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
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 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.
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.
-
- 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.
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.
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.
-
- 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.
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 V6
ASTP/ONC published Draft USCDI v6 on January 14, 2025, and proposes to add 6 new data elements. Please read the Draft USCDI v6 standard document and the ASTP Standards Bulletin 25-1 for details. ASTP/ONC is accepting comments here through May 12, 2025, at 11:59 PM ET.
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.
-
- 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.
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.
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.
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.
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.
-
- 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.
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.
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 aalpern on
Children's Hospital of Orange County comments on Draft USCDI v5
Dear Dr. Tripathi and Mr. Posnack,
Leaders at Children’s Hospital of Orange County (CHOC) submit the following comment regarding ONC’s Request for Public Comment on the Draft USCDI v5 posted in January 2024. CHOC serves over two million children across four counties. Founded in 1964, CHOC is a tertiary care facility with a 388-bed capacity and a medical staff of over 500 physicians. CHOC is comprised of two hospitals, multiple primary and specialty clinics and affiliated practices, and a managed care network that serves 200,000 children and teens, regardless of their family’s ability to pay. Consistent with CHOC’s mission to nurture, advance, and protect the health and well-being of children, CHOC’s vision is to be the leading destination for children’s health by providing exceptional and innovative care.
The CDC estimates that approximately 30% of California middle and high school students identify with a sexual orientation other than straight, and 2-5% of students in California identify as transgender or gender diverse (Center for Disease Control, 2021). Given the importance of affirming healthcare to the overall health of LGBTQ+ young people, we welcome the opportunity to review and comment on the proposed USCDI v5.
Pediatricians and healthcare teams can provide optimal, affirming, and responsible healthcare when they have information about patients’ sexual orientation, gender identity, chosen name, and pronouns; however, only 35% of LGBTQ+ youth have shared their LGBTQ+ identity with any healthcare professional (Goldberg et al. 2023), and 40% of transgender youth have avoided or delayed necessary medical care due to concerns about how they would be treated (Boyer et al. 2022).
Our organization is fully supportive of the inclusion of data on sexual orientation and gender identity (SOGI) in the USCDI, as these data are necessary to optimize clinical outcomes and population health (Liu et al. 2024). Clinicians and members of the healthcare team can use data on chosen name, pronouns, and SOGI to improve delivery of patient-centered care. This is likely to enhance patient engagement, collaborative decision making, and clinical effectiveness. SOGI data are necessary for screening, preventative care, and management of conditions that occur at higher rates among LGBTQ+ youth due to discrimination and minority stress—including but not limited to bullying, mental health conditions, suicide, and high-risk health behaviors.
In addition, collecting these data at the system level is essential to track and address LGBTQ+ inequities and disparities in healthcare utilization, access to preventative care, and clinical outcomes at the population level.
Thank you for the opportunity to comment on USCDI v5. We appreciate your support of SOGI data collection and the collection of pronouns and “name to use” to improve quality of care and enhance health equity among LGBTQ+ individuals. Should you have any questions, please contact Steven Martel, MD, FAAP, VP, Chief Health Information Officer, at Steven.Martel@choc.org.
Sincerely,
Steven Martel, MD, FAAP
VP, Chief Health Information Officer
Neonatal Hospitalist with PSF
UCI Clinical Informatics Fellowship, CHOC Site Director
Clinical Informatics Diplomate of the American Board of Preventive Medicine
CHOC Children’s Hospital
1201 W. La Veta Avenue
Orange, CA 92868
References
Boyer, T. L., Sequeira, G. M., Egan, J. E., Ray, K. N., Miller, E., & Coulter, R. W. (2022). Binary and nonbinary transgender adolescents' healthcare experiences, avoidance, and well visits. Journal of Adolescent Health, 71(4), 438-445.
Center for Disease Control (2021). Results of the Youth Risk Behavior Surveillance Survey. https://www.cdc.gov/healthyyouth/data/yrbs/results.htm Last accessed 4/1/2024.
Goldberg S. K., Lewis T., Kahn E., Watson R. J. (2023). 2023 LGBTQ+ Youth Report. Human Rights Campaign Foundation. hrc.im/youthreport2023
Herman J. L., Flores A. R., Brown T. N. T., Wilson B. D. M., Conron K. J. (2017). Age of Individuals Who Identify as Transgender in the United States. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Age-Trans-Individuals-Jan-2017.pdf Last accessed 4/1/2024 \
Liu, M., Grasso, C., Kim, H. H., Mayer, K. H., & Keuroghlian, A. S. (2024). Advancing Pediatric Sexual Orientation and Gender Identity Data Collection. American Journal of Public Health, 114(1), 17-20.
Submitted by hjeon on
Inclusion of the Medical Record Number in the USCDI v5
The Texas Birth Defects Epidemiology and Surveillance Branch strongly agrees with CDC's recommendation for the inclusion of the "Medical Record Number" (MRN) in the USCDI v5. Serving as a unique identifier, the Medical Record Number is a necessary and critical variable for programs to be able to refer back to the patient’s associated electronic medical record as well as their vital statistics record for supplementing data found in the eCR.
