1 USCDI Submission Form

U.S. Core Data for Interoperability (USCDI)

Task Force Recommendations

Submission Form Questionnaire

New Data Element Submission Form

Submitter Information

1. Name of Submitter (Required)

2. Email address of Submitter (Required)

3. Organization of Submitter (Optional)

Data Element Information

4. Data Element Name (Required, Free Text)

5. Data Element Description (Required, Free Text)

6. Are there similar or related data elements in USCDI Yes/No/Unknown (Required)

   1. If yes, why should this data element be considered separately? (Required)

7. Proposed New or Existing Data Class (Optional) (Pick list of existing data classes plus “other” at bottom)

   1. If “New”, free text (Required)

Use Case Description(s)

1. Briefly describe the main use case to support adoption of the data element into the USCDI:

   1. Free Text Summary (required)

   2. Estimate the number of stakeholders who would capture, access, use or exchange this data element or data class (Free text, required)

   3. Link to use case project page (optional)

   4. Attachment(s) describing the use case (optional)

2. Are there additional use cases for this data element that could affect significant numbers of other stakeholders?

   1. Yes/No/Unknown (Required)

   2. If yes, please describe up to two additional use cases

      1. Free Text Summary (required)

      2. Estimate the number of stakeholders who would capture, access, use or exchange this data element or data class (Free text, required)

      3. Links to additional use cases (optional)

      4. Attachment(s) describing these use case (optional)

3. Does this data element support one or more of the following aims in healthcare? (check all that apply) (Required)

• Improving patient experience of care (e.g., quality, safety, or satisfaction)?

• Improving the health of populations?

• Reducing the cost of care?

• Improving provider experience of care (e.g., usability or satisfaction)?

• None of the above

Maturity of Standards and Technical Specifications for Data Element(s)

1. Does a vocabulary, terminology, content, or structural standard exist for this data element? (e.g., SNOMED CT, LOINC, RxNorm) (required)

   1. If yes, please cite the applicable standard (required)

2. Are there additional technical specifications such as an implementation guide (IG) or profile using this data element? (e.g. HL7® FHIR® US Core Implementation based on FHIR R4) (Yes/No/Unknown) (Required)

1. If yes, please cite the relevant technical specification(s).

3. How mature is the capture and access of this data element within a given organization’s health IT system(s)? It is(check all that apply): (required)

1. Not currently captured or accessed with an organization

2. In limited use in test environments only

3. In limited use in production environments

4. Extensively used in production environments

Please cite supporting artifacts (Optional) (free text, links, attachments)

4. With how many external organizations or individuals (including patients) has this data element been exchanged? (Required)

1. 0-1

2. 2-3

3. 4

4. 5 or more. This data element has been exchanged at scale between multiple production environments to support the majority of anticipated stakeholders.

Please cite supporting artifacts (free text, links, attachments)

Potential Challenges

1. Describe any restrictions on the standardization of this data element (e.g. proprietary code)? (Required)

2. Describe any restrictions on the use of this data element (e.g. licensing, user fees)? (Required)

3. Describe any privacy and security concerns with the use and exchange of this data element? (Required)

4. Please provide an estimate of overall estimate of burden to implement, if known. (Required)

5. Please provide information on other challenges to implementation (free text, optional)