United States Core Data for Interoperability Plus (USCDI+) Background 

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. The USCDI+ initiative supports the identification and establishment of domain or program-specific data element lists that operate as extensions to the existing USCDI. USCDI+ is a service the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP) provides to federal and industry partners to establish, harmonize, and advance the use of interoperable data element lists that extend beyond the core data in the USCDI to meet specific programmatic and/or use case requirements. This approach allows the Department of Health and Human Services (HHS) to ensure that USCDI+ extensions are built from the same core USCDI foundation, align to harmonized data standards and taxonomies, and create the opportunity for aligning similar data needs across programs and use cases. 

USCDI+ Quality Data Element List 

Quality was one of the first domains to launch under the USCDI+ initiative. ASTP developed the USCDI+ Quality data element list in collaboration with many partners, including the Centers for Medicare and Medicaid Services (CMS) and the Health Resource and Services Administration (HRSA). The list aligns data elements that quality reporting programs can use and harmonizes quality data elements into a common list to streamline the development and reporting of quality measures.  ASTP will continue to expand this list over time to look across other quality reporting programs in support of broad electronic and digital quality measure harmonization. 

ASTP published the initial draft of the USCDI+ Quality data element list in May 2023 for public comment and feedback.  This updated USCDI+ Quality data element list takes into account a thorough review of public comments from the May 2023 release as well as additional review and inclusion of quality data elements, including CMS’s electronic clinical quality measures (eCQMs) as reflected in the QI Core Implementation Guide, CMS’s Data Element Library, AHRQ Common Formats, and NCQA HEDIS measures. The USCDI+ Quality data element list is intended to complement CMS’s Digital Quality Measures initiative which seeks to modernize CMS’s quality measurement systems through a transition to digital quality measures that enable increased interoperability though the use of the FHIR standard. 

ASTP has two concepts for review as a part of this next release.  First, there is the USCDI+ Quality Data Element List that includes all quality data elements that were included as a part of our analysis as well as submissions from the public.  This broad USCDI+ Quality Data Element List is labeled as the “Quality Overarching” use case in the USCDI+ Platform and includes data elements that are not considered ready for implementation but continue to be key to track for quality programs.  Second, the Draft USCDI+ Quality V1 use case is a subset of the “Quality Overarching” use case and is intended to be the data element list that captures data elements that are “ready” for implementation (i.e. the data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide) or are needed to calculate an existing CMS eCQM. 

ASTP determined key priorities for the Draft USCDI+ Quality V1 data element list, which include: 

• Policy alignment around existing quality reporting programs at HHS;
• Readiness for implementation;
• Alignment with USCDI and other USCDI+ domains; and
• Needed to calculate a CMS eCQM. 

Summary of Updates to the USCDI+ Quality Data Element List 

ASTP made several updates to the USCDI+ Quality Data Element List according to the priorities described in the previous section.  This updated list includes a total of 32 data classes.  10 data classes extend beyond what are included in USCDI V5.  Those edits included: 

• The addition of all USCDI V4 data elements into the Draft USCDI+ Quality V1 Data Element List;
• The addition of select USCDI V5 data elements in response to public comments;
• Updates to data element names and definitions to align with USCDI and other USCDI+ domains;
• The addition of data elements submitted to USCDI that have not been adopted in a published version of USCDI but are relevant for quality measurement;
• The addition of data elements necessary to calculate eCQMs identified in CMS’s Hospital Inpatient Quality Reporting and Quality Payment Program (CMS eCQMs); and
• The addition of data elements not yet submitted to or included in USCDI necessary to calculate quality measures identified in other programs. 

Requests for 2024 Public Comment Period of USCDI+ Quality Data Element List 

ASTP is seeking public comment on the USCDI+ Quality Data Element List and requests specific attention to the following as a part of the review: 

• Are there additional data elements that need to be added for alignment across quality programs?
• What are federal or nonfederal quality measurement initiatives that should be reflected in USCDI+ Quality?   
• Are there data elements included in the Quality Overarching use case but not in the Draft USCDI+ Quality V1 use case that should be added based on readiness for implementation?
• Data elements in USCDI+ Quality include additional context elements such as usage notes, implementation guides, and recommended value sets. Are there usage notes, implementation guides, and recommended value sets that should be added to specific data elements in the revised USCDI+ Quality?
• Are there data elements included in another USCDI+ domain that should be considered for USCDI+ Quality?
  • For Example, USCDI+ Quality plans to analyze Patient-Reported Outcome Measures to better understand what is important for Quality reporting.  Are there Patient-Reported Outcome Measure data sources ASTP should explore?
• Do the data elements provide enough granularity, similar to USCDI, to allow for further specification at an implementation level?  
  • For example, the data element may be higher level than specific attributes of a FHIR profile while also trying to balance public comments for specificity and understanding.  Data and time data elements are typically at the attribute and metadata levels but are sometimes added as specific data elements.   

Comments are due on the USCDI+ Platform on October 15, 2024, by 11:59PM ET.  Questions?: Contact USCDI.Plus@hhs.gov.