Submitted by dmenkin on
Main Line Health Comment
April 4, 2024
Micky Tripathi, Ph.D., M.P.P., National Coordinator for Health IT
Steven Posnack, M.S., M.H.S., Deputy National Coordinator for Health IT
Office of the National Coordinator for Health Information Technology
Office of the Secretary, United States Department of Health and Human Services
Re: Request for Public Comment, Draft United States Core Data for Interoperability (USCDI) v5
Submitted electronically to https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi#draft-uscdi-v5
Dear Dr. Tripathi and Mr. Posnack,
Main Line Health submits the following comment regarding ONC’s Request for Public Comment on the Draft USCDI v5 posted in January, 2024.We are a large health system in the suburbs of Philadelphia. We serve over 5000 LGBTQ people in both our Inclusive Care Program and our Comprehensive Gender Center Programs.
We welcome the opportunity to review and comment on the proposed USCDI v5.
The value of knowing a patient’s sexual orientation, gender identity, sex assigned at birth, name used (different from a legal name) and pronouns is necessary to provide culturally affirming and responsive health care in many different ways. These demographics highlight people’s identities. When we neglect to validate someone’s identity, they will not trust. If a patient does not trust the care they are being provided they will be unable to hear medical advice, disclose personal information which may be relevant to their care and also allow for the allocation of appropriate resources.
To provide responsive healthcare, ideally we can know what a patient needs without having to ask personal demographic information. This can avoid embarrassing a patient or jeopardizing patient safety should they be asked to disclose sensitive information in a setting where they may not otherwise be out (to those around them). This is especially relevant to youth and LGBTQ seniors.
Many health systems have developed electronic patient portals which allow patients to enter this information in the privacy of their own home. Inclusion of this information into the patient chart allows for current and updated information without having to ask them. These systems are expensive to develop and implement. However, many see it as valuable and the future of patient communication. If health care systems are investing in collecting this information, it seems the ONC would agree.
Main Line Health uses this data to inform clinical decision support, preventive screenings, and for managing health disparities at the population level.
Some examples of this include simple things such as using a name which may be different from a legal name to call a patient from a crowed waiting room. Should a name which does not align with someone’s gender expression be used, there is a significant risk of outing patient and putting them in danger. There is also a risk the patient would not stand and come into the clinical area to avoid being outed.
With regard to clinical decision making, this scenario is not uncommon; When a clinician knows a patient’s natal and present anatomy and is able to include pregnancy risk without asking the patient presenting with abdominal pain, it saves the patient potentially uncomfortable disclosure but will allow the clinician to do their job thoroughly.
All health systems are aware of health disparities and the unmeasurable cost of them to health care provision. We can lessen health disparities when we are able to identify vulnerable populations. We can prevent patients from running into problems with payment, when we have the right name to bill under. If a patient does not trust us to disclose a name different from one which aligns with gender presentation, we may not know there is a different legal name.
When a cisgender male presents for care and does not disclose he has sex with men or transgender women perhaps because he is there with his wife, we might not know that he should be tested for HIV. If we allow for him to provide that information to us privately, we can test and protect him, privately and with dignity.
Thank you for the opportunity to comment on USCDI v5. We appreciate your support of SOGI data collection, and collection of pronouns and “name to use,” to improve quality of care and to enhance LGBTQIA+ health equity. Should you have any questions, please contact Dane Menkin, CRNP; Director of LGBTQ Services Main Line Health.
Sincerely,
Dane Menkin
Main Line Health
Primary Care King of Prussia
120 Valley Green Lane
King of Prussia, PA 19406
215-833-1766
menkind@mlhs.org
Submitted by taraodonnell on
AHIMA Comments on Draft USCDI v5
Please see attached for comments on the Draft USCDI v5 from the American Health Information Management Association (AHIMA).
Submitted by ndaneshvar on
ACP Comments on Draft USCDI v5
Please find the American College of Physicians’ comments on ONC's Draft USCDI v5 attached. The College greatly appreciates the opportunity to share our feedback and looks forward to continuing to work with ONC to implement policies that support and improve the practice of internal medicine.
Submitted by Toni Wilken on
MEDITECH Comments on USCDIv5
Thank you for the opportunity to provide feedback, please see the attached comments for the draft USCDIv5.
Submitted by fiehnr on
American Dental Association Comments on Draft USCDI v5
Please see the American Dental Association's comments on ONC's Draft USCDI v5. We appreciate the opportunity to comment.
Submitted by shannon.vogel@… on
Draft USCDI Version 5 Comments
TMA respectfully submits the attached comments for consideration on Draft USCDI Version 5.
Submitted by NCQA on
NCQA Comments on Draft USCDI v5
The National Committee for Quality Assurance (NCQA) thanks ONC for the opportunity to provide comment on Draft USCDI version 5. Please find attached our recommendations.
Submitted by aflackey on
Regenstrief Institute Comments on Draft USCDI v5
The Regenstrief Institute appreciates the opportunity to provide comments to ONC on Draft USCDI version 5. Please find attached our recommendations.
Regenstrief Institute Comments on USCDI v5 2024 04 11 FINAL.pdf