SDOH Clinical Care
3.0.0 - STU 3

SDOH Clinical Care, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 3.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. 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

## STU2 Publication Changes

Page standards status: Informative

### Jira Tickets – all applied – see changes below

#### Index

- FHIR-35753 Home page should have compelling sale of problem and solution spec solves/offers
  - Provided link to gravity project on the home page

#### General Changes

- FHIR-38772 Document change from US Core 4.0.0 to US Core 3.1.1
  - Changed base reference to US Core to 3.1.1 and adjusted any structure definitions required
- FHIR-34857 Update reference to US Core MS and Missing Data
  - Updated references to US Core MS and Missing Data

#### Mapping

- FHIR-38082 Beef up the mapping instructions page
- FHIR-38081 Mapping page should not have the mapping language content
  - updated mapping instructions

#### Task Instructions

- FHIR-37480 Add `Task.output` slice to allow patient to indicate their "chosen-contact"
- FHIR-35750 Suggest more robust requirements around using Task for patient Communications
- FHIR-35634 Clarify SDOH Task distinction
- FHIR-35746 Be clear on what the patient can change in Task
- FHIR-35740 Tighter specification around the updating of Task fields by Patient.
- FHIR-35751 Link to this in the relevant context
- FHIR-35739 Examples should show historical progression with statuses
  - Added the above changes to the checking task status page

#### Personal Characteristics

- FHIR-34876 Need specificity in requirements, e.g., state statutes.
- FHIR-34863 References from Race Profile to Spec Requirements
- FHIR-34862 References from Ethnicity Profile to Spec Requirements
- FHIR-34860 State Requirements Unclear
- FHIR-34858 Race and Ethnicity Text
- FHIR-35679 Illustrate that laws vary around sharing of race and ethnicity data
- FHIR-35685 Observation Subject Extension - use in Observation Profiles for Race and Ethnicity
- FHIR-35338 Concern over race and ethnicity data of "related person" and "practitioner"
- FHIR-35329 Concern over patient race and ethnicity data being shared for non-treatment purposes
- FHIR-35022 Use a single Observation Resource to include both Race and Ethnicity Observations
- FHIR-34999 Adding R/E Observations to the Structured Definitions without indicating they are draft will cause implementation confusion
- FHIR-35691 "Unknown" is not appropriate as an observation method
- FHIR-34878 Need to consider Provenance when R/E Extensions and Observation Resource is used for R/E
- FHIR-35327 For `Observation.method` value set, add guidance related to use of "observed"
- FHIR-35325 For `Observation.method` value set, clarify the definition of "reported-by-related-person" and add guidance related to use of "self-reported" and "reported-by-related-person"
- FHIR-35206 Patient Application Client CapabilityStatement does not include Observation therefore patients will not be able to Read nor search for R/E Observation Profiles
- FHIR-35715 Unclear what adhoc and adhocresponse are - please clarify
- FHIR-35370 For `Observation.method` value set, add guidance related to use of "observed".
- FHIR-35375 Add a challenge related to the sensitivity of SDOH data
  - Updated the Draft Specifications for Personal Characteristics page and referenced artifacts

#### Value set changes

- FHIR-36591 Add on-hold to the value set for .status to support patient inability to perform task for a period of time
  - Added on-hold to the Task Status Valueset

#### Functional Use Cases

- FHIR-35718 Restructure and add diagrams to make functional requirements of spec clear
- FHIR-35639 The patient should be given an opportunity to weigh in on whether the referral was successful and goals have been accomplished (or progress made)
- FHIR-35633 Clarifications related to Closing the Loop
- FHIR-35623 Clarify: what happens when the CP shares that info with the CBO or other agency assisting with the Food Insecurity?
- FHIR-35621 What is the CP doing on behalf of the provider organization that renders it a business associate?
- FHIR-35377 Additional info about what a CP is might be helpful here
- FHIR-34881 Referral workflow steps need to be aligned
  - Applied the above ticket dispositions to the Functional Use Cases page

#### Structure Definitions

- FHIR-34891 Please relax `Goal.achievement` cardinality to 0..1 to align with goals that are proposed or planned
  - changed `goal.achievement` cardinality to 0..1
- FHIR-35369 Streamline representation of SDOH screening instruments
  - based on US Core decision, change grouping observation to have individual observations for multiple selection questions

#### Exchange Workflow

- FHIR-35733 Patient interaction diagrams need more clarity
- FHIR-35721 Recommend better definition and consistence with diagram and rest of 9
- FHIR-35717 Move this section up so that it is easier to find
- FHIR-35637 Workflow and Managing Consent diagram should be expanded to include API Resources
  - Applied the above ticket dispositions to the Exchange Workflow page

#### Capability Statements

- FHIR-36045 Procedure _id search parameter Definition & Chaining makes reference to PractitionerRole records
- FHIR-35960 Subscription in the capability statements has SDOHCC-Procedure as the supported Profile
- FHIR-35076 Capability Statements - Please provide specific conformance assertions with respect to the various supported profiles
  - updated capability statements

#### Privacy and Security

- FHIR-35676 Add language to clarify that not all legal requests are up to org policy - HIPAA has specific procedures that must be followed regarding these types of disclosures
  - added clarification to the Privacy and Security page