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 about 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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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 about 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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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
Please read the USCDI v3 standard document and the ONC Standards Bulletin 22-2 for details. Consistent with EO 14168 and OPM guidance, ASTP/ONC is exercising enforcement and issuing certification guidance for the ONC Health IT Certification Program with respect to certain data elements in USCDI v3. For more information see https://www.healthit.gov/topic/uscdi-v3-data-elements-enforcement-discretion.
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 about 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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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 V3.1
Please read the USCDI v3.1 standard document and the ONC Standards Bulletin 22-2 for details. USCDI version 3.1 updates USCDI version 3 with the following changes: consistent with Executive Order 14168, the Sex, Sexual Orientation, and Gender Identity data elements have been removed or updated in the Patient Demographics/Information Data Class.
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 about 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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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 about 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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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.
Information that guides 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.
USCDI V5
USCDI v5 was published on July 16, 2024, and includes 16 new data elements and two new data classes. Please read the USCDI v5 standard document and the ONC Standards Bulletin 24-2 for details.
Harmful or undesired physiological responses associated with exposure to a substance.
Information about 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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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.
Provider-authored request for the delivery of patient care services.
Usage notes: Orders convey a provider’s intent to have a service performed on or for a patient, or to give instructions on future care.
Data used to categorize individuals for identification, records matching, and other purposes.
Information that guides 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.
USCDI V6
ASTP/ONC published USCDI v6 on July 24, 2025, which includes 6 new data elements. Please read the USCDI v6 Standard Document and the ASTP/ONC Standards Bulletin 25-2 for details. ASTP/ONC welcomes input on future versions during the USCDI feedback period, open through September 29, 2025, at 11:59 PM ET. During this time, ASTP/ONC is accepting new data element submissions through ONDEC, and comments on existing data elements may be entered via the updated commenting feature on the USCDI data element pages.
Harmful or undesired physiological responses associated with exposure to a substance.
Information that guides treatment of the patient and recommendations for future treatment.
Information about 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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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.
Family member health condition(s) that are relevant to a patient's care.
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.
Provider-authored request for the delivery of patient care services.
Usage notes: Orders convey a provider’s intent to have a service performed on or for a patient, or to give instructions on future care.
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.
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.
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.
Record of vaccine administration.
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.
Provider-authored request for the delivery of patient care services.
Usage notes: Orders convey a provider’s intent to have a service performed on or for a patient, or to give instructions on future care.
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.
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.
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- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
Physical place of available services or resources.
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
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 about 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.
-
- Usage note: Clinical Notes data elements are content exchange standard agnostic. They should not be interpreted or associated with the structured document templates that may share the same name.
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.
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 request for the delivery of patient care services.
Usage notes: Orders convey a provider’s intent to have a service performed on or for a patient, or to give instructions on future care.
Data used to categorize individuals for identification, records matching, and other purposes.
Information that guides 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.
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 Christina Deuschle on
Biologically Derived Product Data Elements in USCDI Version 5
Submission to Support the Biologically Derived Product Data Elements for Inclusion in the USCDI Version 5
Established to guide the efforts toward the development of a nationwide Red Blood Cell Patient Data Exchange (RBCAX), the RBCAX Working Group includes representatives from multiple federal agencies (NIH, FDA) and HHS OASH offices (OMH, OIDP), the Sickle Cell Disease Association of America, the Association for the Advancement of Blood & Biotherapies, the American Red Cross, the American Society of Hematology, patient representatives, and clinicians, among others.
The HHS-sponsored RBCAX Working Group strongly recommends that ONC consider the Biologically Derived Products (BPD) Data Class, currently in discussion under Level 2, in the USCDI version 5. The Working Group believes this information is critical to patient care and safety and furthers ONC’s prioritization of providing and promoting equitable care. Furthermore, it will allow for the eventual development of a nationwide red blood cell antibody patient data exchange, a greatly needed mechanism for preventing avoidable hemolytic transfusion reactions.
Accurate blood transfusion and historical blood bank laboratory testing information is essential to safely provide care to previously transfused or pregnant patients. People living with sickle cell disease and thalassemia, along with people experiencing childbirth complications requiring blood transfusion represent diverse communities, but disproportionately include historically underserved populations in the United States. The inclusion of the BDP Data Class would enable healthcare providers to better identify and track patients' transfusion histories, thereby supporting efforts to address existing health disparities among frequently transfused patient populations. Moreover, integrating the BDP data class into interoperability requirements aligns with the ONC Health IT Standards Bulletin of January 2024, including the provision of equitable care to underserved communities, by improving care to populations most impacted by blood disorders that require transfusions (https://www.healthit.gov/sites/default/files/page/2024-01/Standards_Bulletin_2024-1.pdf).
Background
Recognition of the need for red blood cell (RBC) antibody patient data exchanges in the United States and internationally has grown in recent decades, as such systems can be used to capture and track data associated with patient transfusion histories, including adverse reactions, alloantibodies, antigens, and special transfusion requirements. The RBC antibody patient data exchange was chosen by the HHS Secretary’s “Challenge on Equity Award,” one of 24 projects selected to advance equity in programs, policies, and processes across HHS. In its second stage, this project is steadily progressing toward the development of an RBCAX pilot plan.
