ASTP/ONC Standards Bulletin 2026-1

The USCDI sets the foundation for the access, exchange, and use of electronic health information with the goal of enabling nationwide interoperable health information exchange. The USCDI standard is stewarded and adopted by ASTP/ONC on behalf of the U.S. Department of Health and Human Services (HHS). ASTP/ONC publishes new versions of the USCDI annually, with a draft version released in January and a final version released in July. This publication schedule allows the USCDI to keep pace with clinical, technological, and policy changes that influence the use of clinical and related terminology. Draft USCDI v7 includes new data elements to advance interoperability for patient care. SB26-1 details ASTP/ONCʼs updates to USCDI, including ASTP/ONCʼs consideration of submissions for new data elements, stakeholder comments on previously submitted data elements, and the evolving maturity of data elements specified in the USCDI+ Program.

Background: United States Core Data for Interoperability

ASTP/ONC adopted USCDI version 3 (USCDI v3) as a standard (45 CFR 170.213) and required USCDI v3 for certain certification criteria within the ONC Health IT Certification Program as adopted in the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Final Rule (89 FR 1192). On March 21, 2025, consistent with EO 14168, ASTP/ONC exercised enforcement discretion and issued certification guidance for the ONC Health IT Certification Program with respect to certain data elements in USCDI v3. ASTP/ONC subsequently released USCDI version 3.1 (USCDI v3.1), which reflects the removal of the relevant data elements from USCDI v3. Then on Dec. 15, 2025, ASTP/ONC released the Health Data, Technology, and Interoperability: ASTP/ONC Actions to Unleash Prosperity (HTI-5) proposed rule, which proposed to adopt USCDI v3.1.

As a baseline for data exchange, USCDI provides a standardized set of data elements for interoperability. The USCDI groups data elements into data classes that share a common theme, without limiting how or in what contexts the elements may be used or exchanged. For example, the First Name and Last Name data elements are grouped into the “Patient Demographics/Information” data class, and are used for patient matching, and these data elements can also be used to identify patients within a document, a laboratory result, or an imaging report. Likewise, the data element Performance Time in the “Healthcare Information Attributes” data class can be used to indicate the time of day when a skin biopsy is performed and can also be used to indicate the time when an electrocardiogram (EKG) is performed.

Annual USCDI updates help drive interoperability by keeping pace with clinical, technology, and policy changes. ASTP/ONCʼs Standards Version Advancement Process (SVAP) enables participants in the ONC Health IT Certification Program to voluntarily use newer versions of specific ASTP/ONC regulated standards and implementation specifications in their products, including newer USCDI versions. ASTP/ONC included USCDI v5 in the recently published SVAP Approved Standards for 2025, allowing health IT developers to upgrade their certified health IT products to that standard as of Aug. 29, 2025. ASTP/ONC also included USCDI v3.1 in the SVAP Approved Standards for 2025.

Consistent with the HHS Health IT Alignment Policy, HHS-funded and HHS-regulated programs also reference USCDI. For example, CMSʼs Interoperability and Prior Authorization Final Rule (CMS-0057-F) and the Trusted Exchange Framework and Comment Agreement^TM (TEFCA)^TM require the ability to exchange USCDI data elements.

USCDI also serves as the foundation for datasets developed as part of the ASTP/ONC USCDI+ Program, which identifies extensions to USCDI made to meet specific programmatic and/or use case requirements. Public feedback highlighted several data elements in the USCDI+ Program as technically mature and broadly applicable in healthcare, and therefore are candidates for addition to Draft USCDI v7.

Draft United States Core Data for Interoperability Version 7

Draft USCDI v7 reflects ASTP/ONC’s ongoing commitment to expanding standardized health data exchange to support improved patient care, enhanced nationwide health, greater affordability, and reduced clinician burden. Draft USCDI v7 includes 29 proposed data elements and one significantly revised data element (Tobacco Use, an evolution of the Smoking Status data element) for a total of 30 overall proposed data element additions across multiple data classes. This update was informed by extensive stakeholder feedback and aligned with evolving healthcare priorities. By expanding the scope of standardized data, this version strengthens support for patient safety, nutrition care, and administrative burden reduction in alignment with national health and wellness priorities to Make America Healthy Again.

