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

Get answers to common questions about the UDS Modernization Initiative.

Jump to:

• Goals and benefits
• Why patient-level data is important
• How to prepare for UDS+
• How to voluntarily submit UDS+ reporting for CY 2023
• Where to go for more information

Goals and benefits

What is the Uniform Data System (UDS)?

The Uniform Data System (UDS) is a standardized reporting system made up of a core set of data and measures that Health Center Program awardees and look-alikes are required to report on each calendar year. HRSA uses UDS data to assess the impact and performance of the Health Center Program and to promote data-driven quality improvement.

(Updated: 4/22/2024)

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+ is the electronic submission of de-identified patient-level data from health centers to HRSA that corresponds with portions of existing UDS data elements, including information related to: 

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

Data is transmitted to HRSA using Fast Healthcare Interoperability Standards (FHIR®). These reporting standards are actively being adopted across the U.S. Department of Health and Human Services and the healthcare industry. 

(Updated: 4/22/2024)

How does UDS+ reporting differ from UDS reporting?

UDS data is reported in aggregate, tabular formats within HRSA’s Electronic Handbooks (EHBs). Many health centers are supported by their health information technology (HIT) vendors in gathering the UDS data, but the data submission is done manually at the health center. 

UDS+ data reporting includes de-identified patient-level data. It will be automated and may require more support and coordination with a health center’s HIT vendor(s). Some health centers will be able to self-report their UDS+ data to HRSA, but the majority will work with their vendors. HRSA has been working with HIT vendors to develop their ability to support UDS+ data submission via FHIR®. 

(Updated: 4/22/2024)

What is the timeline for adopting UDS+?

For calendar year (CY) 2023 UDS reporting, UDS+ submission is voluntary. For CY 2024, HRSA will require a minimum submission for UDS+.

We will provide updates related to CY 2024 UDS+ reporting requirements once we have finalized details early into fall 2024. Read more about how you can prepare under: How to prepare for UDS+.
 

Reporting Year	UDS (Legacy)	UDS+
2023  (Submission in 2024)	Required	Voluntary
2024  (Submission in 2025)	Required	Minimum submission required

(Updated: 4/22/2024)

How will UDS+ data be used?

Data submitted through UDS+ will serve the same primary purpose of legacy UDS data: to assess the impact and performance of the Health Center Program and to promote data-driven quality improvement. 

UDS+ will provide HRSA with valuable insight into patients’ experiences with receiving their care at HRSA-supported health centers. 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 in advancing quality improvement and health outcomes for the Health Center Program, including tailoring training and technical assistance (T/TA) and funding opportunities. 

(Updated: 4/22/2024)

How will UDS+ benefit health centers?

UDS+ will provide multiple benefits to health centers by:

• Reducing reporting burden so health centers can better focus on delivering care to patients; health centers will be able to electronically report data from their EHR system and reduce reliance on manual data entry.
• Improving data quality and the ability of health centers and HRSA to communicate the complexity of the patient populations served. 
• Preparing health centers for reporting their data in accordance with federal interoperability standards.

Organizations at the local, state, and federal level will also use UDS+ data to provide targeted T/TA and advance quality improvement research to improve access to high-quality, cost-effective care. Read more about patient privacy under Why patient-level data is important.

(Updated: 4/22/2024)

Why patient-level data is important

Why does HRSA need patient-level data?

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 becoming increasingly critical for advancing quality improvement and health outcomes for the Health Center Program, including tailoring technical assistance and funding opportunities. 

Collecting patient-level data is not an end to itself; it is the means to allow HRSA to better detect areas of opportunity within the program, track emerging and ongoing health trends, direct resources to where they matter most, and better engage in urgent or developing threats to poor health outcomes. Examples of how HRSA can use de-identified patient data to improve health outcomes and address health equity include:

• Identify the specific needs, health outcomes, and interventions of value to special populations, and work collaboratively within HRSA and HHS to identify available supports and programs. For example, veterans experiencing homelessness often have unique health needs and may be eligible to receive support from programs designed to support this population. HRSA could better target resources to help those populations by understanding which health centers serve a significant portion of that population. However, currently, the UDS cannot show the number of patients who are both veterans AND experiencing homelessness within a health center’s patient population. 
• Collect “routine patient” indicators. Health outcomes of routine patients who visit a health center regularly may be different from patients who only visit a health center once. Patient-level data allows HRSA and health centers to analyze the two patient populations separately and address different trends and outcomes that may exist. 
• Identify patient populations that may be at higher risk in the event of another public health emergency or may be eligible to receive interventions based on their specific demographics. In the event of another PHE where limited resources must be disbursed to higher-risk populations, HRSA will have the information required to administer its program effectively and equitably. 