Currently, patient transfusion histories are often inaccessible to providers because they exist in disconnected hospital systems and blood bank registries. This limitation reduces the ability of providers to prevent incompatible transfusions and Delayed Hemolytic Transfusion Reactions (DHTRs), especially for patients who seek transfusion treatment from multiple healthcare facilities or systems. Although patients are screened for antibodies at regular intervals before routine transfusions, previously produced antibodies can evanesce (i.e., disappear over time), making them impossible to detect during screening. Individuals with diseases or conditions that require frequent transfusions are at increased risk for antibody formation and hemolytic transfusion reactions. For example, people living with SCD often require multiple transfusions, and this has resulted in high RBC alloimmunization prevalence rates and higher RBC antibody evanescence rates in this population when compared to others who receive frequent transfusions (Harm et al., 2014; Hendrickson, 2020). Additionally, patients with SCD may need to receive transfusions from multiple hospitals, putting them at higher risks for adverse events. Without standardized accessible patient information, the risk of selecting blood for transfusion that contains antigens against which a patient has historical antibodies against increases, putting patient lives at avoidable risk.
The establishment of a national RBCAX that provides access to real-time transfused patient data is a critical step in preventing adverse patient outcomes and improving equitable access to care. The RBCAX Working Group has determined that the first step to establishing an RBCAX is to integrate standardized RBC antibody information into existing electronic health record (EHR) systems. To accomplish this integration, data must be interoperable. Currently, not all RBC essential data are included in the United States Core Data for Interoperability (USCDI). Consequently, the data are not reflected in the diagnostic codes and data elements used in EHRs. Embedding these data elements into EHR systems is key to the establishment of an RBCAX and requires support and collaboration from agencies, industry, and institutional bodies to define and standardize patient antibody data and build interoperability across hospitals, blood banks, and laboratories. Appropriate changes to the USCDI can support this work, by providing the infrastructure to exchange patient RBC antibody data across hospitals, thus furthering the goal of establishing a national RBCAX.
RBCAX Working Group
Members of the group include representatives from several federal agencies (FDA, NIH) office of the secretary (ONC), and HHS OASH offices (OMH, OWH, OIDP), patient representatives, clinicians, and representatives from EHR vendors. The information provided in the current comment has been endorsed by RBCAX Working Group members, in support of the development of a national RBCAX. Please see table in the attached document for the full working group.
Submitted by MaryShahMLS on
General comments on SOGI v5
Provide an overview of your healthcare facility/system, your patient demographics (including SOGI if possible), and the SOGI data you collect
Nuvance Health is a regional health system comprised of hospitals, medical practices, care centers and telehealth care located throughout New York’s Hudson Valley and Western Connecticut. We have seven campuses with 1433 licensed beds and over 110 outpatient facilities that employ over 1,300 physicians and almost 14,000 people. We serve over 1.2 million and provided $96 million in charity care last fiscal year.
Collecting and using SOGI data is important—improve quality of care, provide culturally responsive care:
• An Important aspect of a patient’s identity, life & well-being
• Honest communication and trust between patient and provider are essential for satisfaction and outcomes
• Conveys cultural responsiveness, that a practice values SGM patients
• SOGI also relates to a patient’s family structure, support system
• Part of a patient-centered approach to care for SGM patients
• Can inform therapeutic and preventive services and screenings
Collecting pronouns and name to use will improve care for gender diverse patients:
• SOGI correlates with health disparities in disease burden, risk behaviors, access to care, insurance coverage i.e.: sexual minority women, nulliparity, and cancer
• SGM disparities in diabetes, cardiovascular disease; SUD, tobacco use
• Collecting SOGI data a first step toward understanding, addressing, eliminating disparities
• SDOH affect SGM people in particular ways, especially POC and transgender people
• SGM people experience widespread social discrimination, which has negative effects on physical and mental health, causes people to avoid or delay seeking health care
In addressing people in the way that they want to be named, it is a step toward addressing past disparities as well as working to practicing person-centered healthcare for all of our colleagues and the communities we serve.
Be well and keep safe,
Mary Shah
Mary Shah, MLS AHIP
Medical Librarian & Archivist
Medical Library/Norwalk Hospital
pronouns: she/her/hers
Submitted by sburnham01 on
Hartford Healthcare Comments on Draft USCDI v
On behalf of Hartford Healthcare, please see the attached comments.
Submitted by cmedina on
Comments on Draft USCDI Version 5
Please see attached for public comments on Draft USCDI v5 submitted by Whitman-Walker Institute, The Fenway Institute, and other healthcare partners. Thank you for your consideration.
Submitted by nussteja on
duplicate - disregard
duplicate - disregard
Submitted by nussteja on
FAST Digital Identity Comments on USCDI v5
Please see attached document to view comments from the FAST Digital Identity Workgroup
Submitted by alec-matulka on
Epic's Comments on the Draft USCDI v5
Please see the attached document with Epic's feedback on the Draft USCDI v5. Thank you for your consideration.
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.
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.
