Standardization is one of healthcare’s most reliable approaches for positive care outcomes. Supporting common health standards are measures like the United States Core Data for Interoperability (USCDI), whose initial version, released in 2020, helped address the need for uniform health data systems in the industry, while promoting interoperability among health information technology (IT) systems.
The USCDI has since received yearly updates to reflect the evolving needs of the health ecosystem, unique advancements in health technology, plus relevant changes in policy and health regulations. We’ll be examining the updates to these data standards, focusing on its fourth year (USCDI Volume 4), and how these changes plan to improve care delivery.
According to the Office of the National Coordinator for Health Information Technology (ONC), the USCDI is “a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange.” To break this down, the purpose of the USCDI is to create a structured collection of health-related information, and the data points commonly found within them.
In this context, a set of health data classes refers to the grouping of health data into a meaningful order. This could be patient demographics where vital information on a patient like name, gender, and contact information will be contained. The records of a patient’s past medical procedures, or even care plans and treatment goals can fall under health data classes.
Constituent data elements are all the pieces that make a data class whole. For example, within the medication class, the drug name, dosage, route of administration, and other particulars grant providers and other professionals the information needed to continue care delivery.
The USCDI makes these data sets available as electronic health information, easily transferred across electronic health records (EHRs) thanks to standardized procedures that support consistency and interoperability.
Every new data element established under the USCDI is part of the ONC Health IT certification program to push collaboration between health systems. The ONC designed the USCDI framework to support the use of Application Programming Interfaces (APIs) in healthcare, mandating that EHR technology meet the certification criteria stipulated for implementing USCDI.
Originally, the office set out to use FHIR formats for API collaboration, before deciding on USCDI standards to exchange health information. As the content standard for the 21st Century Cures Act, concepts like the LOINC, SNOMED, CPT, and ICD10 are adopted under the USCDI to store clinical data.
The first version of the USCDI outlined what qualifies as electronic health information to be available for easy access and use by relevant players like a healthcare provider, developers, and health information exchanges. Under this version, USCDI data elements included information on allergies and intolerances, laboratory, clinical notes, care team members, vital signs, problems, procedures, provenance, and others.
Worth noting is that this version was mandated under the Trusted Exchange Framework (TEF), to cover the data enabled for exchange under Qualified Health Information Networks (QHINs).
To improve on the first provisions of the USCDI, Version 2 addressed important aspects of health that were overlooked such as social determinants of health plus health equity. To cover these areas, datasets on economic stability, education access and quality, healthcare access and quality, neighborhood and social environment, and social and community contexts were core categories.
In particular, Version 2 helped to develop a structure to collect information on sexual orientation and gender identity. With these new data classes in place, health IT developers could now build systems to support data exchange, where this information is required for care.
In 2022, the ONC released USCDI V3 to improve on the information sharing supported in previous versions. This version included 24 new datasets across 6 health data classes, namely: laboratory, medications, patient demographic information, procedures, health status plus assessment, and health insurance information.
This version also expanded on the existing datasets, permitting health IT stakeholders to exchange information on aspects like patient demographics, where information on Date of Death, Related Person Name, Related Person Relationship, Occupation, and Occupation industry, help to improve public health reporting and a broader view of the patient concerned.
The health industry is constantly driving towards a more efficient and effective care delivery system. To further this goal using the USCDI, the ONC has put together a clear, collaborative structure pooling public opinion of previous versions, plus submissions from the health IT community detailing what could be improved in newer updates.
Using these recommendations, the ONC put together a draft USCDI v4 where a set of new data classes and elements were put together. New submissions for this update were entered through the ONC New Data Element and Class (ONDEC) system.
The ONC reviewed over 600 comments when drafting Version 4 of the USCDI to accommodate broader patient-centered data and quality of care measures to improve health equity.
To better reflect needs, V4 updates include 20 new data elements and one new data class. These include substance (non-medication), to expand the allergies and intolerances data class. With this, information on common allergens like latex and pollen can be exchanged between healthcare organizations. Others like encounter identifier also added to the encounter information data class to expand on information related to an encounter.
Patients and providers now have information available via “facility information” datasets, detailing the physical location where care services were administered. Other data classes and new elements like care team members, diagnostic imaging, procedures, goals and preferences, and vital signs are helping to enhance health status assessment for patients and the care services delivered.
The USCDI is a core part of efforts to ensure health IT systems use consistent terminology, formats, and codes when documenting and sharing electronic health information.
The USCDI standards help to fulfill the potential of application programming interfaces like Metriport’s API, to ensure information stored in EHR systems nationwide, health information exchanges, and other data exchanges across the country are easily accessed and retrieved.
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