Uniform Data System (UDS) Modernization Frequently Asked Questions (FAQ)

Below are common questions and corresponding answers about the UDS Modernization Initiative and UDS Patient-Level Submission (UDS+). Check back regularly as new questions may be added as necessary.

• Background
• UDS+ stakeholder engagement
• Implementation
• Funding support, training, and technical assistance
• Updates and feedback

Background

What is the UDS Modernization Initiative?

UDS modernization is a continuous effort to improve UDS content, quality, and reporting procedures. These efforts focus on reducing reporting burden and improving data quality and granularity to better evaluate Health Center Program services and outcomes. The goal is to optimize the use and value of UDS data for health centers and HRSA while improving how health centers prepare and submit UDS data.

(Updated: 4/7/2022)

What is the UDS+?

UDS Patient-Level Submission (UDS+) aims to streamline parts of the UDS by leveraging advances in health information technology and aligning with interoperability standards. These reporting standards are actively being adopted across the Department of Health and Human Services and the healthcare industry. Once UDS+ is fully implemented, health centers will submit de-identified patient-level data instead of aggregated data for existing patient-oriented table data elements. 

(Updated: 6/5/2023)

What is the purpose of UDS+?

The purpose of UDS+ is to provide HRSA with valuable insight into patients’ experience with receiving their care at HRSA-supported health centers. UDS+ data will inform programmatic decisions about the Health Center Program to better serve patients. 

De-identified patient level data will allow HRSA to cross-reference important factors that influence care seeking behavior, care received, and health outcomes. This information is critical in advancing quality improvement and health equity efforts for the Health Center Program, including tailoring technical assistance and funding opportunities. The ability to disaggregate and automate UDS reporting will help health centers improve patient care while simultaneously reducing reporting burden.

(Updated: 2/27/2023)

What are the benefits of UDS+ for health centers?

UDS+ will help reduce reporting burden so health centers can better focus on delivering care to patients. Additionally, UDS+ will improve data quality and granularity and improve the ability of health centers and HRSA to communicate the complexity of the patient populations served. The data will help identify areas for reimbursing health centers for the valuable care provided. De-identified patient-level data also allows for communities, local, state, and federal agencies to better evaluate the Health Center Program; provide targeted training and technical assistance; and advance quality improvement research to improve equitable access to high-quality, cost-effective care. 

This shift will also prepare health centers for reporting their data in accordance with federal interoperability standards. Health centers will be able to electronically report data from their electronic health record (EHR) system with a UDS module and reduce reliance on manual data entry.

(Updated: 2/27/2023)

What are some examples of how UDS+ will improve data granularity?

Data granularity is the level of detail in a database. Granular data can be aggregated and disaggregated to meet the needs of different situations. Examples of expected benefits of improved data granularity through UDS+ include:

• Better understanding needs, interventions, and health outcomes of special populations: For example, veterans experiencing homelessness often have unique health needs and might be eligible to receive support from specific programs designed to provide care to this population. Currently, UDS data cannot show the number of patients who are veterans and experiencing homelessness; it can only show the total number of veterans and the total number of individuals experiencing homelessness within a given health center’s patient population. De-identified patient-level data will allow quality improvement staff, researchers, policymakers, and other stakeholders to identify needs of health center patients and allocate resources accordingly.
• Collecting "routine patient” indicators: For example, health outcomes of routine patients who visit a health center regularly could be analyzed separately from patients who only visit a health center once.

(Added: 12/3/2021)

What is patient-level data reporting referring to in UDS+?

Patient-level data in UDS+ are de-identified data that provide robust information about patients receiving their care at health centers without compromising their privacy. UDS+ will not contain data copied directly from patients' electronic medical record (EMR) and will not contain patient identifiers to ensure the privacy of the individual.

(Added: 12/3/2021)

How can reporting patient-level data reduce reporting burden?

Traditionally, UDS data are generated through health centers’ EHR systems by looking through patient records. The information is then aggregated at the health center level. By reporting de-identified patient-level data, health centers will be able to leverage technology to bypass the manual aggregation step. Adoption of Fast Healthcare Interoperability Resources (FHIR®) standards aligns with CMS electronic clinical quality measures (eCQMs), allows for standardization of data, and reduces the potential for misinterpretation of measures or calculation errors.

(Added: 4/7/2022)

What is HL7® FHIR® R4?

FHIR® stands for Fast Healthcare Interoperability Resources. Plans are underway to enable UDS+ reporting via FHIR®, an application programming interface (API)-focused standard that enables quick and efficient exchange of health data. Interoperability of electronic health information continues to improve with wider adoption of FHIR® standards and associated clinical quality reporting architecture. Learn more by accessing the FHIR® Fact Sheets.

