Thinking outside the box: The USCDI + Initiative

Wise readers of the Health IT Buzz blog (are there any others?) And those familiar with the ONC’s final rule Cures Act (Cures Act of 21st). Final rule of ONC Cures Act passed USCDI version 1 as a standard, creating a new basis for the data elements that must be accessible via the certified electronic health record (EHR) technology. Since it defines the lower bound of what can be shared by certified EHRs, the USCDI is also the basic payload for statewide and state / regional exchange networks and the main driver for the development of the standards of Health Level Seven International® Fast Healthcare Interoperability Resources® in the US. In fact, the USCDI has become the de facto minimum record of the health care system.

Although the USCDI determines data availability, it is not static. ONC has established an expansion process that creates a “rising floor” over time on the basis of contributions from industrial and federal partners and taking into account various factors such as impact, feasibility and standard maturity. In July 2021, ONC published USCDI version 2who have favourited some important updates like the Adding data elements on social determinants of health, sexual orientation and gender identity.

A sign of the success of the USCDI is that ONC is receiving more and more requests for further expansion. We love that, but it also poses a challenge because there is tension in managing USCDI growth. On the one hand, we want to expand it further in order to achieve more interoperability. On the flip side, however, due to the broad applicability of the USCDI to certified EHRs, interoperability transactions and its potential impact on user experience and workflow, we need to be careful about what and how much to add in any given year.

However, we recognize that there are specific but important use cases that require consistency and targeting of datasets beyond the USCDI, and we need to address those needs. For this reason we are starting a new initiative called USCDI + to support the identification and establishment of domain- or program-specific data sets that serve as extensions of the existing USCDI. In particular, USCDI + is a service that the ONC will provide to federal partners who need to create, harmonize and promote interoperable data sets that go beyond the core data in the USCDI in order to meet agency-specific programmatic requirements. This approach will allow us to better serve our federal partners, ensure that extensions are built on the same central USCDI base, and provide the ability to align similar data requirements across agency programs.

The USCDI + quality measurement and public health effort is just beginning with our CMS and CDC partners, and we will add more as the program is more firmly established. Our USCDI + process will follow the same basic principles we used for the USCDI, but with a few additional components including:

• A discovery process and a charter
• Identify use cases, data specifications, and agency programmatic incentives / requirements for use of a particular USCDI + dataset
• Evaluation of data classes / elements according to objective criteria such as industry priority and readiness, degree of maturity of the standards and identified agency needs

We will continue to use similar processes to the USCDI, for example to get input from the Health IT Advisory Committee, to stimulate public engagement and to help shape the USCDI + datasets.

The USCDI + program is another way the ONC performs our “coordinator” role to help our federal and industrial partners successfully complete their missions. It will help the federal government use taxpayers’ money on health IT activities more effectively and will benefit industry through better alignment of data standards across all federal programs.