The Newest USCDI Updates, and Where USCDI Is Going Next

Changes to the USCDI standard indicate new developments in medicine and healthcare policy, and influence the data that health tech developers use.

The USCDI standard - a government-sponsored set of health tech data elements - has just expanded for the third year in a row.

USCDI v3 (the third and latest version of USCDI) was finalized in July 2022 by ONC, the government’s interoperability arm. This version of USCDI has grown to include 94 data elements, from the initial 52 data elements in USCDI v1

“The USCDI is incredibly important for pushing healthcare interoperability forward,” says Particle Sales Engineer Nick Allen. “Access to new data types, ranging from disease-specific biomarker trends to care journey timelines, will enable technologists to deliver clinical insights in new and efficient ways.”

Since electronic health platforms generally support USCDI elements, these changes are a good indication of where medicine and healthcare policy is heading. We’re taking a look at the newest updates to USCDI, and what’s ahead for the future.

USCDI Changelog

USCDI v3 (July 2022)

USCDI v3 “focuses on promoting equity, reducing disparities, and supporting public health data interoperability”, ONC officials wrote. It added two new data classes and 24 new data elements.

New data classes and elements in USCDI v3
Source: ONC Standards Bulletin 2022-2

Some of USCDI v3’s noteworthy changes were:

  • Health Status/Assessments data class - This new data class was added to the draft USCDI v3 release as “Health Status”, but was given an expanded name. Taken as a whole, these elements give more opportunities to track to healthcare concerns that could identify a care need or impact ongoing treatment.
  • Health Insurance Information data class - This first appearance of financial information in the USCDI focuses on basic coverage info. The data class can be used both to inform care and to identify insurance-related care disparities. It’s a promising step for the evolution of non-treatment use cases in FHIR and other open source standards.
  • Medications data elements - This helps make EHRs more compatible with existing CMS reporting programs. The elements may also help facilitate e-prescribing. Due to the amount of input during USCDI’s feedback cycle, they were added despite not being in the draft standard.

USCDI v2 (July 2021)

New data classes and elements in USCDI v2
Source: ONC Standards Bulletin 2021-3

ONC’s goal for this first USCDI update was to add ways to further health equity, with a focus on reporting social determinants of health (SDOH), gender identity and sexual orientation. USCDI v2 grew to 3 new data classes and 22 data elements.

Some of USCDI v2’s noteworthy changes were:

  • The addition of meaningful health equity parameters. Gender identity, sexual orientation and social determinants of health (SDOH) interventions were seen as essential additions to USCDI.
  • Three redundant USDCI v1 elements - Imaging Narrative, Laboratory Report Narrative, and Pathology Report Narrative - were removed in a win for efficiency.

What’s happening in USCDI v4?

That’s up to you. Proposals are open through September 30, 2022 on the ONC New Data Element and Class (ONDEC) submission system. Like past update cycles, there will be a draft release, a review period, and a final release.

What ONC is looking for, however, are changes that

  • Mitigate health and health care inequities and disparities,
  • Address the needs of underserved communities,
  • Address behavioral health integration with primary care and other physical care (an increasingly-discussed result of government-funded studies)
  • Address public health interoperability needs of reporting, investigation, and emergency response,
  • Generally require a low development burden and fill gaps in the USCDI.

Interestingly, the draft version of USCDI v2 included 13 fewer data elements than the final standard; and the draft version of USCDI v3 included 4 fewer new data elements than the final release. In both instances, the review period served to increase, not reduce, the number of additions to the USCDI standard.

How are the USCDI data elements chosen and categorized? 

There are currently three levels of USCDI data elements, of increasing importance:

  • Comment
    • these data elements are seen in the wild in limited test environments or pilots, and may or may not be applicable in common use cases.
  • Level 1
    • These elements have a clearly defined event and scenario where the data is used, and should already be seen in several different production environments or EHR systems.
  • Level 2
    • A data element that reaches this high level shows the need for use and exchange in different settings, is routinely collected by EHRs, and may be a component of large nationwide programs.

Level 2 elements are the most important. Once a data element reaches this level, it may be incorporated into the actual USCDI standard.

In general, the more use cases that an element has, the greater likelihood that it will be placed in a higher level. 

To become an element, ONC asks whether a vocabulary, terminology, content, or structural standard exist for this data element - as all elements must be expressed with standard computer-processable healthcare terminology, like SNOMED CT.

USCDI terminology example for substances
Terminology Examples Source: USCDI v1 July 2020 Errata

ONC also considers the implementation burden of an element. Updates to USCDI should not be overly burdensome to incorporate into existing platforms.

Healthcare stakeholders can submit elements for consideration in the USCDI. Condition-specific advocacy groups, medical societies, and for-profit organizations all weigh in on the submission and comment process. ONC seeks a predictable

Submitters are asked to determine whether proposed data elements meet USCDI’s aims of improving patient care, population health, reducing care costs, or assisting providers. It is repeatedly referred to by ONC as a “predictable, transparent and collaborative process”.

What’s Next for USCDI?

While the USCDI will play an important role in health informatics for years to come, its role will change before the release of USCDI v4.

In October 2022, the data elements that healthcare providers must exchange will no longer be limited to those defined in the USCDI v1. The Cures Act had required that healthcare providers electronically share data upon request, but initially limited that data to the USCDI v1 elements to ease providers into compliance.

Now that USCDI has matured, the Department of Health and Human Services is also increasingly promoting its use across the federal government. In this way, USCDI continues to set the standard for healthcare data.

The Sequoia Project, a quasi-governmental organization that contributes to interoperability, agrees that USCDI will still be a major part of health IT, nothing that USCDI will “generally be expected to be found in [a] portal” whereas organizations may not have control over nonstandard health information that doesn’t conform to the USCDI.

“Holding both health IT vendors and EHRs accountable to the USCDI will give data seekers a more complete picture of a patient’s overall health journey,” adds Particle’s Sales Engineer, Nick Allen. “These ONC data sharing requirements are especially important for newcomers to the digital health space as they aim to care for patients in novel ways.”