(Added: 6/5/2023)

UDS+ stakeholder engagement

How can health centers participate in modernization efforts?

Stakeholder engagement is key to the success of the UDS Modernization Initiative overall, and UDS+ implementation. Health centers and other UDS stakeholders have many opportunities to share their feedback on UDS Modernization activities. The UTC consists of a diverse group of stakeholders who test and offer feedback on proposed UDS changes and enhancements. The UTC includes staff from health centers, PCAs, HCCNs, and HIT vendors. A Steering Committee of health centers representing diverse HHS Regions lead the group. 

Please communicate your interest in joining the UTC via the BPHC Contact Form. Choose UDS, UDS Modernization, How to Join the UDS Test Cooperative. 

(Updated: 6/5/2023)

What is the Health Center Program Community (HCPC) UDS+ Page?

Stakeholder engagement is also facilitated through the Health Center Program Community (HCPC) on BPHC’s Salesforce platform, which includes a UDS+ page with:

• UDS+ updates and announcements
• Calendar of UDS+ events and links to scheduled UTC meetings
• Archived UTC meeting presentations and recordings
• Training and technical assistance resources and opportunities

If your organization is a health center, PCA, HCCN, or NTTAP, access to the HCPC may be requested by submitting a ticket through the BPHC Contact Form and selecting Uniform Data System (UDS), UDS Modernization, How to Join the UDS Test Cooperative.

(Added: 6/5/2023)

What will the UDS Test Cooperative (UTC) be testing next?

HRSA continues to seek volunteers to engage in UDS+ proof of concept and testing activities, including testing two data receiving endpoints that support FHIR®, using the most updated version of the FHIR® Implementation Guide (IG). The IG will provide architectural details and technical reporting specifications for UDS+. Health centers will test the servers’ functionality and ability to receive comprehensible UDS+ data files. Additionally, these tests will be used to ensure the accuracy and validity of UDS+ data elements. If your organization or your HIT vendor is interested in volunteering to be a UDS+ tester, please communicate interest to HRSA using the BPHC Contact Form. Choose UDS, UDS Modernization, How To Join the UDS Test Cooperative.

(Updated: 2/27/2023)

Who is eligible to be a test site?

Health centers, PCAs, HCCNs, and HIT vendors.

(Added: 5/27/2022)

What technology do health centers need in place to be a test site?

Health center HIT vendors must have the infrastructure needed to support UDS+ reporting, such as Bulk FHIR®-enabled EHR system, a Backend Service App, and a Trust Services mechanism to support de-identification of patient data before sending to HRSA. Health centers will need to work with their HIT vendors to prepare for UDS+ reporting.

(Updated: 11/15/2022)

What is the time commitment of being a UTC test site?

The time commitment will vary and tests will not occur during UDS reporting periods. HRSA is currently working to finalize the test kits.

(Updated: 2/27/2023)

Implementation

What are the CY 2023 UDS Reporting Requirements?

All health centers are to submit a full UDS Report within EHBs by February 15, 2024.

Beginning with the 2023 UDS reporting, in addition to an aggregate UDS Report submission with EHBs, health centers may also voluntarily submit de-identified patient-level data (UDS+) using HL7® FHIR® R4 standards for the following UDS tables:

• Patients by ZIP Code Tables
• Table 3A: Patients by Age and by Sex Assigned at Birth
• Table 3B: Demographic Characteristics
• Table 4: Selected Patient Characteristics
• Table 6A: Selected Diagnoses and Services Rendered
• Table 6B: Quality of Care Measures
• Table 7: Health Outcomes and Disparities

Information about 2023 UDS reporting, including the 2023 UDS Manual and Program Assistance Letter (PAL) as well as other resources, will be posted on the UDS Training and Technical Assistance page.

(Updated: 6/5/2023)

What if my UDS+ FHIR® data is inconsistent with my UDS data submission via EHBs?

Submissions using UDS+ FHIR® for CY 2023 reporting are not required and health centers will not be penalized for any variations between data submitted using FHIR® compared to EHBs. Voluntary reporting of UDS+ patient-level data will help you and HRSA understand any challenges with data submission and the impact of patient-level reporting on final UDS reports. These findings will inform our approach in future reporting periods. 

(Updated: 6/5/2023)

If a health center elects to submit UDS data via EHBs and UDS+ via FHIR®, which submission will count as the official submission of record?

The full UDS Report submission within EHBs will be the health center’s official submission of record for CY 2023.

(Updated: 6/5/2023)

What are the benefits of submitting via UDS+ FHIR® for CY23 UDS Reporting?

Health centers that elect to submit using UDS+ FHIR® will distinguish themselves as leading the way toward patient-level data reporting and will help HRSA gain better insight into the impact and needs of the Health Center Program. HRSA encourages UDS stakeholders that are able to submit patient-level data via UDS+ FHIR® to do so to the extent possible.

