SDOH Clinical Care
3.0.0-ballot - STU 3 Ballot US

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-ballot 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

Change History

Page standards status: Informative

   

The Social Determinants of Health (SDOH) Change History page provides a list of detailed changes made in each version of the Implementation Guide (IG). These changes include updates, enhancements, clarifications, and corrections that reflect community feedback, ballot processes, and alignment with evolving standards. Where applicable, a link to the Jira ticket that corresponds to the changes made is provided in the table along with a description of the change and the Jira ticket resolution.

   

STU 3 Publication

Jira Ticket Number Description Resolution
FHIR-54584 Updated the outline format on the Enrollment Status, Capacity Status, rffa, and Self-Referral pages Persuasive with Modification
FHIR-54917 Moved the Patient Coordination Workflow information from the Referral Workflow page to it's own page and updated the corresponding links the IG. Persuasive
FHIR-54912 Copied the technical requirements and description for the SDOHCC Observation Program Enrollment Status text from the Enrollment page and added it to the StructureDefinition-SDOHCC-ObservationProgramEnrollmentStatus-intro page. Persuasive
FHIR-53798 and FHIR-53799 Added text and 4th bullet point text to the sdoh_challenges_gravity page. Persuasive
FHIR-53804 Updated and added link to the overview on the RFFA page. Persuasive
FHIR-51138 Updated the Device Resource Conformance in the Capability Statement from SHALL to SHOULD and fixed the "unspecified" issue for the other resources. Persuasive

 

STU 3 Ballot

The Gravity Project team has drafted a new STU3 version of the IG for balloters to review and submit feedback. Below are the requirements that we have worked through for this ballot and the associated updates to the IG:

  • Capacity Status

  • Enrollment Status

  • Self-Referral

  • Referral for Further Assessment

    • NEW: Referral for Further Assessment Narrative Guidance
    • Updated: [SDOHCC Task for Referral Management] (added slice to Task.output to include resources associated with outcomes from the completion of the task(s))

  • Content-Rich Referral

    • Updated: Referral Workflow additional guidance on pushing additional content in a closed-loop referral
    • Updated: [SDOHCC Task for Referral Management] (added slice to Task.input to include resources relevant in the provision of services to a referral recipient)

  • Protective Factors

    • Updated [SDOHCC Condition] to include Protective Factors as a possible category code. Additional guidance is present in the profile as well on how to use Protective Factors
Jira Ticket Number Description Resolution
FHIR-53456 New narrative pages to address new use cases Persuasive
FHIR-53455 Promote Personal Characteristics Narrative out of draft status Persuasive
FHIR-53454 Update to Referral Workflow Narrative to address communication of additional info for a referral Persuasive
FHIR-53453 Updates to SDOHCC Task for Referral Management .input and .output Persuasive with Modification
FHIR-53451 Adding Protective Factors as an SDOHCC Category code Persuasive
FHIR-53450 New Extension - SDOHCC Extension HealthcareService Capacity Status Persuasive
FHIR-53449 Update VS in SDOHCC Observation Recorded Sex Gender Persuasive
FHIR-53448 Update dependency of SDOHCC Observation Sexual Orientation to US Core 7 profile Persuasive
FHIR-53447 Promote Personal Characteristics profiles out of draft status Persuasive with Modification
FHIR-53446 New Profile - SDOHCC Observation Enrollment Status Persuasive with Modification
FHIR-53445 New Profile - SDOHCC HealthcareService For Referral Management Persuasive with Modification

 

STU 2.3 Publication Update

The impetus for creating an STU2.3 version of the SDOH Clinical Care IG was for the FHIR artifacts to be able to support US Core 3.1.1, US Core 6.1.0, and US Core 7.0.0. Updates made to the IG were related to this and do not alter the scope of the guide.

Jira Ticket Number Description Resolution
FHIR-48802 When updating Goal to US Core 6.1+, use US Goal Codes ValueSet for Goal profile Persuasive with Modification
FHIR-48886 When updating Goal to US Core 6.1+, use US Goal Codes ValueSet for Goal profile Persuasive
FHIR-49385 When updating to US Core 6.1, add invariant for Condition to match US Core requirements Persuasive with Modification
FHIR-49386 Create a PractitionerRole Profile to support US Core 3.1.1 and 6.1 Persuasive with Modification
FHIR-49387 Correct the wording of Goal.description requirements in the Goal Usage notes Persuasive
FHIR-49388 Update all Profile intro notes where relationship to US Core needs to be noted Persuasive with Modification
FHIR-49644 Observation Assessment Profile Derived from US Core Simple Observation 7.0.0 Persuasive
FHIR-49645 Observation Screening Response Profile Derived from US Core Observation Screening Assessment 7.0.0 Persuasive
FHIR-50149 Set FMM to Maturity Level 2 Persuasive
FHIR-50168 Include HRex as a Dependency Persuasive
FHIR-50169 Update Dependency Table Persuasive
FHIR-50170 Remove Terminology Parameters from Artifacts Persuasive