(Added: 12/3/2021)

When UDS+ is implemented, will patient privacy be protected?

Yes, patient privacy will be protected. HRSA requires health centers and vendors to comply with the HHS Safe Harbor Method for patient data de-identification to ensure alignment with HIPPA rules.

Data submitted to UDS+ is not copied directly from a patient’s electronic health record (EHR). The data collected from the EHR passes through a solution at the health center or vendor system-level that de-identifies the data. The de-identification specifications are included in the UDS+ FHIR IG®. This means that the data is fully de-identified prior to being submitted to HRSA and cannot be re-identified by any entity other than the health center. This is done to ensure that no identifiable information is submitted to HRSA’s IT environments. In addition, HRSA’s IT environments have data checks in place to ensure that protected health information (PHI) cannot enter our systems. 

We recognize that while the UDS+ data is de-identified, these data are still sensitive and HRSA is taking every step we can to protect patient privacy.

(Updated: 4/22/2024)

How can reporting patient-level data reduce health centers’ reporting burden?

Traditionally, UDS data is generated through health centers’ EHR systems by looking through patient records. The information is then manually 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 FHIR® standards: 

• Aligns with the Centers for Medicare & Medicaid Services electronic clinical quality measures (eCQMs), 
• Allows for the 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 the 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)

How to prepare for UDS+

How can health centers prepare for UDS+?

• Join the UDS Test Cooperative (UTC) and consider volunteering to submit UDS+ data for CY 2023. Learn more in How to voluntarily submit UDS+ reporting for CY 2023.
• 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 through joining the UTC.
• Visit the UDS Modernization Initiative webpage to learn more.
• Submit questions through the BPHC Contact Form by selecting Uniform Data System (UDS) > UDS Modernization > Patient-Level Submission (UDS+).

Note: For those who plan to report UDS+ data themselves (self-report), we will share additional guidance early this fall.

(Updated: 4/22/2024) 

What is the UDS Test Collaborative (UTC)?

The UTC is a voluntary group of representatives from health centers, Primary Care Associations (PCAs), Health Center Control Networks (HCCNs), National Training and Technical Assistance Partners (NTTAPs), and HIT vendors. The group provides feedback on UDS Modernization. A steering committee of health centers representing diverse HHS Regions leads the group.

Please communicate your interest in joining the UTC via the BPHC Contact Form by selecting Uniform Data System (UDS) > UDS Modernization > Join the UDS Test Cooperative. 

If you are already a member of the UTC, visit the UDS+ Community in our Health Center Program Community (HCPC) to view past meeting presentations, recordings, and more. The HCPC is an online platform for participants in specific BPHC programs to get timely updates, interact with other health centers, and access T/TA resources. If you do not have a login, click “Request Access,” and walk through the steps to request one.

(Updated: 4/22/2024) 

When does the UTC meet?

The UTC currently meets on the third Wednesday of the month, 2 – 3 p.m. ET. We ask that you first join the UTC and then you may register to attend the meetings. Upcoming meeting dates include:

• Wednesday, May 15
• Wednesday, June 12, 4 – 5 p.m. ET (Moved to a different date and time due to the federal holiday on June 19)

In addition, we host UDS+ Testing Office Hours bimonthly on Thursdays, 1 – 2 p.m. ET. The purpose of these office hours is to provide participants an open forum to ask questions and follow up with the UDS+ team about registration and testing issues. The office hours are open to both technical and non-technical participants.

(Updated: 4/22/2024)  

What is the UTC currently testing?

Currently, the UTC is providing input and feedback on the CY 2023 UDS+ voluntary submission onboarding, testing and submission process. UTC members may voluntarily submit UDS+ data for CY 2023 but it is not a requirement for UTC membership.

The UTC Steering Committee and UTC members are critical partners to HRSA at this stage of UDS+ implementation. The UTC meetings include the most current updates on the program and allow HRSA staff to learn what opportunities and barriers health centers are encountering in preparing for UDS+ data submission. 

HRSA continues seeking volunteers to engage in UDS+ proof of concept and testing activities, including testing two data receiving endpoints that support FHIR®, using the current version of the FHIR® Implementation Guide (IG). The UDS+ FHIR® IG provides the 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.

