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

Below are some common questions and corresponding answers about the UDS Modernization Initiative and UDS Patient-Level Submission (UDS+). New FAQs will be added as necessary.

• Background
• UDS+ Proof of Concept Testing
• Implementation
• FHIR
• Funding Support, Training, and Technical Assistance
• Stakeholder Engagement and Feedback

Background

What is the UDS Modernization Initiative?

UDS modernization is a continuous effort to improve UDS content, quality, and reporting procedures from participants of the Health Center Program. 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+?

The UDS Patient-Level Submission (UDS+) is an implementation of recent UDS modernization efforts. UDS+ has streamlined 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 U.S. Department of Health and Human Services and the healthcare industry. These redesigns will augment the existing table data elements aggregated at the health center level with de-identified patient-level data for the 2023 UDS report.

(Updated: 2/27/2023)

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-funded health centers. UDS+ data will inform programmatic decisions about the Health Center Program to better serve patients. 

De-identified patient level data will allow us 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 focus on delivering care to patients. Additionally, UDS+ will improve data quality and granularity and improve health centers’ and HRSA’s ability to communicate the complexity of the patient populations they serve. The data will help identify areas for reimbursing health centers for the valuable care they provide. 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. 

The shift to UDS+ 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. UDS+ will improve data granularity by:

• 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 every year for an annual exam 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+ is de-identified data that includes more granular information that provides more 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 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 align with CMS electronic clinical quality measures (eCQMs), allow for standardization of data, and reduce the potential for misinterpretation of measures or calculation errors.

(Added: 4/7/2022)

UDS+ Proof of Concept Testing

How can health centers participate in testing 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 UDS Test Cooperative (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, Primary Care Associations (PCA), Health Center-Controlled Networks (HCCN), and health information technology (IT) Vendors. A Steering Committee of health centers representing diverse HHS Regions lead the group. Other feedback channels include interactive sessions with health centers, surveys and participation in UDS+ proof of concept and testing projects. 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: 2/27/2023)

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

HRSA is currently seeking 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+. Our target timeline to begin testing the  IG is early 2023. 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 EHR vendor is interested in volunteering to be a UDS+ tester, please communicate your 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, EHR vendors, and other trusted third-party vendors.

(Added: 5/27/2022)

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

Health center EHR vendors will 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 EHR 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)

What is the status of the UTC? Are you still accepting participants?

The UTC is operational and conducting meetings with volunteer UTC members to provide the latest UDS+ updates and prepare for UDS+ FHIR proof of concept testing beginning in early 2023. If your organization is interested in participating in the UTC, please communicate your interest via the BPHC Contact Form. Choose UDS, UDS Modernization, How to Join the UDS Test Cooperative.

In the interim, we encourage health centers, PCAs, EHR vendors, and HCCNs to review publicly available HL7 FHIR resources, including HL7.org and the HL7 FHIR resources webpage.

(Updated: 2/27/2023)

Implementation

What is the timeline for adopting UDS+?

UDS+ will be part of 2023 UDS reporting requirements. Health centers will be able to report de-identified patient-level data for UDS+ applicable tables when reporting CY 2023 UDS data (i.e., submission in February 2024).

(Updated: 2/27/2023)

How will UDS+ change how health centers report UDS data?

During the first cycle of UDS+ reporting, HRSA will accept de-identified patient-level report data using FHIR (Fast Healthcare Interoperability Resources) for the following UDS tables:

• Patients by ZIP Code
• 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

Data for the following tables will continue to be reported in an aggregated format:

• Table 5: Staffing and Utilization
• Table 5: Selected Service Detail Addendum
• Table 8A: Financial Costs
• Table 9D: Patient Service Revenue
• Table 9E: Other Revenues
• Appendix D: Health Center Health Information Technology (HIT) Capabilities
• Appendix E: Other Data Elements
• Appendix F: Workforce

(Updated: 2/27/2023)

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.
• 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: 11/15/2022)

When do health centers need to stop using chart sampling?

Health centers will be required to report on their full universe of patients in the CY2022 UDS reporting cycle. By retiring chart sampling as a method for reporting on any of the clinical quality measures (CQMs) in UDS Tables 6B and 7, the data will provide a more accurate and complete reflection of the quality of care for all patients served, and better identify opportunities to improve care services.

(Updated: 4/7/2022)

How can health centers ensure their EHR vendor can submit UDS+ data?

HRSA encourages health centers, as EHR vendor clients, to collaborate with their EHR vendors directly to support the submission of timely and accurate UDS+ data. Additionally, health centers should ask their EHR vendors to consider participating in the UDS+ proof of concept and testing activities. 

(Updated: 7/25/2022)

Will health centers be able to review their UDS patient-level data before the submission is finalized?

Yes, health centers and other stakeholders will be able to review their UDS de-identified patient-level data before submission to HRSA is finalized. UDS+ reporting, review, and submission details will be detailed in the draft UDS+ FHIR IG that is currently in development.

(Added: 5/27/2022)

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. Please review the UDS+ FHIR IG for more information. If you need access to the UDS+ FHIR IG, please submit a request via the BPHC Contact Form.

(Updated: 2/27/2023)

How will the de-identification process work?

Data will be de-identified using Trust Services, which 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. The availability and functionalities of the PRE for UDS+-related data are in development.

(Updated: 11/15/2022)

FHIR

What is FHIR?

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: 12/3/2021)

Where can health centers learn about UDS FHIR specifications?

HRSA is currently developing a FHIR Implementation Guide (IG), which will provide architectural details and technical reporting specifications for UDS+. The most updated version of the FHIR IG should be available for proof of concept testing in early 2023. See the answer to “What will the UDS Test Cooperative (UTC) be testing next?” to learn how to get involved.

For the latest updates about the UDS+ FHIR IG, please check the UDS Modernization webpage, subscribe to the Primary Care Digest, or submit an inquiry through the BPHC Contact Form to join the UTC meetings.

(Updated: 11/15/2022)

Funding Support, Training, and Technical Assistance

Will there be funding support to implement UDS+ reporting?

American Rescue Plan UDS+ (ARP-UDS+) Supplemental Funding was awarded on August 8, 2022. These funds are being made available as needed 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)

How should health centers request more time to spend ARP-UDS+ Supplemental funding?

If a health center needs more time to complete its approved American Rescue Plan (ARP) activities, including those related to the ARP-UDS+ supplemental funding, the health center must submit an Extension Without Funds (no cost extension) Prior Approval Request through HRSA’s Electronic Handbooks (EHBs). Since ARP-UDS+ awards supplement H8F or L2C ARP awards, if the request is approved and the ARP period of performance is extended, the health center will have until the extended end date to complete its ARP-UDS+ activities. 

Health centers should make these requests beginning around two months ahead of the period of performance end date. The period of performance end dates are:

ARP (H8F)-funded health centers: Friday, March 31, 2023
ARP (L2C)-funded look-alikes: Friday, June 30, 2023

All extension requests are reviewed on a case-by-case basis and are subject to HRSA approval. If you expect to need such an extension, contact your Grants Management Specialist and Investment Oversight Advisor to discuss the requirements for submitting the request in EHBs.

(Updated: 2/27/2023)

Stakeholder Engagement 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.
• 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: 7/25/2022)

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)