The Office of the National Coordinator for Health IT’s just-announced United States Core Data for Interoperability Standard, version 4, includes new data elements that advance the Biden-Harris administration’s priorities of advancing equity, diversity and access across all healthcare settings, according to ONC in this week’s Health IT Standards Bulletin.


ONC published the draft USCDI v4 in January and received nearly 600 comments, including a number of recommendations from the Health Information Technology Advisory Committee. 

The new data elements – from allergies and intolerances to health assessments, procedures, vital signs and others – reflect priorities for USCDI expansion that include assessment for industry-wide implementation impact, the agency said in the bulletin.

Changes to certain data elements proposed in Draft USCDI v4 clarify the definitions, uses and standards of data elements.

ONC is also accepting submissions for new data elements for USCDI v5 and feedback on existing data elements until September 20.


Annual updates of USCDI, which sets the foundation for access, exchange and use of electronic health information to support nationwide health information interoperability, are an effort to keep pace with medical, technological and policy changes.

Previously, ONC has proposed to adopt USCDI v3 in its info blocking rule, known as the Health Data, Technology and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing proposed rule. 

HTI-1 will help “keep a pace,” If the agency needs to add new functionality, it can align adoption to ONC’s time line for developers to be able to update and implement that feasible technology in the real world, according to ONC’s policy specialists providing an overview of the proposed rule expectations at HIMSS23.

Of note, the HIMSS Electronic Health Record Association took issue with the implementation time frame, which has not changed, and several other “burdens.”

“It really seems like the time frames that were drafted last fall were not adjusted, even though we’re six to eight months further along,” said David Bucciferro, special advisor at Foothold Technology-Radicle Health and chair of the EHRA at an open meeting in May.

“It really doesn’t give us sufficient time to complete the sizable work that the development teams have to do to make this a reality.”

The Standards Version Advancement Process enables health IT developers to voluntarily update health IT products certified under the ONC Health IT Certification Program to newer versions of adopted standards as part of the Real World Testing Condition and Maintenance of Certification requirement of the 21st Century Cures Act. The SVAP standards announced on July 12 will be available for voluntary certification on September 11, ONC said on its website. 

“We really think that [adopting USCDI v3 in HTI-1] will allow us to be more innovative and to make sure that all of you aren’t having to do a massive overhaul of all the systems across all of the entire country all at the same time,” Elisabeth Myers, deputy director of ONC’s Office of Policy said during the agency’s HIMSS23 presentation.

Updated test tools and test procedures will be made available in December 2023 for any developers looking to explore new certifications that include SVAP versions, ONC said.


Over the last year, ONC has heard from a variety of entities, individuals, and interested parties including [HITAC] that providing shareable links or detailed information about individual diagnostic imaging studies, series and images offers great potential to improve access to images,” the agency said in the bulletin.

“ONC believes additional work is needed in this space to advance the meaningful, secure and shareable access to images.”

Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]

Healthcare IT News is a HIMSS Media publication.


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