Enhancing FHIR to address Social Services and Social Determinants (Jira PSS-2248)

The objective of this project is to determine the best path forward for implementing FHIR-based solutions that need to address Social Determinant needs and work with organizations that provide those services while retaining the current FHIR capability to address clinical and behavioral concerns and activities. Because of this objective, a constraint of this project is any outcome presented must be backward compatible with the FHIR R5.0.0-ballot release.

This project will be driven by Use Cases, where different Approaches will be developed for each Use Case, and Evaluation Criteria will be applied to each Approach for each Use Case.

The Use Cases will have documented Persona(s). There will be at least one Use Case that focuses on providing the individual only a social service in a social domain. There will also be at least one Use Case where the Persona has documented issues in clinical, behavioral, and social determinants domains. At the present time, it is anticipated there will be at 3-4 Use Cases.

During the socialization of this project within the HL7 community, several Approaches have been recommended. This project will test different Approaches. At a minimum, there will be two Approaches tested. One will be enhancements to the FHIR Standard to enable Social Services and Social Determinates Centric semantics and relationships. The second Approach will be to use the present FHIR R5 published specification to address the Use Cases.

If there are additional resources available for the project, additional approaches will be considered such as developing new FHIR profiles and exploring the development of FHIR extensions for the Social Services and Social Determinates Centric approach.

Based on the US Department for the Administration of Children and Families (ACF) experience and socialization within the HL7 community, the following Evaluation Criteria will be considered for each Use Case for each Approach. An objective of the project is to create the necessary information to ballot.

FHIR (CRUD) operations: These basic FHIR operations will be required for different scenarios within individual Use Case. Some operations may be for data capture operations, some may be for displaying data, some may be required for shaping data required for exchanging of data. The baseline for evaluation of these operations that use the FHIR R5.0.0 3/26/2023 release. Other proposed approaches should provide illustrative, and if all possible executable, examples that can be used in the evaluation of recommended enhancements.Bi-directional exchange of digital information: Exchange in the Use Cases between FHIR-based systems such as the ACF’s care coordination system and other systems non-FHIR systems that capture SD data and social relationships.Human communications between participants provide services to the individual when the description of the role of the individual is important.Development and re-use of software such as Artificial Intelligence, Machine Learning, and other analytical applications: Many of these classes of applications are developed by non-clinical Subject Matter Experts who do not have the concept of the role of a Patient in their vocabulary. Not being able to represent terms in the appropriate semantics may, at best, require additional data wrangling in order to leverage these capabilities and this expertise.Privacy, security, and legal considerations: Identify concerns when the semantics used to define the role of the individual in a FHIR-based system may raise issues because of legal and regulatory considerations.

All use cases, technical artifacts, minutes from scheduled program meetings, and other information will be accessible for the project from the HSS Home Page:

Enhancing FHIR to address Social Services and Social Determinants - Home - Human and Social Services - Confluence (hl7.org)].