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HHS Updates Interoperability Standards to Support the Electronic Exchange of Sexual Orientation, Gender Identity and Social Determinants of Health

The U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) today released the United States Core Data for Interoperability version 2 (USCDI v2), a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange.

With this new update, health IT stakeholders nationwide will have clearer direction toward the standardized, electronic exchange of social determinants of health (SDOH), sexual orientation, and gender identity (SO/GI) among several other updated data elements. This lays the foundation for the provider community to start systemizing the capture and use of SDOH and SO/GI data in the clinical setting. While encouraged, this update does not require health professionals, such as doctors and nurses, to record this data or individuals to share such data. It does however set a path forward for health IT to build in support for exchanging these data as they become applicable to an individual's care.

"USCDI version 2 builds on the feedback we received from a wide variety of stakeholders," said Micky Tripathi, Ph.D., national coordinator for health information technology. "We heard that this new version of the USCDI should reflect America's diversity and include data elements like sexual orientation, gender identity, and social determinants of health while helping to address disparities in health outcomes for minoritized, marginalized, and underrepresented individuals and communities."

The COVID-19 pandemic exposed many challenges in the nation's healthcare system and among them, the need for more reliable data to better understand the public health needs of all Americans – particularly vulnerable individuals or those long felt marginalized by the medical community. Currently, many health care facilities have not developed systems to collect structured SO/GI data from all patients. Without this information, lesbian, gay, bisexual, and transgender (LGBT) patients and their specific health care needs cannot be identified, targeted, and addressed. Similarly, without insights into social determinants factors that may be impacting one's ability to successfully manage their health, health professionals may be hampered from truly delivering quality care.

"The updated US Core Data for Interoperability takes an important step in reflecting the needs of all patients who access the nation's healthcare system," said Dr. Rachel Levine, HHS assistant secretary for health. "For accurate, compassionate, and safe care, it is important for a patient's sexual orientation and gender identity to be part of their care coordination and this new version helps prioritize next steps for the healthcare community as well as help identify patients' specific nonmedical needs— like housing, transportation, and poverty — that affect health to coordinate care and assistance to improve health outcomes."

More than 600 data classes and elements, including merged and duplicated data elements, were submitted by the health IT community as part of USCDI version 2's development cycle. The USCDI will continue to grow as standards mature and industry needs evolve. USCDI version 2 includes three new data classes and a total of 22 new data elements. Today's release makes USCDI version 2 available for consideration as part of ONC's Standards Version Advancement Process (SVAP), which will take place this fall. The SVAP allows health IT developers to update their certified health IT to support newer versions of the USCDI (among other standards) and provide those updates to their customers, including providers and hospitals, before they are required by regulation. Equally, USCDI version 2's release will kick-off additional work within standards development organizations to update implementation guides and other technical requirements to come into alignment with version 2's new data elements.

As required by ONC's Cures Act Final Rule published in May 2020, and in a subsequent interim final rule extending the compliance deadline published in April 2021, certain developers of certified health IT are required to provide their customers with upgraded certified health IT that supports USCDI version 1 by December 31, 2022. Any future versions of USCDI, as approved through the SVAP, would be voluntary for implementation until a new final rule is published requiring such an update.

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