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Uniform Data System (UDS) Modernization Initiative

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Focus areas

Health Center Program awardees and look-alikes must report on a core set of data and measures each calendar year as defined in the Uniform Data System (UDS), a standardized reporting system. HRSA uses UDS data to assess the impact and performance of the Health Center Program and to promote data-driven quality improvement.

The UDS Modernization Initiative will modernize the UDS data set and the technology that supports the submission, collection, and analysis of UDS data. Our goals are to: 

  • Reduce reporting burden for health centers
  • Create transparency across the UDS data life cycle
  • Demonstrate the value of the Health Center Program

We focus on three main areas:

  • Reporting modernization: Improve UDS reporting through advances in health information technology. 
  • Stakeholder engagement: Get feedback from UDS stakeholders on proposed innovations or changes to reporting processes, tables, and measures. This may include testing.
  • Content review: Update UDS tables and content to improve data standardization and quality, including through clinical quality measures (CQM) alignment with updated specifications.

Reporting modernization

The importance of patient-level data

UDS+ is the electronic submission of de-identified patient-level data from health centers to HRSA through automated reporting platforms. Automating UDS reporting will eventually eliminate the need for health centers to dedicate resources required to manually enter UDS data into the EHBs, while simultaneously allowing health centers to submit more granular, specific data about their patient population. 

Through UDS+, health centers will submit de-identified patient-level data instead of aggregated data for existing patient-oriented tables. De-identified data elements include information related to: 

  • Health center patient demographics
  • Health center services utilized
  • Select electronic Clinical Quality Measures (eCQMs)

De-identified patient-level data allows HRSA to cross-reference important factors that influence care-seeking behavior, care received, and patient health outcomes. This information is critical for advancing quality improvement and health outcomes 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 also reducing reporting burden. View UDS+ Frequently Asked Questions to learn more.

Transparency through engagement

We are working closely with our federal partners, health centers, and health information technology (HIT) vendors to test UDS+ implementation with de-identified data elements that include information related to health center patient demographics, services utilized, and select eCQMs.

We are seeking volunteer health centers to help test UDS+ with their 2023 UDS reporting and provide feedback on UDS+ implementation. To learn more about UDS+ and volunteer, join the UDS Test Cooperative (UTC) and review our UDS+ Cohort Model One-pager (PDF - 91 KB). You may join the UTC even if you choose not to voluntarily submit UDS+ data for 2023 reporting.

New technical standards

UDS+ aims to increase the utility of UDS report data and to reduce the 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.

Alignment and standardization are important to support the interoperability of electronic health information through standard application programming interfaces (API). Fast Healthcare Interoperability Resources (FHIR®) is an API with standards and an associated clinical quality reporting architecture that is used to represent and exchange health information. 

We have developed a UDS+ FHIR® data receipt and submission process. Health centers will use Health Level Seven International (HL7®) developed FHIR® version release 4 (R4) standards. The UDS+ FHIR ® Implementation Guide provides technical specifications for UDS+ and is available on the HL7® website. 

Stakeholder engagement

Stakeholder engagement is key to the success of the UDS Modernization Initiative. We convene the UTC to obtain stakeholder feedback on needs and proposed innovations. UTC members have tested a variety of UDS reporting innovations, including:

  • Routine patient visits definition (Completed in 2020): Using electronic standards to improve the accuracy of health center clinical performance by evaluating: 
    • Whether CQM scores reflect the quality of care given to well-established patients who have identified their health center as their medical home.
    • If CQM scores change when non-routine patient data were included in performance calculations.
    • Routine patient tests showed a meaningful difference in CQM performance by separating routine and non-routine patients. 
  • Standardized countable visits reporting (Completed in 2020): Testing whether health centers can collect and report UDS countable visits by using eCQM standards from the National Library of Medicine. In general, testing found that transitioning to full alignment with CMS eCQMs would lower performance rates on average a few percentage points. However, the improvements in data reliability, consistency of reporting across health centers, and burden reduction outweigh the impact of short-term changes to performance rates.
  • Streamlined diagnoses and services reporting (UDS Table 6A) (Completed in 2020): 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. Testing confirmed that the use of value sets increases reporting accuracy and consistency and streamlined the process for identifying and collecting health data.

Content review

We review and update UDS content and tables each year. This ensures that the data has consistent quality and value for the Health Center Program. This helps us better measure health center services, evaluate clinical quality improvement, and address the needs of our patient population.

Possible changes include:

  • Aligning UDS CQMs with Centers for Medicare and Medicaid Services (CMS) eCQM specifications. 
  • Using national value sets and electronic standards for reporting diagnoses and services.

We describe changes through UDS Program Assistance Letters, Federal Register Notices, and the annual UDS Manual. We share these on the UDS Training and Technical Assistance microsite.

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