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United States Core Data for Interoperability Plus (USCDI+) Quality - Draft Data Element List

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Overview: USCDI+ Quality

The Office of the National Coordinator for Health Information Technology (ONC) launched the USCDI+ initiative in Fall 2021 to help government and industry partners build on USCDI to support specific program needs. Since that time, ONC has developed several USCDI+ domains, including one for Public Health and one for Quality, through collaboration with the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the Centers for Medicare and Medicaid Services (CMS).

One objective of the USCDI+ Quality domain is to identify opportunities that align policies for quality reporting programs across agencies in the Department of Health and Human Services. An additional objective is to harmonize quality data elements into a common list of data elements to streamline the development and reporting of quality measures. The USCDI+ Quality data element list includes the data in USCDI.

About the Draft Data Element List for USCDI+ Quality

The draft data element list for USCDI+ Quality develops a framework to provide a predictable, transparent process for evaluating and organizing data elements to support the exchange and use of data for quality measurement across programs, payers, and care settings.

Over the last year, ONC gathered input from a variety of sources to develop the first draft of the data element list for USCDI+ Quality. ONC and partners reviewed data requirements for electronic clinical quality measures (eCQMs) currently used in CMS’s eligible hospital/critical access hospital and eligible clinician quality reporting programs. ONC also reviewed data elements included in draft and published Health Level Seven International® Fast Healthcare Interoperability Resources® (FHIR) ® Implementation Guides (IG) for various use cases, such as long-term and post-acute care, oncology, and federally qualified health center reporting requirements. ONC also held a series of discussions with organizations in the public and private sector, involved in measure development, measure evaluation, and quality reporting, to go beyond the current specifications in eCQMs to identify high priority data elements for inclusion in the draft data element list for USCDI+ Quality.

Like USCDI, the draft USCDI+ Quality data element list provides a high-level picture of important data for exchange that is agnostic to specific data standards.  However, we anticipate the community will use USCDI+ Quality to support the transition of quality reporting to a FHIR-based ecosystem. Further, the intent of these data elements is intended to inform technical specifications and IGs containing far greater specificity needed by measure developers, measure implementers, and standards development professionals.

Two files are included in the draft data element list for USCDI+ Quality:

  • USCDI+ Quality Data Element List: Contains the data classes and data elements for inclusion in the first data element list for USCDI+ Quality. The intent of this list is for review by quality improvement leaders responsible for policy and programmatic decisions about measurement priorities and individuals that develop quality measures and data standards. The file includes the current USCDI status of each element to illustrate how USCDI+ Quality complements USCDI. The final column provides the source of the data element and indicates use in existing CMS eCQMs.
  • USCDI+ Quality – eCQM Use Case Mapping: Is a specific use case for CMS quality reporting programs and contains a crosswalk from the proposed data classes in USCDI+ Quality Data Element List to data elements that have been extracted from an analysis of eCQMs, currently used in the CMS quality programs to concepts in the FHIR Quality Improvement (QI) Core IG expressed through profiles and corresponding data elements. In addition, there are crosswalks of the data elements to CMS eCQMs. The intent of this example is to provide a degree of technical guidance and insight to individuals that translate prioritized data classes and data elements into detailed specifications and standards for quality measures.

Feedback Sought

Level of completeness: To what extent does the data element list contain a comprehensive list of data elements relevant to measuring quality for important health processes and outcomes? Are there additional data classes and/or elements ONC should consider for inclusion?

Level of specificity: Are the data classes and data elements listed in sufficient detail to result in adoption in electronic systems that would make data available for use in quality measures? For example, we assume that a published version of the USCDI+ Quality data element list contains elements such as health status assessments or procedures. These data elements would reference one or more technical specifications or FHIR IGs that could further specify specific needs and terminology requirements, e.g., Functional Status identified by Logical Observation Identifiers, Names, and Codes (LOINC) codes. Does this data element list provide clear guidance about data priorities that would incentivize capture of data elements relevant to quality measurement within electronic systems?

Usefulness of companion guidance: ONC published the data element list with a complementary crosswalk specific to the CMS quality reporting use case. How useful is this information to individuals who develop and implement measures and FHIR IGs? What companion guidance about the relationship between data classes and data elements, and their potential expression in FHIR would be useful in future publications?

Frequency of updates: ONC's updates to the USCDI and standards advisories typically occur once a year. One goal for USCDI+ is to help stakeholders with tailored needs to establish standardized data sets in a more flexible manner. What frequency of updates to USCDI+ Quality would be useful for achieving this objective?

Instructions on Submitting Comments and Feedback:

Please submit your comments and feedback to the USCDI+ Quality tracker in the ONC Project Tracking System. Submission requires an active Jira account, you may create an account here.

This initial comment period is open for 30 days and closes on Friday, June 16, 2023 at midnight EDT.

ONC will not provide direct responses back for each comment. However, ONC will look to develop a public-facing communication after review and consideration of all comments to describe updates to the USCDI+ Quality data element list. 

If you have any questions about the USCDI+ initiative, please contact USCDI.Plus@hhs.gov. 

Additional Information on Sources Referenced in the USCDI+ Quality Data Elements List

Last Updated: May 18, 2023