Of the 30 overall proposed data elements, 13 are already represented in exchange specifications required in the ONC Health IT Certification Program, and thus, already largely supported by certified health IT. The addition of these data elements to USCDI should not require new standards development or certified health IT to make any changes to current exchange capabilities. Of the remaining 17 proposed data elements, nine are also referenced in USCDI+ initiatives such as USCDI+ Quality. The remaining eight were derived from the ONC New Data Element and Class (ONDEC) submission system, which collects proposals for new data classes and data elements from the public. In addition to proposals for new data elements, ASTP/ONC invites feedback on existing data elements via the commenting feature on the USCDI data element pages. Further, ASTP/ONC uses feedback on our USCDI+ datasets to grade the technical maturity and breadth of applicability of its data elements, which in turn can be considered for inclusion in Draft USCDI v7.

New Data Elements and Classes Added to Draft USCDI v7

NEW DATA CLASS Adverse Events	Allergies and Intolerances	Care Team Members
Adverse Event + Adverse Event Outcome	Allergy Intolerance Criticality	Healthcare Agent +

Clinical Notes	Diagnostic Imaging	Encounter Information
Referral Note	Diagnostic Imaging Reference +	Appointment

Facility Information	NEW DATA CLASS Healthcare Information Attributes	Health Insurance Information
Facility Telecom S	Reason Not Performed + Diagnostic Report Date + S	Health Insurance Coverage Period + S Health Insurance Payer S Health Insurance Plan + S Health Insurance Plan Identifier + S

Health Status Assessment	Immunizations	Laboratory
Nutrition Assessment + Tobacco Use*	Immunization Status + S Immunization Record Source + S	Specimen Collection Method

Medical Devices	Medications	Orders
Device Type + S	Medication Administration + Medication Dispense Quantity + S	Medical Device Order + Nutrition Order + Referral Order

Patient Demographics/ Information	Problems	Procedures
Accommodation Deceased Indicator + Patient Identifier + S	Condition Status + S	Procedure Status + S

+ In USCDI+

S US Core Must Support

*Significantly modified data element (see more information below)

What’s New in Draft USCDI v7

Adverse Events and Safety

Draft USCDI v7 introduces a new Adverse Events data class with two complementary data elements. Adverse Event details a change to patient condition that could be an unintended effect of clinical interventions (such as medication reaction or vaccination reaction), providing essential information for patient safety monitoring and quality improvement activities. Adverse Event Outcome documents the patient’s clinical outcome resulting from an adverse event, with examples including hospitalized, recovered, recovered with sequelae, death. Together, these data elements support comprehensive adverse event tracking across care settings, enabling healthcare organizations to identify patterns, implement preventive measures, and improve treatment protocols. The interoperable exchange of adverse event information enhances patient safety by ensuring that all members of a care team are aware of previous adverse events, supports regulatory reporting requirements, and provides the data foundation necessary for analyzing and reducing preventable harm in healthcare delivery.

Allergy Intolerance Criticality is a new data element that indicates the potential severity of harm if a patient is re-exposed to a substance that has caused or is expected to cause an allergic or intolerance reaction. This data element addresses a critical gap in allergy documentation by enabling clinicians to distinguish between reactions that are potentially life-threatening—such as anaphylaxis to peanuts—and those that are uncomfortable but less severe, such as a mild rash from a medication. By supporting clinical decision support, allergy notification prioritization, and safe ordering of medications, foods, contrast agents, and other substances across care settings, criticality information becomes a vital component of patient safety infrastructure. The standardized exchange of this data element helps health IT developers and implementers align allergy documentation and alerting behavior, reduces alert fatigue by differentiating high-priority from lower-priority allergies, and improves patient safety during care transitions, emergency encounters, and pharmacy dispensing workflows.

Reason Not Performed specifies structured information about why an ordered test, procedure, immunization, or other planned intervention did not occur, such as patient refusal, clinical contraindication, or logistical constraints. The consistent exchange of Reason Not Performed supports accurate quality measurement by helping distinguish between true care gaps and documented decisions not to proceed with care, interpreting apparent gaps in population health analytics, and can be leveraged in safety and operational reviews to identify systemic issues that prevent care delivery.

