ONC Standards Bulletin 2026-2

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 ONC on behalf of the U.S. Department of Health and Human Services (HHS). ONC publishes new versions of the USCDI annually, with a draft version released for comment 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. USCDI v7 includes new data elements to advance interoperability for patient care. This standards bulletin details updates to USCDI, including 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

As a baseline for data exchange, USCDI provides a standardized set of data elements for interoperability. 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 multiple purposes: patient matching, to identify patients within a document, a laboratory result, or an imaging report.

Annual USCDI updates help drive interoperability by keeping pace with clinical data and policy changes. ONC included USCDI v6 in the recently published SVAP Approved Standards for 2026, allowing health IT developers to upgrade their certified health IT products to that standard as of August 29, 2026.

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

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

United States Core Data for Interoperability Version 7

USCDI v7 includes 30 new data elements and one significantly revised data element (Tobacco and Nicotine Product Use, an evolution of the Smoking Status data element) for a total of 31 overall new data elements 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 that is available for nationwide interoperability, the new 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 31 overall new data elements, 15 data elements are already represented in implementation specifications required in the ONC Health IT Certification Program and are already largely supported by certified health IT. Their inclusion in USCDI v7 reflects ONC’s continued focus on aligning USCDI with interoperability capabilities that are already widely implemented. Other additions advance alignment with USCDI+ initiatives, including USCDI+ Quality, and reflect use of real-world program needs to inform USCDI. USCDI v7 also incorporated input submitted through the ONC New Data Element and Class (ONDEC) system, which enables the public to propose new data elements. Together, these sources, alongside administration priorities, help ONC assess technical maturity, implementation readiness, and broad applicability when identifying data elements for inclusion in USCDI.

New Data Elements Added to USCDI v7

Data Elements Not Currently Referenced in ONC Health IT Certification	Data Elements Already Required as part of Adopted Standards in ONC Health IT Certification *
Accommodation Adverse Event Condition + Adverse Event Outcome Allergy Intolerance Criticality Appointment Diagnostic Imaging Reference + Healthcare Agent + Medication Administration + Medical Device Order + Nutrition Assessment + Nutrition Order + Reason Not Performed + Referral Note Referral Order + Specimen Collection Method Tobacco and Nicotine Product Use	Condition Status + Deceased Indicator + Device Type + Diagnostic Report Date and Time  + Facility Telecom + Health Insurance Coverage Period + Health Insurance Payer + Health Insurance Plan + Health Insurance Plan Identifier + Immunization Record Source + Immunization Status + Medication Dispense Quantity + Patient Identifier + Procedure Status + Specimen Collection Date and Time

+ In USCDI+

* Already supported through HL7® FHIR® US Core

What’s New in USCDI v7

Adverse Events and Safety

USCDI v7 adds a new Adverse Events data class with two complementary data elements. Adverse Event Condition details a change to patient condition that could be an unintended effect of clinical interventions, such as medication reaction or vaccination reaction. Adverse Event Outcome documents the patient’s clinical outcome resulting from an adverse event, with examples including hospitalized, recovered, recovered with sequelae, and death. Health IT must be capable of exchanging these data elements for at least medication adverse events and immunization adverse events.**

Allergy Intolerance Criticality 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 differs from allergic reaction severity, which describes the intensity or seriousness of a specific allergic reaction. This data element helps distinguish high-risk allergies from lower-risk sensitivities, prioritize clinical decision support alerts, and support safer ordering.

Reason Not Performed specifies why an ordered test or planned activity did not occur, such as patient refusal, clinical contraindication, or logistical constraints. Exchange of Reason Not Performed supports quality measurement, interpretation of care gaps, and systemic analysis of factors that delay care delivery. Health IT must be capable of exchanging this data element for at least procedures, immunizations, and medications.

** This data class does not include the exchange of patient safety analyses, internal risk management documentation, or patient safety work products as defined under the Patient Safety and Quality Improvement Act of 2005 (42 U.S.C. 299b 21 et seq.) and implementing regulations (42 CFR part 3). It also does not include Patient Safety Organization (PSO) investigations, safety reviews, or facility-level reporting activities.

Care Coordination and Patient Context

Accommodation includes the supports and services necessary to access care, including modifications, tools, and technologies. Examples include sign language interpreters, wheelchair accessibility requirements, or sensory accommodation. Interoperability of accommodation information ensures that care teams across settings are aware of patient-specific access needs, thereby supporting care delivery, and removing barriers so everyone can pursue optimal health. In response to public feedback, the final USCDI v7 data element no longer includes SNOMED CT® as an applicable vocabulary standard.

