Last month, the Office of the National Coordinator for Health Information Technology (ONC) released USCDIv2 as promised under their new Standards Version Advancement Process (SVAP) as well as we participated in the HL7 C-CDA IAT. Today we will explain the differences between USCDIv1 and USCDIv2, and provide helpful information ONC shared during Topic 5: Ask the ONC, USCDI V2 at July’s HL7 C-CDA Implementation-A-Thon agenda, “accelerating advances through collaboration and teamwork.”
In our blog, Health IT Developers: Information Blocking Deadline Postponed, we explained that USCDI could be thought of as a superset of the old Common Clinical Dataset (CCDS). According to ONC, it “sets a foundation for broader sharing of electronic health information to support patient care”. Micky Tripathi, Ph.D., National Coordinator for health information technology explained,
"We heard that this new version of the USCDI should reflect America's diversity and include data elements like sexual orientation, gender identity, and social determinants of health while helping to address disparities in health outcomes for minoritized, marginalized, and underrepresented individuals and communities."
USCDIv2 has 3 new data classes, 22 new data elements, and 4 data elements removed. As you will see, USCDIv2, built with feedback from various stakeholders, sets the direction of a standard for interoperability as it relates to social detriments of health (SDOH), sexual orientation and gender identity (SOGI), as well as Immunizations. Problems, Procedures, Goals, and more.
New Data Classes:
USCDIv2 contains 3 new data classes:
As part of the 2015 Edition Final Rule, Certified Health IT modules must record standardized data on a patient’s SOGI. Until now, SOGI was not part of USCDI, so adding these 2 elements to USCDIv2 provides the framework to use them in care coordination. Adding the 4 new SDOH data elements provides an opportunity to improve health outcomes based upon food, housing, and transportation limitations. The new SDOH data elements are included in existing USCDI Data Classes:
Reference: ONC Health IT Standards Bulletin Issue
Other ONC Changes to Note:
Acknowledging the reality that most clinicians use ICD-10 to record problems, ONC added the flexibility to use either SNOMED CT (required in USCDIv1) or ICD-10-CM for classifying problems.
They also removed 4 data elements from USCDIv1 (narrative components remain incorporated into Diagnostic Imaging Report and Laboratory Values/Results data elements in USCDI v2):
Care Team Member (Replaced by the 5 new data elements in Care Team Members Data Class)
Imaging Narrative (Part of Clinical Notes Data Class in USCDI v1. Removed data element and incorporated narrative into the definition of Diagnostic Imaging Report)
Laboratory Report Narrative (Removed data element and incorporated narrative into the definition of Laboratory Value/Result)
Pathology Report Narrative (Removed data element and incorporated narrative into the definition of Laboratory Value/Result)
Information Blocking restrictions (based on the USCDIv1 dataset) went into effect in April 2021. You have till December 31, 2022, to certify the 21st Century Cures Act updates for the USCDIv1 dataset and make them available to your customers. For now, SDOH and SOGI, as well as other data elements in USCDIv2, are part of the voluntary SVAP process, at least until ONC publishes a ruling making them required.
Don’t take too long to absorb USCDIv2 because it is already time to prepare for USCDIv3. As a collaborative effort, stakeholders are asked to submit new data classes or elements using ONDEC. The submission period for USCDI v3 ends Thursday, September 30, 2021, at 11:59 pm ET. For more information about the submission of data elements and classes, review the USCDI ONDEC Submission Prep Sheet.
DHIT is committed to supporting SVAP changes in all our products. The pace at which we implement new data elements will be driven by client demand. Several of our existing partners have expressed interest in the new SDOH data elements. As the HL7 implementation guides for C-CDA and FHIR are upgraded to support the data elements, DHIT will move forward. Contact Michelle Bond, firstname.lastname@example.org, for more information about USCDIv2.