SDOH FHIR IG Proposal

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SDOH Data Element Profiles

Owning Workgroup

HL7 Patient Care (PC WG)

Committee Approval Date:

Sept 2019

Publishing Lead

Cheng Liu (CLiu@max.md)

Contributing or Reviewing Work Groups

  HL7 Vocabulary (VOCAB)

FHIR Development Project Insight ID

TBD

Scope of coverage

The Gravity Social Determinant of Health (SDOH) Data Element FHIR implementation guide (IG) intends to formalize the SDOH-specific data-elements sufficient to support screening, diagnosis, care planning, treatment and secondary uses such as research, risk adjustment, and quality measurement. The FHIR implementation guidance focuses on data elements determined to be relevant by the Gravity Project Community to three core use cases:

Document SDOH data in conjunction with the patient encounter.
Document and track SDOH related interventions to completion.
Gather and aggregate SDOH data for uses beyond the point of care (e.g., population health management, quality reporting, and risk adjustment/risk stratification).

The implementation guide is expected to cover these three core use cases first for one SDOH domain (Food Insecurity) and over time it will expand to cover the data elements for these three use cases in other SDOH domains, e.g. Housing Stability & Quality, Transportation Access.

Content location

https://github.com/HL7/fhir-food-insecurity-ig

Proposed IG realm and code

IG Realm is US

Codes for the IG will be sdoh-cc for the use cases driven out of the Clinical Care setting. Eventually as other IGs are added for use cases driven out of other settings, the collection will include an sdoh-o for the "over view" IG that will gather specifications promoted to be "common technical specifications" that are shared among the different sdoh-xx ig's, for example sdoh-cbo (Community Based Organizations) or sdoh-ph (Public Health) or sdoh-rr (Registry/Research).


Maintenance Plan

The PC WG is aware and willing to maintain the content in the future. The Gravity Project engages a large multistakeholder group committed and funded to evolve and maintain the content.

This IG comprises FHIR Profiles for Food Security core data elements for which the Gravity Project is developing stakeholder consensus around the definition and use of the data in care activities including: screening, clinical assessment, diagnosis, goal setting, intervention planning and intervention performing.

In the first 'For Comment' cycle the terminology bindings are preliminary, and in some cases, defined in terms of placeholder codes only.

Our team is collaborating with SNOMED CT, Regenstrief (LOINC) and Code System SDOs who steward over ICD-10, CPT and HCPCs to organize and fund the required unique concept authoring efforts that will be necessary to sufficiently define the data-elements and value-sets represented in the 'For Comment' May 2020, and STU Sept 2020 ballot cycles.

Short Description

US Realm FHIR Profiles for data elements used to document an individual's social determinants of health (SDOH) which covers many different factors considered social risks and social needs, e.g. Food Insecurity, Housing Stability and Quality, Transportation Access and others. The IG covers three use cases identified from the clinical care setting: Gathering and Documenting SDOH information in a clinical setting; Documenting and Tracking to completion SDOH interventions; and Sharing individual's SDOH information with organizations for secondary uses.

Long Description

US Realm FHIR Profiles for data elements used to document an individual's social determinants of health (SDOH) which covers many different factors considered social risks and social needs, e.g. Food Insecurity, Housing Stability and Quality, Transportation Access and others. It looks at information needed, gathered , and shared in the full cycle of clinical care activities including: screening, clinical assessment, diagnosis, care planning, and intervention.

This IG defines FHIR profiles for data elements that are envisioned to be recorded in the clinical care setting:

  1. Gathering and Documenting SDOH information in a clinical setting
  2. Documenting and Tracking to completion SDOH interventions
  3. Sharing individual's SDOH information with organizations for secondary uses

The first iteration of the SDOH Data Element Profiles IG focuses on the core modeling structures, patterns and informational relationships between these architectural elements for the Food Insecurity SDOH Domain. Subsequent iterations will expand the IG to cover two additional SDOH domains: Housing Instability and Transportation Access.

Involved parties

The SDOH IG is being authored through a formal collaboration under the FHIR Accelerator Program through the Gravity Project working together with the larger HL7 Community through HL7-PC and HL7-VOCAB workgroups. The effort engages a wide range of organizations and individual contributors that informally refer the themselves as the Gravity Community, which includes representatives from 13 different types of organizations, standards developers, various health IT vendors, and interested solution vendors.


Expected implementations

 MaxMD
 TBD - Just beginning to confirm our initial participants for the December 2019 and January 2020 Connectathons.  
 Several implementers have expressed interest for the December 2019 and January 2020 Connectathons.

Content sources

  Social Intervention Research and Evaluation Network,
  American Academy of Nutrition and Dietetics, American Medical Association
The Gravity Project solicits input from over 250 different organizations from 13 different stakeholder groups.
  

Example Scenarios

Gathering SDOH Screening Results. Documenting Clinical Assessment Observations of SDOH needs and risks. Documentation of SDOH related Diagnosis. Care Planning to record SDOH related goals, planned and completed interventions and evaluation of progress toward recorded goals.


IG Relationships

The SDOH FHIR IG is intended to target compliance with a suite of FHIR R4-compliant standards. It also will be leveraging C-CDA On FHIR, Da Vinci CDex, SDC, BSER, and Da Vinci QDEM

Timelines

  For Comment May 2020 Ballot
  STU September 2020 Ballot


FMG Notes