Appointment represents the information about a scheduled healthcare event, such as the date, time, location, and provider(s). This data element is distinct from Encounter, which represents the clinical interaction that includes the service delivery and clinical diagnoses. Exchange of appointment information supports patient’s access to healthcare, referral management, patient reminders, care team coordination, and reduced missed visits.

Healthcare Agent identifies the person legally authorized to make healthcare decisions on behalf of a patient if the person cannot communicate with medical personnel. Sharing this information supports advance care planning and enables timely decision-making during care transitions and emergencies, when rapid identification of an authorized decision-maker can facilitate appropriate 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 housing services. Referral Note is a narrative summary of the clinical explanation and background information that helps the receiving provider understand the referral and provide care. This 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 strengthen referral management, support care coordination across specialties and organizations, and help ensure that patients receive timely access to needed healthcare services.

Clinical Care

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. Exchanging imaging references helps clinicians access relevant prior imaging, reduce duplicative imaging, and support diagnostic decision-making. Realizing these benefits requires interoperability agreements with the organizations hosting the PACS (Picture Archiving and Communication System) or imaging servers where studies are stored. While this data element does not by itself ensure image exchange from external PACS, it provides an important foundation for connecting clinical systems to the imaging information they need.

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 pacemaker, home blood pressure monitor, infusion pump, or durable medical equipment. The data element 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.

Medication Administration includes structured information about medications given to a patient, including medication, dose, route, timing, and site, when applicable. This data element complements Medication Order by documenting what occurred, supporting medication reconciliation, care transitions, and efforts to reduce medication errors.

Nutrition Assessment and Nutrition Order work together to support comprehensive nutrition care that is recognized as foundational to health outcomes across populations. Nutrition Assessment represents information about a person’s dietary intake. Nutrition Order describes a provider’s directions for diet and nutrition interventions, such as diet type, texture or allergy restrictions, and route of nutrition delivery. The capability to exchange these data elements supports an interoperable foundation for nutrition care that recognizes the central role of nutrition in preventing chronic disease and promoting overall health and well-being.

Specimen Collection Method details how a specimen was obtained, such as including venipuncture, swab, biopsy, aspiration, and catheter collection. The standardized exchange of this information provides context for specimen quality and laboratory result interpretation. In response to public feedback, USCDI v7 also adds Specimen Collection Date and Time to clearly capture when a specimen was obtained, separate from Performance Date and Time, reducing confusion between the timing of a procedure or intervention and the timing of specimen collection.

Tobacco and Nicotine Product Use updates the Smoking Status data element to more comprehensively include use of tobacco and nicotine products. In response to public feedback and through collaboration with federal partners, ONC revised the data element name and definition between Draft USCDI v7 and USCDI v7 to better reflect the range of tobacco and nicotine products. This expansion reflects the Food and Drug Administration’s (FDA’s) definition of tobacco use, which includes products such as cigarettes, e-cigarettes, vaping devices, and smokeless tobacco. The standardized exchange of Tobacco and Nicotine Product 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.

Other USCDI v7 Changes

The following updates were made to data classes and elements:

• SDOH Goals, SDOH Problems/Health Concerns, and SDOH Interventions are now included as examples of the broader data elements Patient Goal, Problem, and Procedure.
• Health Concern was moved to the Problems data class.
• Performance Date and Time and Indication were moved to the new Healthcare Information Attributes data class.
• Data element names were updated for clarity. Encounter Date and Time, Diagnostic Date and Time, and Performance Date and Time were revised to include “date and time” in each name to align with the data element definitions.
• The Medical Device data class definition was updated to align with the FDA definition of medical device.
• USCDI v7 introduces two new data classes: Adverse Events and Healthcare Information Attributes.
  • Adverse Events includes information about unintended effects associated with medications and immunizations and includes the data elements Adverse Event Condition and Adverse Event Outcome.
  • The Healthcare Information Attributes data class represents contextual information providing supporting details for healthcare data. This data class includes two new data elements, Diagnostic Report Date and Time and Reason Not Performed, and two existing elements relocated from other data classes, Indication and Performance Date and Time. Together, these data elements provide essential context that enhances the interpretability and clinical utility of healthcare data.

ONC updated the applicable vocabularies to the latest versions as of the publication of 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.

USCDI v8 Submission Period

With the publication of USCDI v7, ONC begins the next cycle to update USCDI to Version 8. The ONDEC submission system is open and accepting recommendations for data elements. ONC has updated the comment feature on the USCDI data element pages, making it easier to post comments on multiple data elements. In addition to proposals for new data elements, ONC invites feedback on existing data elements via the commenting feature on the USCDI data element pages.

ONC encourages the community to engage and collaborate. The open comment period ends Monday, September 28, 2026, at 11:59 PM ET.

ONC is targeting release of Draft USCDI v8 in January 2027.