(Updated: 6/5/2023)

What is the timeline for adopting UDS+?

For CY 2023 UDS reporting, UDS+ FHIR® submission will be optional. To be optimally prepared for future reporting periods, HRSA highly encourages health centers to transition to the FHIR® standard and have the capacity to support bulk FHIR® as early as possible. HRSA will provide updates related to CY 2024 UDS reporting requirements once reporting details have been finalized.

(Updated: 6/5/2023)

How can health centers prepare for UDS Modernization overall and UDS+ implementation?

• Begin discussions with UDS stakeholders (e.g., health IT staff and vendors) to understand UDS+ requirements.
• Review publicly available HL7® FHIR® resources, including HL7.org and the HL7® FHIR® resources page.
• Collaborate with your HIT vendors directly and encourage them to consider participating in the UDS+ proof of concept and testing activities.
• Visit the UDS Modernization Initiative webpage to learn more.
• Submit questions about UDS Modernization through the BPHC Contact Form. Choose UDS, UDS Modernization, Patient-Level Submission (UDS+).

(Updated: 6/5/2023)

Will health centers be able to review their UDS patient-level data?

Yes, HRSA is developing a mechanism to allow health centers to review their UDS+ submission. UDS+ review and submission functionality is in development and HRSA will provide details on these at a later time. 

(Updated: 6/5/2023)

Will health centers be able to validate submitted UDS+ data to ensure accuracy?

There are layers of validation built into the FHIR® transactions, but HRSA is also developing internal business logic to perform validation analyses on the submitted patient level data. UDS+ review functionality is in development and HRSA will provide details on these at a later time. 

(Updated: 6/5/2023)

How will the de-identification process work?

Data will be de-identified at the health center level using Trust Services before submission to HRSA. De-identification details will be outlined in the UDS+ FHIR® IG. Health centers are encouraged to work with their vendors directly to develop a strategy and plan for submission to HRSA. If you need access to the UDS+ FHIR® IG, please submit a request via the BPHC Contact Form.

(Updated: 2/27/2023)

Will the Preliminary Reporting Environment (PRE) be available for both UDS+ and traditionally aggregated format tables?

The PRE will be made available for traditionally aggregated format UDS tables. UDS+ review and submission functionality is in development and HRSA will provide details on these at a later time. 

(Updated: 6/5/2023)

Funding support, training, and technical assistance

What is the funding support to implement UDS+ reporting?

American Rescue Plan UDS+ (ARP-UDS+) Supplemental Funding was awarded on August 8, 2022. These funds were made available to support high-quality, patient-level Uniform Data System (UDS+) data submissions consistent with HRSA’s UDS Modernization Initiative. More information can be found on the BPHC website.

Additionally, HRSA added a one-time $40,817 funding supplement to FY 2022 Health Center Controlled Network awards to further support health centers with leveraging health information technology and data to deliver high-quality, culturally competent, equitable, and comprehensive primary health care, with a specific focus on improvements in clinical quality, patient-centered care, and provider and staff well-being. This funding may be used to support training and technical assistance (T/TA) on Uniform Data System (UDS) modernization efforts, also known as UDS+, for participating health centers in your networks. More information can be found on the BPHC website.

(Updated: 9/16/2022)

Where should I go for training and technical assistance on Fast Healthcare Interoperability Resources (e.g., Bulk FHIR® API, SMART on FHIR®, USCDI/US Core, FHIR® Server, and FHIR® Client, etc.)?

Health centers, PCAs, and NTTAPs are encouraged to contact their HCCNs or HIT vendors as training and technical assistance resources. Additionally, HRSA recommends that health centers reference and review publicly available HL7® FHIR® resources on HL7.org.

(Added: 6/5/2023)

Updates and feedback

How can health centers get more information about UDS+?

• Learn more about UDS+, patient-level reporting, and FHIR® by visiting the Uniform Data System (UDS) Modernization Initiative webpage.
• Join the UTC to receive the latest updates on the UDS+ initiative. Request to join using the BPHC Contact Form. Select UDS, UDS Modernization, How to Join the UDS Test Cooperative.
• Subscribe to the Primary Care Digest to receive updates about UDS+, including training and technical assistance opportunities.
• Submit questions about UDS+ through the BPHC Contact Form. Choose UDS, UDS Modernization, Patient-Level Submission (UDS+).

(Updated: 6/5/2023)

Where should I submit concerns about readiness to submit UDS+ data?

Health centers can submit concerns about their readiness to submit UDS+ data via the BPHC Contact Form. Choose UDS, UDS Modernization, Patient-Level Submission (UDS+).

(Updated: 11/15/2022)