Enhancing FHIR for Social Services, published by SDOH. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/efss/ and changes regularly. See the Directory of published versions

Background

Providing Better Outcomes

It is becoming increasingly evident that Social Determinants (SD) are key factors in determining the well-being of an individual and can negatively impact clinical conditions when these social needs are not met. Numerous studies have shown the impact of SD factors. For example, a National Academy of Medicine Report stated that “Medical care is estimated to account for only 10-20 percent of the modifiable contributors to healthy outcomes for a population. The other 80 to 90 percent are sometimes broadly called the “SDoH”. Significant resources are expended by non-clinical organizations to deliver social and human services to address SD needs. For these non-clinical organizations, their work focuses on the person or individual, their social relationships, and providing social services that can improve the well-being of the individual.

The Approach

The work product is a Companion Guide (Guide) to the Gravity Project’s SDOH Clinical Care 2.1 Implementation Guide.

• Use cases were developed by Subject Matter Experts from Social Services Domains and identified requirements for enhancements to FHIR.
• An implementation approach (SDOH CC Approach) was developed based on the SDOH Clinical Care 2.1 Implementation Guide.
• An SS DAM was developed to provide an alternative implementation approach (SS DAM Approach).
• Using the above two approaches, the Implementation Guideline was developed leveraging the functional benefits provided by the SDOH CC Approach and the SS DAM Approach.

Other Design Considerations

Complementing the SDOH CC IG: To integrate and complement the SDOH CC IG, this guide scope contains the following two actors. To integrate and complement the SDOH CC IG, this guide scope contains the following two actors.

1. FHIR System – A FHIR system in this Guide is a software system that is compliant with the HL7 FHIR Standard. The FHIR System provides a Whole Person Care (WPC) view. A WPC view enables any member of the care team, with appropriate authorization, to view an individual’s record that includes information across clinical, behavioral, and social domains. This record includes the ability to capture an individual’s care support team and their associations with other individuals and social groups such as family, household, religious and spiritual, and social and work organizations. The FHIR system provides care coordination and care management functional capabilities and can interact with other systems that deliver social services.
2. Program System – A Program System in this Guide is a software system that accepts referrals from the FHIR System that can address social risks and fulfill social domain goals. Given a referral, the Program System will determine eligibility for the individual or a group the individuals (e.g., family or household) for a program, enroll the participants in the program, and specify who will receive the service, what the service is, when the service(s) are utilized, and other quantifiable properties. This data is provided to the FHIR System that was the source of the referral.

In the realm of social care, it’s widely acknowledged that an individual’s outcomes are significantly influenced by the people around them. For instance, a child with diabetes, residing in a household where one parent is gainfully employed and both parents are actively involved in her care, is likely to experience better outcomes compared to a child with a similar diagnosis living with a single parent who is facing financial struggles and battling drug addiction. In striving for improved outcomes, human services often emphasize this comprehensive understanding of a person, encompassing environmental and relational factors.

This recognition has spurred the efforts of our working group to devise a technical framework enabling human services to delineate the role of relationships that impact individual outcomes, including family dynamics, household structures, and tribal affiliations. The objective of this project is to standardize the interpretation of these relationships, ensuring that individuals seeking services to enhance their well-being outside clinical settings are accurately comprehended. By adopting this holistic perspective of individuals, we can analyze the support systems and challenges posed by these relationships, which often play pivotal roles in determining improved outcomes.

Out-of-Scope:

To deliver a solution for providing WPC in an operational environment is a complex endeavor. This Guide does not address other necessary functional requirements.

Implementation of Workflow: This Guide does not attempt to define an implementation approach for exchanging data between the FHIR-based system and the Agency System. Several patterns are available and analysis and recommendations will be deferred to a later publication.

Capability for FHIR System to identify specific Social Services Program: Some FHIR systems can identify the appropriate specific program to address the specific social need or risk. This specific version of the Companion Guide assumes that the Agency System will determine the appropriate social service program based on its eligibility rules. Future versions may include the scope where computable eligibility requirements may be available to the FHIR system and recommendations for specific social services may be recommended.

Eligibility for a Social Services Program: Although of great benefit for an FHIR system would be if a particular individual or group of individuals are eligible for a Social Service, this will be considered in future Use Cases. Having such capability for the FHIR system to do this could increase the efficiency for all parties.

Privacy Policies: It is assumed that data can flow freely and unencumbered between the FHIR System and the Program System as the implementation of Privacy Policies is out of scope. However, consideration of Privacy Policies will need to be considered in the future.