NYSDA Publications

ONC Issues Newsletter

Aug 31, 2026

Office of the National Coordinator for Health Information Technology (ONC)

USCDI+ Quality on FHIR: Where Things Stand

For those who have been following USCDI+ Quality from afar, here is a quick look at how much progress has been made this year.  What began as a published data element list has now advanced into a full technical implementation guide—along with a deployed Inferno test kit you can use today to evaluate your own systems.

Building on the USCDI and US Core Foundation

USCDI and US Core are already widely implemented across certified health IT, serving as the foundation for core standardized health data exchange in the United States.  Our approach with USCDI+ Quality has been to align to and extend this existing foundation.  ONC released the final USCDI+ Quality Version 1 in January which contains 179 data elements across 29 data classes, developed in close alignment with CMS's ongoing digital quality measure transition activities.  The list has continued to evolve with the June release of Draft Version 2.  Like USCDI itself, the USCDI+ Quality data element list is a policy artifact that catalogs which data elements matter rather than a technical implementation specification for how to exchange them.  And just as US Core is the FHIR implementation of USCDI, we've developed the US Quality Core Implementation Guide (IG) to implement USCDI+ Quality in FHIR.  The first version of US Quality Core is derived from QI-Core version 6 and aligned to US Core 6.1.0 and USCDI v3.1.0, the current floor for certified health IT.  Think of it as the same foundation as US Core but with a focused set of quality additions.  The goal is a common, data-element-first foundation for quality that measures across many different quality reporting programs can be built on, with an API that enables consistent, standardized data access across vendors.

Test and Explore it Today!

ONC has developed and released a test kit in Inferno that supports testing both US Quality Core servers and clients.  Since the US Quality Core IG is new and not yet implemented, US Core implementers are encouraged to point it at their existing US Core implementations and see how close they already are.  In our own experiments running the Quality test kit against a US Core only reference server, roughly 60% of the tests passed out of the box, and most of what was left came back as data-completeness skips rather than outright failures.  Tests that fail are key feedback at this stage, especially across vendors, so we can compare how our additions hold up across implementations.  At this point, the early test kit failures help us improve the test kit itself and surface things we may not be testing correctly yet.

Ways We've been Engaging with the Community

To foster industry involvement, ONC has brought this work to recent FHIR Connectathons.  There was a strong turnout at the July CMS Connectathon,  where we ran our US Quality Core test kit against real provider sandboxes.  Our sessions drew more than 80 participants, spanning measure developers, EHR vendors, payers, quality organizations, and federal partners.  We also had broad discussions where we received a lot of great feedback on things like how to best stay aligned with the existing certification floor, how to avoid a pile-up of overlapping IGs, and the data mapping and representation issues that real-world implementers face — like how "encounter" differs between the clinical space and the payer space.

What's Next?

We are looking forward to an open community review, as we are on track to ballot US Quality Core for the first time during this upcoming September HL7 ballot cycle.  We will also be running a US Quality Core track at the upcoming September FHIR Connectathon.  This will be a great chance to engage with the work, test your systems, and give us feedback in-person.  Over time our goal is a predictable cadence where the guide aligns with US Core publication.  In the meantime:

This Implementation Guide (IG) is not an update to health IT certification criteria or processes regulated by the Office of the National Coordinator for Health Information Technology (ONC).  Readers should monitor final rules provided by programs such as the Centers for Medicare & Medicaid Services and/or ONC for information on official updates to the health IT certification process and measure submission requirements for quality programs.  This is early, pre-ballot work, and we're sharing it openly to give people visibility as it develops.

For Certification Program upcoming deadlines and events, please visit the ONC Program Resources page.  To submit questions or comments to ONC please use our Inquiry Portal.