(Updated: 2/27/2023)

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

Health centers, PCAs, HCCNs, and HIT vendors participating in the submission of UDS+ must have the right infrastructure, including a:

• Bulk FHIR®-enabled EHR system, 
• Backend Service App, and 
• Trust Services mechanism to support de-identification of patient data before sending to HRSA. 

Additionally, health centers, PCAs, HCCNs, and HIT vendors will need to participate in a registration process to ensure their systems have the appropriate security requirements. 

For more information about the registration process, submit inquiries via the BPHC Contact Form (Uniform Data System (UDS) > UDS Modernization > UDS+ Synthetic Data Testing).

(Updated: 1/3/2024)

How to voluntarily submit UDS+ reporting for CY 2023

What are the calendar year (CY) 2023 UDS reporting requirements?

All health centers were required to submit a full UDS Report within EHBs by February 15, 2024. This is the submission of record.

Beginning with the 2023 UDS reporting cycle, in addition to an aggregated legacy UDS submission via EHBs, health centers may also voluntarily submit de-identified patient-level data (UDS+) using HL7® FHIR® R4 standards. Technical specifications for UDS+ are available in the UDS+ FHIR® Implementation Guide (IG) on the HL7® website. 

Health centers interested in voluntarily submitting UDS+ data may join one of our cohorts; to learn more, view the UDS+ Cohort Model (PDF - 91 KB). 

HRSA requests that health centers voluntarily submitting CY 2023 UDS+ data submit the data elements listed below. This abbreviated portion of the full UDS data set will help HRSA compare UDS and UDS+ submissions. 

• Submit data for the entire universe of patients (not a subset)
• Submit all demographic tables data for:
  • Patients by ZIP Code Table
  • Table 3A: Patients by Age and by Sex Assigned at Birth
  • Table 3B: Demographic Characteristics
  • Table 4: Selected Patient Characteristics
• Submit all or part of the clinical tables data
  • Table 6A: Selected Diagnoses and Services Rendered - optional
  • Table 6B: Quality of Care Measures – submit 2 or more eCQMs from this table
  • Table 7: Health Outcomes and Disparities – submit 2 or more eCQMs from this table

Based on UTC feedback, health centers may be most ready to submit the following eCQMs:

• Table 6B: Quality of Care Measures
  • Cervical Cancer Screening
  • Colorectal Cancer Screening
• Table 7: Health Outcomes and Disparities
  • Controlling High Blood Pressure
  • Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)

Health centers may choose any eCQM from Tables 6B and 7 for voluntary UDS+ submission as long as they submit at least two measures from each table.

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

(Updated: 1/3/2024)

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 effort toward patient-level data reporting and will help HRSA gain better insight into the impact and needs of the Health Center Program.

In addition, these health centers will be better prepared to submit UDS+ data for CY 2024 reporting when there will be a minimum reporting requirement.

(Updated: 4/22/2024)

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® and 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)

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?

Layers of validation are 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 are 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. 

(Updated: 1/3/2024)

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

The PRE will be 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)

Where to go for more information

Is there funding to support UDS+ implementation?

We awarded American Rescue Plan UDS+ (ARP-UDS+) supplemental funding on August 8, 2022. These funds were made available to support high-quality UDS+ submissions. 

HRSA also added a one-time $40,817 funding supplement to Fiscal Year 2022 Health Center Controlled Network awards. This funding was used to support T/TA on UDS+. Find more information on the BPHC website.

(Updated: 4/22/2024)

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

Health centers, PCAs, and NTTAPs should contact their HCCNs or HIT vendors as T/TA resources. We also recommend that health centers reference and review HL7® FHIR® resources on HL7.org.

(Added: 6/5/2023)

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

The HCPC is an online platform for participants in specific BPHC programs to get timely updates, interact with other health centers, and access T/TA resources. 

The HCPC includes a UDS+ section with:

• UDS+ updates and announcements
• Calendar of UDS+ events and links to scheduled UTC meetings
• Archived UTC meeting presentations and recordings
• T/TA resources and opportunities

(Added: 6/5/2023)

How can health centers get more information about UDS+?

• Visit the Uniform Data System (UDS) Modernization Initiative webpage.
• Join the UTC. 
• View Health Care Interoperability Resources. (PDF - 112 KB)
• Subscribe to the Primary Care Digest to receive updates about UDS+, including T/TA.
• Submit questions about UDS+ through the BPHC Contact Form by selecting Uniform Data System (UDS) > UDS Modernization > Patient-Level Submission (UDS+).

(Updated: 6/5/2023)