Care Coordination and Patient Context

Appointment represents the administrative booking and scheduling of a healthcare event, focusing on logistics such as date, time, location, and participating providers. This data element is distinct from Encounter, which represents the clinical interaction including the service delivery and clinical diagnoses. The standardized exchange of appointment information addresses a critical gap in care coordination by enabling consistent sharing of scheduling logistics across systems, supporting referral management, reducing missed visits, and ensuring that patients and care teams have aligned expectations about upcoming care activities.

Healthcare Agent identifies an individual legally authorized to make healthcare decisions on behalf of a patient if the person cannot communicate with medical personnel. The consistent exchange of healthcare agent information ensures care teams across settings know who has legal authority to participate in care decisions, empowering patient autonomy and alignment with advance care planning documentation. This data element is particularly important during care transitions and emergency situations when rapid identification of authorized decision-makers can facilitate appropriate and timely care.

Referral Order represents a provider-authored request to another provider, specialist, or organization for care services, such as a referral order from a primary care provider to a wound care specialist or podiatrist. Referral Note provides a narrative summary that may include the reason for referral, relevant patient history, and requested services or questions to support continuity and coordination of care between providers. Together, these data elements create a more complete referral workflow, ensuring that receiving providers have both the structured order information and the clinical context necessary to deliver appropriate care. The interoperable exchange of referral orders and notes reduces redundant communication, supports care coordination across specialties and organizations, and helps ensure that patients receive timely access to needed specialty services.

Accommodation includes information about modifications, tools, technologies, and other supports necessary to enable a patient to access care. This data element can include, for example, sign language interpreters, wheelchair accessibility requirements, or sensory accommodation. The standardized exchange of accommodation information ensures that care teams across settings are aware of patient-specific access needs, supporting care delivery, and removing barriers so everyone can pursue optimal health.

Deceased Indicator specifies whether a patient is known to be deceased, typically represented as a yes/no flag that may be used in conjunction with separate elements for date or cause of death where available. While seemingly straightforward, the reliable exchange of deceased status is essential for accurate patient identification and matching across systems, prevents inappropriate outreach or scheduling that can cause distress to family members, and reduces the likelihood of erroneous clinical or administrative actions. This indicator is used for organ donation too when a date of death has not been recorded and is required for reporting vital statistics.

Clinical Care

Medical Device Order represents a provider-authored request to initiate, modify, or discontinue the use of a medical device for a patient, such as a home blood pressure monitor, infusion pump, or durable medical equipment. The inclusion of Medical Device Order in USCDI supports coordination between clinicians, suppliers, and payers by creating a standardized way to communicate device-related care plans, helping track device-related care across settings, and reducing administrative burden and duplicative purchasing associated with coordinating device orders and delivery.

Diagnostic Imaging Reference represents a link or other computable reference that enables access to diagnostic imaging studies, a series, or individual images associated with a patient encounter. The ability to consistently exchange imaging references across networks and organizations directly supports improved diagnostic decision-making by ensuring that relevant prior studies are available when and where they are needed. Realizing these benefits requires interoperability agreements with the organizations hosting the PACS (Picture Archiving and Communication System) or imaging servers where studies are stored. This capability reduces duplicative imaging and associated radiation exposure, benefiting both patient safety and healthcare efficiency.

Nutrition Assessment and Nutrition Order work together to support comprehensive nutrition care that is increasingly recognized as foundational to health outcomes across populations. Nutrition Assessment represents structured findings from a clinician’s or care team’s evaluation of a patient’s nutritional status, needs, and risks. This could include screening results indicating risk for malnutrition, documentation of unintentional weight loss, information on food intake patterns, or findings related to conditions such as obesity, undernutrition, and nutrition-related complications. Nutrition Order describes a provider’s directions for a patient’s dietary intake and related nutrition interventions, such as diet type, caloric goals, texture or allergy restrictions, and timing or route of nutrition delivery.

