Sdohclinicalcare, published by HL7 International Patient Care WG. This is not an authorized publication; it is the continuous build for version 2.0.0-update). This version is based on the current content of https://github.com/HL7/fhir-sdoh-clinicalcare/ and changes regularly. See the Directory of published versions
Official URL: http://hl7.org/fhir/us/sdoh-clinicalcare/ImplementationGuide/hl7.fhir.us.sdoh-clinicalcare | Version: 2.0.0-update | |||
Draft as of 2023-03-27 | Computable Name: Sdohclinicalcare |
Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks1. They are increasingly being recognized as essential factors that influence healthcare outcomes. This HL7 Implementation Guide (IG) defines how to exchange coded content using the HL7 FHIR Standard for the following SDOH-focused care activities: screening, clinical assessment/diagnosis, goal setting, and the planning and performing of interventions. This IG addresses the need to gather SDOH information in multiple settings, share that information between stakeholders, and exchange referrals between organizations to address specific social risk needs, all with appropriate patient consent. In addition, the IG demonstrates how to share clinical data to support secondary purposes such as population health, quality, and research.
This IG was developed by the Gravity Project, which aims to build and promulgate consensus driven social determinants of health (SDOH) data standards for health and social care interoperability and use among multi-stakeholders. Both the project and this implementation guide are focused on the U.S. environment. This IG leverages content from the US Core Implementation Guide and binds to US-specific terminology. However, the basic constructs and interaction patterns may well be applicable outside the U.S.
The IG supports the following use cases:
The activities supported by this IG include (see Clinical Scope for more details)
Currently, this IG is intended to support Patient Applications, Provider’s Electronic Health Record(EHR) systems, Coordinating Platforms that intermediate between Providers and Community Based SDOH Service providers, and Community Based SDOH Service Providers. In the future Payer systems and governmental systems will be supported. The IG establishes a framework for SDOH-related interventions including:
Implementation Guide | Version | Dependency |
---|---|---|
US Core | 3.1.1 | All profiles except those based on Observation, Task, and ServiceRequest are based on USCore profiles |
Structured Document Capture (SDC) | 3.0.0 | SDC is the basis for mapping QuestionnaireResponses into Observations and Conditions |
Subscriptions R5 Backport | 1.1.0 | Subscriptions are recommended for monitoring completion of referrals |
VSAC | 0.9.0 | Published Gravity Project social risk data elements are curated within the National Library of Medicine (NLM) Value Set Authority Center (VSAC) value sets. The value sets can be identified by searching for “The Gravity Project” steward. You will need to create a free NLM account to access the value sets. These value sets are updated after the completion of the planned social risk domain cycles (Jul/Dec) and following major terminology release dates (LOINC: Feb/Aug, SNOMED: Mar/Sept, ICD-10: Apr/Oct) in May/Nov. |
Implementation Guide | Relationship |
---|---|
Human Services Directory | Can be used by a provider to identify referral targets for SDOH-related services |
National Healthcare Directory Exchange | A U.S. Office of the National Coordinator-sponsored IG supporting the exchange of directory information for a wide range of service providers and organizations |
SmartApp Launch | Allows launching third party applications in the context of another system, including allowing the application to controlled access to patient information. |
Bidirectional Service eReferral (BSeR) | Whereas this IG orchestrates referrals using the FHIR query interface, BSeR bases referral management on the exchange of self-contained Bundles of FHIR resources. The approaches for referral management offered by this IG and BSeR should be harmonized to provide a consistent template for management of referrals by all IGs. |
This IG contains a wealth of material targetting different audiences. Some sections provide more general or introductory content, while others provide detailed technical information targetted at implementors. The table below provides a listing of the key sections of the IG in the rough order that they should be read.
Section | Sub-section | Description | Audience |
---|---|---|---|
Background | SDOH and Gravity | General background on the importance of collecting and standardizing SDOH data, and the Gravity Project | General |
Background | SDOH Clinical Care Scope | A description of the clinical scope of this IG | General |
Background | FHIR Technical Background | Background material that should be understood prior to attempting to understand this IG | General/Introductory |
Implementation Guidance | Assessment Instrument Support | The importance of standard survey instruments for the collection of SDOH, and how survey instruments are mapped to SDOH Conditions, Observations and Goals | General |
Implementation Guidance | Referral Workflow | Provides a high level description of the referral workflows and patient interactions supported by this IG, and then drills down to a detailed description of the FHIR API calls implementing the referral workflow | Introductiory and Detailed Technical |
Implementation Guidance | Connecting Applications with API Data Sources | Provides a description of establishing connections to enable the exchange of information supporting the Referral Workflow. | Detailed Technical |
Specifications | FHIR Artifacts | An index of the FHIR artifacts defined as part of this implementation guide | Detailed Technical |
Specifications | Conformance | Conformance requirements for must support and missing data | Detailed Technical |
Specifications | Privacy and Security | Conformance requirements for privacy and security considerations | Detailed Technical |
Specifications | Draft FHIR Artifacts for Personal Characteristics | Draft proposals for profiles of Observation supporting Personal Characteristics | Detailed Technical |
Specifications | Downloads | Downloads | Detailed Technical |