Thousands of community health centers — and the EHR vendors and IT organizations that support them — are in the midst of a huge shift in how they report on quality measures to the federal Health Resources & Services Administration (HRSA).
The new platform now being tested, UDS+, is expected to become mandatory in 2025 or 2026 and will overhaul HRSA’s Uniform Data System reporting methodology. HRSA uses UDS data to assess the impact and performance of the Health Center Program and to promote data-driven quality improvement.
UDS+ will involve electronic submission of de-identified patient-level data from health centers to HRSA through automated reporting platforms. HRSA stresses that automating UDS reporting will eventually eliminate the need for health centers to have staff members manually enter UDS data, while simultaneously allowing them to submit more granular data about their patient populations.
HRSA is hoping that UDS+ will increase the utility of UDS report data by aligning with interoperability standards and reporting requirements used across the U.S. Department of Health and Human Services and within the healthcare industry. The new program uses standard application programming interfaces (APIs), and HRSA has developed a UDS+ FHIR data receipt and submission process.
Community health centers often operate on tight budgets and have small IT teams. Many rely on third-party data aggregators or Health Center Controlled Networks (HCCNs), nonprofit organizations that help health centers use health IT to reduce costs and improve care coordination. HCCNs offer specialized training and technical assistance.
One of the organizations working on the UDS+ transformation is Oregon-based OCHIN, which has more than 250 healthcare organizations with more than 2,000 delivery sites in its network. Through its Health Center Controlled Network grant, it provides support for about 35 health centers that are on disparate EHRs by helping them pull out the data for their UDS reports.
“Our holy grail is data standardization, and streamlining of data movement, because there's a lot of waste in the system and there are multiple standards,” said Jennifer Stoll, chief external affairs officer at OCHIN. “The more that we can standardize data sets, the more that we can all exchange information for patient care. Also, the more that we can have access to claims data, the more we can actually look at total cost of care.”
Stoll says the question is how do you flip from one UDS process to another without disrupting patient care or hurting the sustainability of health centers, particularly at a time when many are facing budget cuts. “We want to make sure that we do this thoughtfully and methodically, and we do enough testing.”
While HRSA is actively moving forward, they have to worry about leaving behind the health centers that don't have systems or people to be able to do this work, she added. “Some health centers have not been able to make the investments to upgrade their EHR. That’s a big concern and an area of focused support for OCHIN.”
Using the technology the way it was intended
Rebecca Rudd is director of government affairs at OSIS, a nonprofit organization that provides NextGen EHR assistance to community health centers around the country. The Ohio-based organization has 28 health centers in its Health Center Controlled Network and it supports 79 practices across the nation using the NextGen platform.
Rudd explained that previously with UDS, HRSA was behind the times in terms of standardized measurement reporting and had its own definitions. Now HRSA is trying to be able to look across the nation, similar to what CMS has done, and assess the care that's being rendered and make apples-to-apples comparisons.
Part of this is about getting discrete data, such as an A1C lab result, into a structured field that can be exported for analytics, rather than in a narrative text field, she adds.
“It's really going to make the health centers use the technology the way it was intended, which could be painful and burdensome,” Rudd said. “We know they don't like the clicks. That's what we always hear. But it's going to give HRSA so much more insight into the care that is actually being rendered at the health centers, not only from a quality of care perspective, but also for costs. Each of these health centers gets funding from HRSA. How are they using that money? What are their true patient outcomes? Are they improving metrics?”
Rudd said it is unclear how many EHR vendors are going to be ready to do the required testing this year. At a recent National Association of Community Health Centers forum, EHR vendors were sharing with health centers where they are in the process. “I listened to yesterday's meeting and it was concerning,” she said. Several vendors explained that they are not going to be able to participate in any of the cohort testing for this year, so that leaves their practices out.
Experience in Cohort 1
NextGen Healthcare, which serves more than 400 FQHCs and integrated care centers nationwide, is one vendor that did take part in the first cohort of testing, along with its Cohort 1 beta clients—a group of health centers that volunteered to be early adopters while UDS+ compliance is still elective. They completed their first test submissions March 31, 2024.
Javier Favela, vice president for solutions at NextGen Healthcare, said he would call the first cohort successful, “because we did successfully submit data. There were some challenges and some lessons learned. We definitely found that our health centers needed some hand-holding with things like data mapping and codification of the data. Not all of their data sets were properly codified. It gave us an opportunity to optimize using the tools that are already available to the health centers that they may not have been using to help codify their data in a much more streamlined, efficient fashion.”
He said NextGen found the spectrum of health centers varied from those with fairly strong IT and business intelligence teams to those that aren’t very sophisticated. “For some, it was much more time-consuming than they were accustomed to.”
Although one of the main goals of UDS+ is to reduce the overall reporting burden, that did not happen in the first practice cohort. “I would probably say in cohort one, we did not experience that just because it's a big shift that required a lot of hand holding, Favela said. “It is like it's a foreign language. They're seeing data in a way that they've never seen it before.
“We're excited because it gives us an opportunity to enhance the solutions that we're bringing to our customers, whereas I think some of the other vendors might be a little bit late to the table with the solutions that they bring because they didn't experience what we went through in the first cohort.”