Standardizing nutrition assessment and orders supports safe transitions of care, reduces errors in diet and feeding instructions, and enables better integration of nutrition into care planning for patients with chronic conditions, acute illness, or special dietary needs. These data elements will help support an interoperable foundation for nutrition care that recognizes the central role of nutrition in preventing chronic disease and promoting overall health and wellbeing.

Tobacco Use is a revised data element that expands the Smoking Status data element to more comprehensively capture information about a patient’s use of tobacco and nicotine products. This expansion reflects the Food and Drug Administration’s definition of tobacco use, which includes products such as e-cigarettes, vaping devices, and smokeless tobacco, in addition to traditional cigarettes. The standardized exchange of Tobacco Use information enables more complete risk assessment, supports targeted cessation interventions, and improves public health surveillance of evolving tobacco and nicotine consumption patterns across diverse product types.

Specimen Collection Method details the technique or procedure used to obtain a specimen from a patient, with examples including venipuncture, swab, biopsy, aspiration, and catheter collection. The standardized exchange of this information provides essential context for interpreting laboratory results, as collection method can affect specimen quality and test accuracy.

Medication Administration includes structured information about medications given to a patient, including details such as the administered drug, dose, route, timing, and site when applicable. This data element complements the existing Medication Order data element by documenting what was carried out rather than what was ordered. The ability to exchange accurate medication administration information supports the creation of complete medication histories, enables effective medication reconciliation across care settings, and helps reduce medication errors by ensuring that all members of a care team have access to current information about what medications have been given.

Other Draft USCDI v7 Changes

The following updates would be made to data classes and elements:

• SDOH Goals, SDOH Problems/Health Concerns, and SDOH Interventions are included as examples of the broader data elements Patient Goal, Problem, and Procedure.
• Health Concern has moved to the Problems data class.
• Performance Time and Indication have moved to the new Healthcare Information Attributes data class.
• Data element names have been updated for clarity.
• Draft USCDI v7 introduces two new data classes: Adverse Events and Healthcare Information Attributes.
  • Adverse Events includes information about unintended effects associated with clinical interventions and includes the data elements Adverse Event and Adverse Event Outcome.
  • Healthcare Information Attributes data class that represents contextual information providing supporting details for healthcare data. This data class includes two new data elements, Diagnostic Report Date and Reason Not Performed, and two existing elements relocated from other data classes, Indication and Performance Time. Together, these data elements provide essential context that enhances the interpretability and clinical utility of healthcare data.

ASTP/ONC updated the applicable vocabularies to the latest versions as of the publication of Draft USCDI v7. Quality patient care depends on the availability of current terminology for code systems such as SNOMED Clinical Terms® U.S. Edition, Logical Identifiers Names and Codes® (LOINC), RxNorm, and others. Health IT developers are encouraged to make the most up-to-date terminology available to their customers.

ASTP Requests Specific Feedback

With its publication, Draft USCDI v7 is open for public comment until April 13, 2026, at 11:59 pm ET. In addition to the feedback requested above, ASTP is seeking feedback on any aspect of Draft USCDI v7 and is requesting specific input on the following areas:

1. Suggestions for improvement in the data classes or elements in Draft USCDI v7, including:
   1. Data class and element definitions, usage notes, and examples; and
   2. Examples of code systems used by health IT developers and implementers to communicate data element scope.
2. Should other existing Level 2 data elements be added to USCDI v7 instead of, or in addition to, those in Draft USCDI v7?  If so, why?
3. What additional Level 2 data elements or USCDI+ data elements are appropriate for inclusion in USCDI v7, and why?
4. Are there significant barriers to development, implementation, or use of any of these data elements that warrant a change in the final version of USCDI v7?
5. ASTP/ONC seeks input on the Tobacco Use data element, including the optimal approach for representing this information in USCDI.

ASTP/ONC is working with the public and our sister federal agencies to find areas that need more attention in future versions of USCDI. To help address specific use cases that need aligned datasets beyond USCDI, ASTP/ONC continues to work with governmental and industry partners through the USCDI+ Program. Where appropriate, ASTP/ONC will consider data elements from the USCDI+ Program for inclusion in USCDI.

ASTP/ONC is targeting release of the final USCDI v7 in July 2026.