 

STU 2.2 Publication Update

Jira Ticket Number Description Resolution
FHIR-44753 Add new codes to SDOHCC ValueSet SDOH Category and update value set tables for ObservationScreeningResponse, Condition, Procedure, ServiceRequest and Goal profile Persuasive with Modification
FHIR-46247 Update "Assessment Instrument Support" Page Persuasive
FHIR-46248 Update "Gravity Value Sets" Page Persuasive
FHIR-46249 Add Additional Bindings Tables for Condition, Goal, OSR, ServiceRequest and Task Profiles Persuasive
FHIR-46250 Update Descriptions for Condition, Goal, OSR, ServiceRequest and Task Profiles Persuasive
FHIR-46251 Hyperlink QA Persuasive
FHIR-46422 Update Subscription Backport dependency version (from 0.1.0 to 1.1.0) Persuasive

 

STU 2.1 Publication Update

Jira Ticket Number Description Resolution
FHIR-40447 Document the use of Gravity VS in the multi-domain profiles Persuasive
FHIR-40449 Improve rendering of Capability Statements Persuasive with Modification
FHIR-40450 Glossary Persuasive
FHIR-40460 SDOHCC Observation Assessment is not abstract Persuasive
FHIR-40586 Referral Task outputs bound appropriately Persuasive
FHIR-40611 Added slice to to ObservationScreeningResponse.member to reference all observations that are members of the group Persuasive
FHIR-40771 Constrained TaskForReferralManagement.status to exclude requested value Persuasive
FHIR-41278 Fixed cardinality of extension to HealthcareService.telecom so that there would be one boolean flag per telecom Persuasive
FHIR-41310 ObservationScreeningResponse.hasMember[SupportedHasMember] can only reference an ObservationScreeningResponse. Previously it could also reference a QuestionnaireResponse. Persuasive

This update was focused on improving the readability of the IG narrative content.

StructureDefinitions

  • Included value set references in narrative for the multi-domain profiles (Condition, Goal, ServiceRequest, Procedure, and Observation)
  • Improved narrative in all Profiles
  • Abstract flag in SDOHCCObservationAssessment is now false - FHIR-40460
  • Corrected bindings for output procedures in SDOHCCTaskForReferralManagement - FHIR-40586
  • Added slice to to ObservationScreeningResponse.member to reference all observations that are members of the group FHIR-40611
  • Updated valuesets and state transition diagrams for [SDOHCCTaskForReferralManagement].status and [SDOHCCTaskForPatient].status FHIR-41199
  • Remove abstract from SDOHCCGroup Profile. FHIR-41198

CapabilityStatements

Narrative

  • The narrative has been restructured and edited and all of the figures redrawn to improve overall readability
  • Glossary – Added glossary FHIR-40450

FHIR Shorthand

 

STU 2 Publication

Index

Jira Ticket Number Description Resolution
FHIR-35753 Home page should have compelling sale of problem and solution spec solves/offers - Provided link to gravity project on the home page Persuasive with Modification

General Changes

Jira Ticket Number Description Resolution
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 Persuasive
FHIR-34857 Update reference to US Core MS and Missing Data - Updated references to US Core MS and Missing Data Persuasive

Mapping

Jira Ticket Number Description Resolution
FHIR-38082 Beef up the mapping instructions page Persuasive
FHIR-38081 Mapping page should not have the mapping language content - updated mapping instructions Persuasive

Task Instructions

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

Personal Characteristics

Jira Ticket Number Description Resolution
FHIR-34876 Need specificity in requirements, e.g., state statutes. Persuasive
FHIR-34863 References from Race Profile to Spec Requirements Persuasive
FHIR-34862 References from Ethnicity Profile to Spec Requirements Persuasive
FHIR-34860 State Requirements Unclear Persuasive
FHIR-34858 Race and Ethnicity Text Persuasive with Modification
FHIR-35679 Illustrate that laws vary around sharing of race and ethnicity data Persuasive with Modification
FHIR-35685 Observation Subject Extension - use in Observation Profiles for Race and Ethnicity Persuasive with Modification
FHIR-35338 Concern over race and ethnicity data of "related person" and "practitioner" Persuasive with Modification
FHIR-35329 Concern over patient race and ethnicity data being shared for non-treatment purposes Persuasive with Modification
FHIR-35022 Use a single Observation Resource to include both Race and Ethnicity Observations Not Persuasive with Modification
FHIR-34999 Adding R/E Observations to the Structured Definitions without indicating they are draft will cause implementation confusion Persuasive with Modification
FHIR-35691 "Unknown" is not appropriate as an observation method Not Persuasive with Modification
FHIR-34878 Need to consider Provenance when R/E Extensions and Observation Resource is used for R/E Persuasive with Modification
FHIR-35327 For Observation.method value set, add guidance related to use of "observed" Persuasive with Modification
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" Not Persuasive with Modification
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 Persuasive with Modification
FHIR-35715 Unclear what adhoc and adhocresponse are - please clarify Persuasive with Modification
FHIR-35370 For Observation.method value set, add guidance related to use of "observed". Persuasive with Modification
FHIR-35375 Add a challenge related to the sensitivity of SDOH data - Updated the Draft Specifications for Personal Characteristics page and referenced artifacts Persuasive

