SDOH Clinical Care
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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

Patient Coordination Workflow

Page standards status: Informative

The Gravity Project team has added text to the "Referral Use Care Overview" to provide guidance on how to include additional relevant information in a referral request, such as completed questionnaires, assessments, procedures, etc. We would encourage balloters to review this guidance and provide feedback.

This section describes the interactions between the actors in an SDOH referral starting both at a high-level and at the level of FHIR API calls. First, a high-level overview of the interactions is provided. This description abstracts technical details and should be accessible to the non-technical reader. For the sake of simplicity, only relationships critical to the Referral Workflow are provided. (For additional details on task status updates see Checking Task Status, and on relationships between profiles see Data Modeling Framework.)

The use cases here relate to the Gravity Use Cases. Implementers will benefit from looking at the detailed technical description of the exchange work flow for each use case, as well as the Capability Statements associated with each workflow and the conformance artifacts generally.

Patient Coordination Workflow

This implementation guide supports additional interactions with a patient/client application (on a smartphone or portal) including:

Functional Use Case Task.code Description Actors
Complete Questionnaire Request complete-questionnaire Requesting party (e.g., provider, CBO, or CP) asks a patient to complete a questionnaire. This functionality can be used to assess social risks, inform service qualification or application, indicate reasons for cancellation, or determine the patient’s view of their interaction with the CBO and whether the service provided met their needs. providericon, patienticon, cboicon, cpicon
General Information Request general-information-request Requesting party sends a patient a free text question and receives a free text response. providericon, patienticon, cboicon, cpicon
Make Contact Request make-contact-directions Requesting party provides contact information for the CBO (in cases where the patient does not want the CBO to initiate contact). providericon, patienticon, cboicon, cpicon
Review Material Request review-material Requesting party requests that the patient review a document (usually a PDF), video, etc. providericon, patienticon, cboicon, cpicon

In the examples below, it is assumed that the patient has been equipped with the patient application, and authenticated communication between the patient application and the requester has already been established. See Connecting Applications with API Data Sources for more details. The referenced data instances are all in their completed state. In practice, they would move through the state transitions indicated, with the requester initializing their input fields, and the patient completing the output fields, and updating the status.

Complete Questionnaire Request

Here we provide a detailed view of an example interaction between a patient application and a requester (provider, CBO, or CP) for the completion of a questionnaire. The example shows one of the four ways the questionnaire can be transmitted and the response received from the patient.

Complete Questionnaire Request FlowRequesterPatient1CreateSDOHCC Task for Patientand referenceQuestionnaireas .input2Notify to completeQuestionnaire3GetSDOHCC Task for Patient4GetQuestionnaire5UpdateSDOHCC Task for Patient(in-progress)6CompleteQuestionnaireProduce outputQuestionnaireResponse7PostQuestionnaireResponse8UpdateSDOHCC Task for Patient(completed)Task.output referencesQuestionnaireResponse


General Information Request

Here we provide a detailed view of an interaction between a patient application and a requester (provider, CBO, or CP) for a general information request. The example shows the patient returning an optional response.

General Information Request FlowRequesterPatient1CreateSDOHCC Task for Patientwith question as .description2Notify Patient3GetSDOHCC Task for Patient4UpdateSDOHCC Task for Patient(in-progress)5Respond to Request for Information6UpdateSDOHCC Task for Patient(completed)Task.output includes text of response


Make Contact Request

Here we provide a detailed view of an interaction between a patient application and a requester (provider, CBO, or CP) for providing one or more options from which to select to make contact with a service, provider or organization. The example shows the patient returning an optional response.

Review Material Request FlowRequesterPatient1CreateSDOHCC Task for Patientand reference contacts as .input2Notify Patient3GetSDOHCC Task for Patient4Get Contact(s) viaSDOHCC Healthcare Service5UpdateSDOHCC Task for Patient(in-progress)6Select Contact(s) to share7UpdateSDOHCC Task for Patient(completed)Task.output includes chosen contact


Review Material Request

Here we provide a detailed view of an interaction between a patient application and a requester (provider, CBO, or CP) for providing review material.

Review Material Request FlowRequesterPatient1CreateSDOHCC Task for PatientwithDocumentReferenceas .focus2Notify Patient3GetSDOHCC Task for Patient4GetDocumentReference5UpdateSDOHCC Task for Patient(in-progress)6Review Document7UpdateSDOHCC Task for Patient(completed)