The Cures Act final rule deadline is upon us, and with it comes the United States Core Data for Interoperability (USCDI). There's a lot of information to process when it comes to USCDI and the Cures Act final rule, so we've put together an explainer to help you understand what you need to know. Let's get started!

What is USCDI?

The USCDI is a set of structured data elements that can be exchanged between electronic health records (EHRs) and other health information systems in the United States under the Cures Act final rule. The goal of the USCDI is to support interoperability in healthcare by standardizing the way that health information is represented, making it easier for different systems to exchange data while maintaining privacy and security.

ONC was tasked with designing the USCDI framework since the Cures Act mandated the use of APIs in healthcare that could exchange electronic health information. The FHIR format was ONC’s original selection for an API, however the Cures Act did not state what the definition of electronic health information exactly was. ONC decided that to fulfill the API mandate it was necessary to develop USCDI. This enabled healthcare developers to begin to introduce the API-based sharing of healthcare data by primarily using USCDI elements.

At the moment, USCDI version two is the most recent standard, and version three is in the review process. In the United States certified EHR systems have to share data points that map to the USCDI version one elements.

Under the Cures Act final rule, covered entities must represent USCDI patient data points using a standard code set through APIs that meet standards promulgated by HHS. The data points are organized into six categories: demographics, clinical observations, medications, laboratory tests and results, immunizations, and procedures. The full list of USCDI elements can be found here.

The USCDI is a critical tool for improving interoperability in the United States, but it is only one piece of the puzzle. In order to truly improve the flow of information between different health care organizations, we need to also adopt standardized methods for exchanging data. The good news is that there are already a number of these standards in place, and many more are under development.

Think of USCDI as not just a static list of data elements, but rather a dynamic framework that can be updated over time to reflect changing interoperability needs. For example, in the future the USCDI might add new data elements related to genomics or population health. Or it could remove some of its existing data elements if they are no longer considered essential for interoperability. The Cures Act requires HHS to periodically review and update the USCDI. After consulting with stakeholders, HHS will determine whether to add or remove data elements from the USCDI.

If you work in healthcare in the United States, then you know that interoperability is a hot topic. The ability to share patient data between different health care organizations is essential for providing quality care, but it is also notoriously difficult to achieve. There are a number of factors that contribute to this difficulty, but one of the most important is the lack of a standardized way to represent and exchange data.

This is where USCDI comes in. By ensuring that all USCDI data is represented using a standard code set, the USCDI makes it possible for different EHR systems to exchange information with each other.

The USCDI is the first nationwide dataset released by the Federal government to support interoperability between public sector health information systems. USCDI also helps regulators decide whether a healthcare provider is information blocking. The dataset was created through close collaboration with public and private sector stakeholders, and it reflects the current state of health data sharing in the United States.

Uses for the USCDI

The USCDI can be used to support a variety of health data exchange scenarios, including:

Patient matching: The USCDI can be used to improve the accuracy of patient matching algorithms, which are used to link together a patient's records from different health care providers.
Data normalization: The USCDI can be used to map data from different EHRs into a common format, making it easier to compare and analyze data from multiple sources.
Public health reporting: The USCDI can be used to support electronic reporting of public health data, such as immunization rates or infectious disease incidence.
Quality measurement: The USCDI can be used to support the creation of quality measures, such as those used in the Centers for Medicare & Medicaid Services' (CMS) Quality Payment Program.
Clinical decision support: The USCDI can be used to create or enhance clinical decision support tools, such as alerts and reminders that are triggered by a patient's health data.

Getting Started with USCDI

If you're a covered entity, there are a few things you need to do to get started with USCDI:

First, you'll need to select an API that meets the standards promulgated by HHS. There are a few different options available, so it's important to do your research and select the one that best meets your needs.
Once you've selected an API, you'll need to develop and test it to ensure it meets the requirements of the Cures Act final rule.
Finally, you'll need to register your API with HHS. This will allow other covered entities to discover and use your API for interoperability purposes.

Challenges with USCDI Implementation

One of the biggest challenges with USCDI implementation is developing and testing an API that meets the standards promulgated by HHS. These standards are quite technical, and many covered entities lack the in-house expertise to develop an compliant API.

Another challenge is registering your API with HHS. This process can be time-consuming and complex, particularly for smaller organizations without a lot of resources.

Finally, it's important to keep in mind that USCDI is a moving target. The standards and requirements are subject to change, so covered entities need to be prepared to adapt their API on an ongoing basis.

What's Next for the USCDI?

HHS is currently working on a number of initiatives to improve interoperability, including updating the USCDI to align with international standards and expanding the scope of the USCDI to include additional data types.

The USCDI is a key part of the HHS' efforts to improve interoperability and promote the free flow of health information. The release of the USCDI is an important step in achieving this goal. By providing a common set of data elements that can be used to exchange health information, the USCDI supports HHS' goal of ensuring that everyone has access to their health information when and where they need it.

The ForeSee Medical rules engine leverages structured data included in the USCDI. The new Cures API standards will make it easier for ForeSee Medical users to interact with their healthcare ecosystem to assist in the discovery and coding of diseases that have not yet been added to a patient assessment or problem list.

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