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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

What is the UDS Modernization Initiative?

UDS modernization is a continuous effort to improve data content and reporting 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 redesigned parts of the UDS to increase data granularity and reduce UDS reporting burden by leveraging advances in health information technology and aligning with interoperability standards and reporting requirements being adopted across the U.S. Department of Health and Human Services and the healthcare industry. These redesigns will replace the existing table data elements aggregated at the health center level with patient-level data for the 2023 UDS report.

(Updated: 4/7/2022)

What is the purpose of UDS+?

The purpose of UDS+ is to facilitate patient-level reporting data that will better articulate the unique characteristics and needs of health center patients, illustrate the impact, breadth, and depth of health center services and their impact on health outcomes; better inform training, technical assistance, and research and evaluation efforts; and better inform health equity work.

(Added: 12/3/2021)

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, improving health centers’ and HRSA’s ability to communicate the complexity of the patient populations they serve and provide evidence for aligned reimbursements for care provided. 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. For example:

  • UDS+ will allow for a better understanding of the Health Center Program patient population by including both routine (i.e., patients who received care at least once during the reporting year and at least once during the previous year) and other patients. This information can help health centers better track health outcomes and identify trends or needs that can be used to inform policy and funding on two potentially distinct patient groups.
  • The shift to UDS+ will 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: 4/7/2022)

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. 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 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 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)

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 pilot projects. Please communicate your interest in joining the UTC via the BPHC Contact Form. Choose UDS, UDS Modernization, How to Get Involved.

(Updated: 5/27/2022)

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

HRSA is looking for volunteers to test two UDS+ FHIR servers, Azure and HAPI, using a draft FHIR Implementation Guide (IG). The IG will provide architectural details and technical reporting specifications for UDS+. Our target timeline to begin testing the draft IG is late 2022. 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 Get Involved.

(Added: 5/27/2022)

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 centers and other stakeholders will need a Bulk FHIR-enabled EHR system, a Backend Service App, and a Trust Services mechanism to support de-identification of patient personally identifiable information (PII).bulk . Health centers need to have this technology by mid- to late-2022.

(Added: 5/27/2022)

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

Participating health centers would conduct approximately 1-2 tests per year, but the time commitment would vary. The tests would not occur during UDS reporting periods.

(Added: 5/27/2022)

When will the UTC be engaged again for testing?

UTC testing is scheduled to reconvene in late-2022. Stakeholders who have indicated their interest in joining UTC testing via the BPHC Contact Form will be contacted when testing begins. In the interim, we encourage health centers, PCAs, EHR vendors, and HCCNs to review publicly available HL7 FHIR resources, including HL7 FHIR, the HL7 FHIR resources webpage, and the HL7 MedMorph home page.

(Added: 5/27/2022)

Implementation

What is the timeline for adopting UDS+?

UDS+ will become part of 2023 UDS reporting requirements. Health centers will need to adopt UDS+ when reporting CY 2023 UDS data (i.e., submission in February 2024).

(Added: 12/3/2021)

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

Beginning with the 2023 UDS reporting cycle, HRSA will accept patient-level report data using FHIR (Fast Healthcare Interoperability Resources) or alternatively through a manual file upload for the following UDS tables’ data elements:

  • 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

(Added: 12/3/2021)

What tables will continue to be accepted in the traditional 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

(Added: 12/3/2021)

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 in anticipation of CY2023 UDS reporting.
  • 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: 4/7/2022)

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 about the FHIR Fact Sheets.

(Added: 12/3/2021)

Is FHIR required for UDS+?

Although FHIR is not required to submit UDS+ for the calendar year 2023 UDS, HRSA highly encourages health centers to transition to the FHIR standard, have the capacity to support bulk FHIR, and consider submitting their 2023 UDS report using FHIR. For health centers that are unable to make the transition to FHIR by 2023 UDS, HRSA will accept patient level data via UDS+ File, which is a manual XML file upload.

(Updated: 5/27/2022)

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 FHIR IG should be available in late-2022. 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, and subscribe to the Primary Care Digest.

(Updated: 5/27/2022)

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+ testing activities.

(Added: 5/27/2022)

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 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 the Preliminary Reporting Environment (PRE) be available for both UDS+ and traditionally aggregated format tables for CY 2023?

The PRE will continue to be available for legacy UDS data reporting in CY 2023. The availability and functionalities of the PRE for UDS+-related data are in development.

(Added: 5/27/2022)

Funding Support, Training, and Technical Assistance

Will there be funding support to implement UDS+ reporting?

American Rescue Plan UDS+ Supplemental Funding was announced on April 22, 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. Applications are due May 23, 2022 at 5 pm ET and more information can be found on the BPHC website.

(Added: 5/27/2022)

Stakeholder Engagement and Feedback

How can health centers get more information about UDS+?

(Updated: 4/7/2022)

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

Health centers can submit concerns about their readiness to submit UDS+ data for the CY 2023 reporting period due February 15, 2024 via the BPHC Contact Form. Choose UDS, UDS Modernization, Patient-Level Submission (UDS+).

(Added: 5/27/2022)

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