Help
1. Optional: Background Text / Cover Letter
The "Optional Background Text / Cover Letter" field provides space for additional context or introductory information related to your comment.
If you wish to provide context, explanation, or an introduction to your comment, enter this information in the field labeled "Optional Background Text / Cover Letter." This is entirely optional and is most useful when submitting multiple related comments or when additional background would help reviewers understand your feedback.
If you are only commenting on a single data class or element, you may leave this field blank.
2. Select the Data Class
To specify which data class your comment addresses:
- In the "Data Class" drop-down menu, select the appropriate data class you want to comment on.
- If you are providing a general comment that is not specific to a data element, select "General" from the options. Comments with this designation will be displayed on the USCDI landing page.
- Note that the Data Class field will automatically populate based on your current location in the platform:
- If you are on a data class page, the field will be set to that specific data class
- If you are on a data element page, the corresponding data class will be pre-selected
3. Select the Data Element
To specify which data element your comment addresses:
- In the "Data Element" drop-down menu, select the specific data element you want to comment on.
- The drop-down menu will display only the elements available under the data class you selected in the previous step.
- You can use the search function within the drop-down to quickly locate a specific data element.
- If you are commenting on the data class itself rather than a specific element, you may leave this field blank.
Note: Comments on a specific data element will appear on the respective data element page, while comments on a data class (without a specific element selected) will appear on the landing page for that data class.
Fig 1 The "Data Class" and "Data Element" dropdown menus allow users to specify the exact content they wish to comment on.
4. Optional: Propose New Data Class or Element
If you cannot find the appropriate data class or element for your comment:
- Instead of clicking the "Comment On An Existing Data Class Or Element" button, click the adjacent button labeled "Propose a New Data Class or Data Element."
- This will redirect you to the ONDEC (ONC New Data Element and Class) Submission System.
- In the ONDEC system, follow the provided instructions to submit your proposal for a new data class or element.
- Once your proposal is submitted through ONDEC, it will be reviewed separately from the commenting process.
Fig 2 The "Propose a New Data Class or Data Element" button redirects users to the ONDEC Submission System for proposing new data elements not currently available in the system.
5. Complete the Comment Form
Fill out the required fields in the comment form:
Subject: Enter a brief, descriptive title that summarizes your comment. This helps reviewers quickly understand the nature of your feedback.
Comment: In this field, provide the full details of your comment or feedback. Be as clear and specific as possible about your suggestions, concerns, or observations. Include any relevant details that support your position.
6. Optional: Add Additional Comments
If you need to comment on multiple data classes or elements:
- After completing your first comment, click the link labeled "Comment on another data element" at the bottom of the form.
- A new comment section will appear, allowing you to enter details for your additional comment.
- For each additional comment, you must select the appropriate data class and data element from the drop-down menus.
- Complete the Subject and Comment fields for your additional comment.
- Repeat this process for each additional comment you wish to submit.
Fig 3 The "Comment on another data element" link enables users to create multiple comments addressing different elements within a single submission.
7. Optional: Upload Supporting Files
The platform allows you to upload supporting documentation to enhance your comment:
- Locate the "File Upload" section at the bottom of the comment form.
- Click to upload any files (such as PDFs or documents) that provide additional context, evidence, or clarification for your comment.
Important: If you have already entered your comments using the form fields, there is no need to upload duplicate content in PDF format. The file upload feature is intended for supplementary materials only. Please avoid uploading files that contain the same information already provided in your comment text.
Fig 4 The "File Upload" section permits users to attach supporting documentation that supplements their written comments.
8. Optional: Save and Exit
If you need to pause your work and return to complete your comment later:
- Click the "Save and Exit" button at the bottom of the form.
- Your comment will be saved as a draft that you can access and complete later.
- When you return to the platform, you will see a red triangle with an exclamation mark next to the “Return to saved Comment” button, indicating that you have saved comments in draft status.
- Click this button to continue working on your draft.
- You will be taken to a review page where you can:
- Select "Submit Comment" to officially submit your feedback.
- Click "Edit" to return to the comment form and make changes
- Select "Discard Draft" to delete the saved draft and start fresh
Fig 5 A red triangle with exclamation mark indicator appears next to the “Return to saved Comment” button when draft comments are saved in the system.
9. Review and Submit
Once you have completed your comment:
- Click the "Review and Submit" button at the bottom of the form.
- This will take you to a review screen displaying your comment(s) in full.
- Review all information for accuracy and completeness.
- On this review screen, you have three options:
- Click "Submit Comment" to officially submit your feedback
- Click "Edit" to return to the comment form and make changes
- Click "Discard Draft" to delete the comment and start fresh
- The review screen also includes a "Print" button that allows you to create a printed copy of your comments for your records.
- If you choose to submit, your comment will be recorded in the system and made available for review by the appropriate stakeholders.
Fig 6 The review screen allows users to verify comment content and make any necessary modifications before final submission.
Submitted by kballantine on
Phreesia's Comments to USCDI V5
Please see the attached document with Phreesia's feedback on the Draft USCDI v5. Thank you for your consideration.
Phreesia Comments to USCDI V5 04 15 24.pdf