questions or to request more information.
Submitted by mmoen48 on
MyDirectives Comments on USCDI Draft 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 this version 5 of USCDI and those items that will enable individuals to express the most impactful and personally important aspects of their healthcare experience, by ensuring systems make those expressed values and preferences for their healthcare journey available across care settings, MyDirectives strongly recommends that our suggestions related to the following health data classes and constituent data elements, including clarifications to their naming convention, be considered.
Submitted by ktenoever on
USCDI v5
The Federation of American Hospitals appreciates the opportunity to comment on the draft USCDI v5. Please see our attached comments.
Submitted by naomiggoldberg on
Comment from 10 Organizations Committed to LGBTQI+ Equity
Please see attached comments on USCDI v5 from 10 organizations committed to LGBTQI+ equity.
Submitted by BHT221 on
The Allegheny Health Network Comments on Draft USCDI v5
On behalf of the Allegheny Health Network (AHN), please see the attached comments.
Submitted by JAndress316 on
USCDI v5 CMS Public Comment
On behalf of The Centers for Medicare & Medicaid Services (CMS) and The Center for Clinical Standards and Quality (CCSQ), we submit the following comments on USCDI Draft version 5 (v5) for consideration. We recognize there are many needs and multiple perspectives that must be balanced by ONC and the USCDI Committee and thank ONC for the opportunity to contribute comments.
CMS continues to support the USCDI as the central mechanism in defining the foundational set of electronic health information for interoperable health exchange. This, in turn, defines what data patients have access to, and helps define what we are sharing across sites to support clinical care and best outcomes. CMS is committed to the digital transformation of its quality measurement programs. The USCDI, as well as the USCDI+, allows us to build on a foundational framework for this transition. Attached are our formal comments on USCDI draft v5.
Submitted by EmoryHealthcare on
Emory Healthcare's Comments on the Draft USCDI v5
Emory Healthcare is pleased to submit the attached letter and comments on the Draft USCDI v5 for consideration.
Submitted by mbkurilo@immre… on
AIRA Comments on USDCI Draft Version 5
Please see the attached comments on behalf of the members of the American Immunization Registry Association (AIRA), made up of over 100 organizations representing Public Health Immunization Information Systems (IIS), IIS implementers and vendors, non-profit organizations and partners. Thank you for the opportunity to share our perspectives.
Submitted by naomiggoldberg on
LGBTQ Equity Organizations Comment on Draft USCDI V5
Ten organizations focused on LGBTQI+ equity write in response to the request for public comment from the Office of the National Coordinator for Health Information Technology (ONC) on the Draft United States Core Data for Interoperability Version 5 (Draft USCDI v5).
Submitted by Robert Hussey on
Comments from Wolters Kluwer on USCDI v. 5
Attached please find comments from Wolters Kluwer on USCDI v.5. Thanks for allowing us to share our views.
WK Comments to ONC on USCDI Version 5 April 2024 Final.pdf