The UDS Modernization Initiative aims to reduce reporting burden, improve data quality, and better measure program services and outcomes. The goal is to expand the value of UDS data to the Health Center Program while improving how health centers prepare and submit UDS data by focusing on four main areas:
- Reporting Modernization. Improve UDS reporting through advances in health information technology. This effort includes the UDS Patient Level Submission (UDS+) Initiative to transform aggregation of UDS clinical quality measures from health center- to patient-level data for the 2023 UDS report.
- Content Review. Update UDS tables and content to improve data standardization and quality, including clinical quality measure (CQM) alignment.
- Stakeholder Engagement. Get feedback from UDS stakeholders on proposed changes to UDS reporting processes, tables, and measures.
- Testing. Before implementing changes, testing innovations with health centers through the UDS Test Cooperative and other pilots (such as the UDS+ CAREWare Pilot).
For more detailed information about the initiative, visit UDS Modernization Frequently Asked Questions.
The UDS Patient-Level Submission (UDS+) is a redesigned section of the UDS report that will replace the existing patient-oriented tables, aggregated at the health center level, with patient-level data in the 2023 UDS report. The UDS+ Initiative aims to increase the utility of UDS report data and to reduce annual reporting burden by aligning with interoperability standards and reporting requirements used across the U.S. Department of Health and Human Services and within the healthcare industry.
BPHC launched a pilot program in 2019 based on CAREWare, a reporting tool used by many Ryan White HIV/AIDS Program Medical Providers, to work toward this UDS+ redesign.
Plans are underway to enable UDS+ reporting via FHIR (Fast Healthcare Interoperability Resources) as interoperability of electronic health information continues to improve with wider adoption of FHIR standards and associated clinical quality reporting architecture. FHIR is an application programming interface (API)-focused standard used to represent and exchange health information.
The UDS Modernization Initiative is starting to develop a UDS+FHIR process and is closely following advancements in FHIR-based reporting by work groups, industry members, and other federal agencies.
Completed Reporting Tools
Recently completed UDS Modernization projects have focused on creating reporting tools to help health centers submit UDS data via HRSA Electronic Handbooks (EHBs) system, including:
- Preliminary Reporting Environment (PRE): From October to December, health centers can use the PRE to enter UDS data before the official reporting season starts in January. This helps identify potential data reporting issues earlier and gives health centers additional lead time to prepare their data for submission.
- Offline Excel files: Health centers can download UDS tables in Excel to local computers and enter data from electronic health records, and then upload to EHBs. More than one person can fill out the tables at the same time. Health centers can use the error report to correct the data in Excel, or in the EHBs. Also, health centers can use the Excel mapping document as a guide to write commands that extract data and populate the Excel file.
- Hyper Text Markup Language (HTML) files: Health centers can download the UDS tables in a format that looks like what is in the EHBs. The HTML file validates data when information is entered. More than one person can enter data into different tables at the same time. As each staff member completes their part in Excel, health centers can import these data into the offline HTML file. Health center staff can also export certain data to share with colleagues for review before uploading into the EHBs.
Enhancements to UDS tables and content ensures consistent quality and value of UDS data to the Health Center Program. This process helps the program better measure health center services, clinical quality improvement, and the patient population.
Each year, changes to UDS tables and content are described in advance through Program Assistance Letters (PALs), Federal Register Notices, and the annual UDS Manual available on the UDS Resources webpage. They include aligning UDS clinical quality measures with Centers for Medicare and Medicaid Services (CMS) electronic-specified clinical quality measures (eCQMs).
Stakeholder engagement is key to the success of the UDS Modernization Initiative. 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 UDS stakeholders who test and offer feedback on proposed UDS changes and enhancements. The UTC includes staff from health centers, Primary Care Associations, Health Center-Controlled Networks, and Health IT Vendors. A Steering Committee of health center representatives from the ten HHS Regions leads the group.
Other feedback channels include interactive sessions with health centers, surveys and participation in pilot projects.
Ongoing and Future Testing
UDS+ CAREWare. The UDS+ CAREWare test is currently underway and accepting testing participants, including health centers and Health Center Controlled Networks (HCCNs).
The goals of the UDS+CAREWare test are to:
- Investigate data and reporting workflow at health centers, Primary Care Associations, and Health Center Controlled Networks.
- Rebuild CAREWare software to test a transition to a UDS+ patent level reporting structure and to output a test version of a UDS+ report file.
- Demonstrate the value and feasibility of transitioning the UDS to patient-level aggregated data (without compromising patient privacy and data security).
- Identify how health information technology and interoperability standards (such as FHIR) can facilitate UDS+ reporting in the future.
UDS+ FHIR. This initiative provides opportunities for participants to engage in tests of UDS+ data reporting via FHIR—especially of patient-level eCQMs and demographics information.
Contact us through the BPHC Contact Form if your organization or electronic health record (EHR) vendor is interested in volunteering to be a UDS+ FHIR tester. Choose UDS Modernization under the Uniform Data System (UDS) category, and then choose the “How to Get Involved” option.
A variety of UDS reporting innovations have been tested with stakeholders through the UDS Test Cooperative (note: updates to the UDS are initially presented in the Program Assistance Letters (PALs) and subsequently included in the annual UDS manuals). Completed tests include:
- Routine patient visits definition: Evaluating a data-driven definition for routine patient and visit counts (patients typically seen for primary or preventive care at a health center) using electronic standards to improve the accuracy of health center clinical performance by looking at:
- Whether clinical quality measure (CQM) scores reflect the quality of care given to well-established patients who have ongoing contact with their health center.
- If CQM scores change when non-routine patient data were included.
- Standardized countable visits reporting: Testing whether health centers can collect and report UDS countable visits by using electronic clinical quality measure (eCQM) standards from the National Library of Medicine. Using electronic standards increases data reliability, reduces inconsistent reporting of visits across health centers, and decreases reporting burden.
- Streamlined diagnoses and services reporting (UDS Table 6A). Aligning diagnoses and services in Table 6A with national, standard clinical language to improve consistency and accuracy and reduce reporting burden. Before this change, health centers interpreted and aligned diagnoses and services codes with UDS Table 6A and national systems, which created variation in data and additional burden.
- Financial tables redesign: Analyzing financial information collected in the UDS to find data that is rarely or inconsistently reported, not comparable to financial audits, and not reflective of a health center’s overall wellbeing.
- Contact us through the BPHC Contact Form if your organization is interested in learning more about UDS modernization efforts. Choose UDS Modernization under the Uniform Data System (UDS) category, and then choose the “How To Get Involved” option.
- Subscribe to the Primary Care Digest for updates about UDS modernization efforts.
- View Health Care Data Interoperability Resources (PDF - 112 KB) for information about health IT implementation from BPHC and its partners, other federal government agencies, and non-profit organizations.