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Gravity Project SDOH Data Elements FHIR IG (PSS in Confluence)

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Basics

Gravity Project SDOH Data Elements FHIR IG (PSS in Confluence)

1567
Ballot - STU to Normative


FHIR Implementation Guide

Implementation Guide

Details

The Gravity Project creates and maintains a consensus-building community to expand available Core Social Determinant of Health (SDOH) Data for Interoperability and accelerate standards-based information exchange by using HL7 FHIR. Gravity Project is part of the HL7 FHIR Accelerator Program.

Many of the recent innovations at scale in this area begin with the strategic collection of SDOH data. As examples, the Centers for Medicare and Medicaid Services Innovation Center (CMS Innovation Center) Comprehensive Primary Care Plus Model requires providers to assess patients social risks; and the CMS Innovation Center’s Accountable Health Communities Model developed a social risk assessment tool to help identify and address social risks across clinical and community-based settings. However, there is no consensus on the coding and standards-based modeling to facilitate the data uses envisioned for SDOH information.

This project seeks to incrementally develop one (1) FHIR IG covering 3 primary use cases for three (3) SDOH Domain: food Insecurity, housing stability, and transportation barriers.

Participation in many Connectathon events will be conducted to build greater consensus on needed implementer. The May 2020 ballot could be a STU ballot or a for comment ballot depending on the degree of readiness. Subsequent iterations will refine the guidance for the SDOH Core Data for Interoperability and expand the use case coverage until the full scope of this PSS is reached.

The goal is to add a minimal number of core SDOH data elements that support key interoperability use cases, and work within and across the context of other HL7 projects to bring together the capabilities to demonstrate the range of data exchange needed for the 3 use cases. This project seeks to:

(1) determine a minimal data set required to exchange valuable SDOH information for identified use cases and

(2) develop FHIR Implementation Guides, resource profiles, and necessary extensions to specify how to syntactically and semantically exchange that data between care settings, and work closely with Code System SDOs to address data coding needs.

The project also will work with other FHIR Accelerator Projects (Da Vinci CDex implementers and CARIN implementers engaged in giving patients access to their health records) to

(3) add SDOH core data elements in their developing client and server reference implementations to validate the Implementation Guide, Profiles, and Extensions work in a software system,

(4) develop automated test suites to validate data representation, and

(5) build real world pilots that successfully demonstrate integration of SDOH information in new capabilities adopted in production.


The influence of social determinants on health outcomes is increasingly recognized in emerging payment reform programs, federal and state-based policies, and information technology initiatives. Social determinants of health (SDOH) are defined by the World Health Organization as the conditions in which people are born, live, work, and age.

The growing awareness of how SDOH shape health has contributed to efforts to address actionable

socioeconomic risk factors through the health care delivery system. Recommendations from national groups, including the American Academy of Pediatrics, American Academy of Family Physicians, Agency for Healthcare Research and Quality, National Quality Forum (NQF), and Institute for Health Care Improvement underscore the various roles the health care system could play in helping to reduce patients’ social risk factors.

These national 'calls to action' for health care systems have spurred the proliferation of innovations, including a wide range of social risk screening tools and practice-based interventions. Some of these innovations have helped to reduce social risks, improve health outcomes, and lower costs. The experimentation in this area has been bolstered by new value-based payment models and accountable care organizations (ACOs), which together offer an array of incentives to advance coordinated care between medical and social service organizations.

However, many of the recent innovations at scale in this area begin with the strategic collection of SDOH data. As examples, the Centers for Medicare and Medicaid Services Innovation Center (CMS Innovation Center) Comprehensive Primary Care Plus Model requires providers to assess patients’ social risks; and the CMS Innovation Center’s Accountable Health Communities Model developed a social risk assessment tool to help identify and address social risks across clinical and community-based settings.

Presently, clear shared definitions for these SDOH Core Data for Interoperability and FHIR based information exchange resources do not exist. SDOH covers a very broad space which is categorized and defined in many different ways. The Gravity Project aims to address only three SDOH areas from among the many identified SDOH domains. The project will create and maintain a consensus-building community to expand available SDOH Core Data for Interoperability for the Food Insecurity, Housing Instability, Transportation Barriers domains, and accelerate standards-based information exchange by using HL7 FHIR.