Value set changes

Jira Ticket Number Description Resolution
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 Persuasive

Functional Use Cases

Jira Ticket Number Description Resolution
FHIR-35718 Restructure and add diagrams to make functional requirements of spec clear Persuasive with Modification
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) Persuasive with Modification
FHIR-35633 Clarifications related to Closing the Loop Persuasive with Modification
FHIR-35623 Clarify: what happens when the CP shares that info with the CBO or other agency assisting with the Food Insecurity? Persuasive with Modification
FHIR-35621 What is the CP doing on behalf of the provider organization that renders it a business associate? Persuasive with Modification
FHIR-35377 Additional info about what a CP is might be helpful here Persuasive with Modification
FHIR-34881 Referral workflow steps need to be aligned - Applied the above ticket dispositions to the Functional Use Cases page Persuasive with Modification

Structure Definitions

Jira Ticket Number Description Resolution
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 Persuasive
FHIR-35369 Streamline representation of SDOH screening instruments - based on US Core decision, change grouping observation to have individual observations for multiple selection questions Persuasive

Exchange Workflow

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

Capability Statements

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

Privacy and Security

Jira Ticket Number Description Resolution
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 Persuasive

 

STU 2 Ballot

Jira Ticket Number Description Resolution
FHIR-34237 Replace Task with a Task for Referrals and one for the Patient, and add documentation. Patient task should support surveys, documentation, and contact information Persuasive
FHIR-34238 Add Draft observations for race and ethnicity that support the identification of “source” and “method” of collection and add documentation – need US core exceptions from CPWG for observations – submitted variance request to CPG and was approved (see profiles) Persuasive
FHIR-34242 Change ServiceRequest and Procedure profiles to use US core value set for .code Persuasive
FHIR-34243 Change Condition profile to use US Core .code value set and provide guidance on the use of both SNOMED-CT and ICD-10 (as codings) Persuasive
FHIR-34244 Add profile for HealthcareService and Location to use in the Patient Task to indicate contact information Persuasive
FHIR-34246 Add Service order detail in the ServiceRequest to indicate that the service organization is not to call the patient/client Persuasive
FHIR-34255 Define workflow with patient involvement Persuasive
FHIR-34256 Define workflow with multiple services organization Persuasive
FHIR-34257 Add additional examples for each of the new / changed profiles /requirements Persuasive
FHIR-34236 Update profiles must support and element definitions based on feedback from implementers Persuasive
FHIR-34233 Add support for external terminologies as part of ServiceRequest and Procedure. Persuasive
FHIR-34339 Add Guidance on relationship between new Race and Ethnicity Observation with US Core Persuasive

This ballot was focused on a number of additions and corrections based on feedback from addresses several additions, modifications, technical corrections, errata, clarifications listed below.

CodeSystems

Added values and notes FHIR-34237, FHIR-34238, FHIR-34246

Value Sets

Adopted US Core Value Sets FHIR-34233

Removed Values Sets (no longer required) FHIR-34233

Added Value Sets for Race/Ethnicity Observation Profile FHIR-34238

Added Value Sets for Patient Task FHIR-34237

Added values and notes FHIR-34233

StructureDefinitions

US Core FHIR-34233

  • Updated from 3.1.1 to 4.0.0

Updated Profiles FHIR-34233

  • SDOHCC Condition FHIR-34243

    • Added guidance on use of SDOH value sets

  • SDOHCC Goal FHIR 34233

    • Added guidance on use of SDOH value sets in VSAC
    • Make Goal.value due date MS

  • SDOHCC Procedure FHIR-34233, FHIR-34242

    • Procedure.code.coding – added slice for example of social services taxonomy (e.g. 211 LA) as Must Support

  • SDOHCC ServiceRequest FHIR-34246, FHIR-34233, FHIR-34242

    • ServiceRequest.status –- updated guidance
    • ServiceRequest.code – removed slices and added reference to US Core Procedure value set
    • ServiceRequest.code.coding – added slice for example of social services taxonomy (e.g. 211 LA) as Must Support
    • ServiceRequest.reasonReference – added guidance
    • ServiceRequest.orderDetail – added order detail to indicate that the service organization is not to call the patient/client

Added new profiles

New Draft Observation Profiles for Race and Ethnicity

Removed

CapabilityStatements

Changed name and updated content

Added CapabilityStatement

Documentation

Examples

  • Many of the examples have been renamed, updated, or added to appropriately provide examples of the changes noted above FHIR-34257