Our initial milestone will be a draft FHIR IG including developed Use Cases, Concept Domains and temporary codes to support Connectathon Testing of just the first 1. Food Security and Food Insecurity Observations in early December, 2019. We will then improve that IG with feedback from the Connectathon and use the improved version for additional Connectathon Testing in January 2020. (Same narrow scope of just the Food Security and Food Insecurity Observations, but more robust guidance for implementers.) A 'For Comment' Ballot is planned for May 2020 (may consider STU ballot if appropriate). Following the May 2020 ballot, the Gravity community will expand the SDOH content where it has developed consensus definitions and modeling. Priorities for additional profile development will follow this order and will utilize work done elsewhere in the FHIR Community where possible: 2. Food Insecurity Health Concern (Condition) 3. Food Insecurity Screening Questions and Answers (Questionnaire) 4. Food Security Care Planning Goal (Goal) 5. Planned and Completed Food Insecurity Interventions (ServiceRequest and Procedure) 6. Health Status Evaluation/Progress Toward Goal (observation) It may take several interations to add the additional profiles needed to complete all three use cases in the first Food Security domain. On-going participation in Connectathons and subsequent ballot cycles will be used to incrementally add the similar set of SDOH Core Data Elements (and Profiles, such as 1-6 above) for Housing Stability and Transportation Barriers covering all three use cases.


https://confluence.hl7.org/display/GRAV/Gravity+SDOH+FHIR+IG

The influence of social determinants on health outcomes is increasingly recognized in emerging payment reform programs, federal and state-based policies, and information technology initiatives. Social determinants of health (SDH) are defined by the World Health Organization as the conditions in which people are born, live, work, and age. The growing awareness of how SDOH shapes health has contributed to efforts to address actionable socioeconomic risk factors through the health care delivery system. Recommendations from national groups, including the American Academy of Pediatrics, American Academy of Family Physicians, Agency for Healthcare Research and Quality, National Quality Forum (NQF), and Institute for Health Care Improvement underscore the various roles the health care system could play in helping to reduce patients’ social risk factors.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile we will request approval from US Realm SC, and provide the US Realm approved rationale for deviation in the implementation guide where applicable. Connectathon Testing will be incorporated within Connectathons driven by HL7, Da Vinci and CARIN.

Quality Reporting Agencies, Regulatory Agency, Payors,Emergency Services; Local and State Departments of Health; Other (specify in Misc. Notes below),EHR, PHR; Health Care IT

Data Integrator/HISP (MaxMD); Payer organizations, EHR vendor, Health IT Vendors interested in collecting SDOH data from Consumers; Community Based Organizations or Public Health organizations.

The shift to value based care and the growing recognition of the impact addressing SDOH issues can have on increasing the value of care, decreasing its cost, and improving care outcomes

Gravity Project, SDOH Data Elements, SDOH Core Data for Interoperability

This is the initial project PSS from the Gravity FHIR Accelerator Project

Yes


No

2025 May: TSC approved an STU Extension and Unballoted STU Update Publication Request for HL7 FHIR® Implementation Guide: SDOH Clinical Care, Release 2.3 - US Realm 2023 July: TSC approved Unballoted STU Update Publication Request for HL7 FHIR Implementation Guide: SDOH Clinical Care, Release 2.1 - US Realm 2022 November: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: SDOH Clinical Care, Release 1.1 - US Realm 2021 August: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: Social Determinants of Health (SDOH) Clinical Care, Release 1- US Realm Other Stakeholders: Clinicians, Community Based Organizations, Patients Other Providers: Community Based Organizations
Organization & Realm

Realm Specific - Enter "U.S." or name of HL7 Affiliate below

U.S.
People

Lisa Nelson



Patient Care Work Group

Terminology Infrastructure Work Group

Status & Dates

Active

STU - Test Period/Accepting Comments

09/23/2019

01/01/2028

2028 Jan WGM/Ballot

01/01/2027

2027 Jan WGM/Ballot

2026 Jan Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 26 Negatives to reconcile Document Name: HL7 FHIR® Implementation Guide: Social Determinants of Health (SDOH) Clinical Care, Edition 3 - US Realm 2022 Jan Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 23 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Social Determinants of Health (SDOH) Clinical Care, Release 2 - US Realm (See Jira Ballot Dashboard) 2021 Jan Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 30 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Social Determinants of Health (SDOH) Clinical Care, Release 1- US Realm
Approvals

11/18/2019


Received


All Received




System Info



View Ballot Items (with NIBs)



04/09/2026

Anne Wizauer
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