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Submitting WG/Project/Implementer Group

Justification and Objectives

For details on the approved scope for the Gravity Project SDOH Data Element FHIR IG, read the HL7 PSS.


Gravity demo 2020.05.15: View here

Gravity Report Out 2020.05.15: Download here

Gravity Report Out with Lessons Learned 2020.05.26: Download here


This track will use R4 version of FHIR.


Clinical input requested (if any)


Zulip Chat for SDOH CC: https://chat.fhir.org/#narrow/stream/233957-Gravity-sdoh-cc

Sign up for Zulip: https://chat.fhir.org/register/


Related tracks

2020-05 Care Coordination Track


Virtual Connectathon Schedule:

Date

Time

Gravity

PACIO/eLTSS

Care Coordination

May 131:30 to 3pm
Dry-Run (6 scenes)
May 134 to 4:30 pmHL7 kick-offHL7 kick-offHL7 kick-off
May 134:30 to 5 pm
Track kick-offParticipate in PACIO track
May 135 to 5:30pmTrack kick-off
Participate in Gravity track
May 135:30 to 6. pm

Track kick-off
May 149 to 10 amIntro, overview, provide resources
Intro, review other track schedules
May 1410 am to 5:30 pmTrack testingTrack testingParticipate in Gravity and PACIO tracks
May 159 to 10 amRecap and review Thurs. testing problems and solutionsStarts at 9.15am. From 9.15am till 2pm, we will be recording demos.
May 1510 am to 12:30pmTrack report-outs (break from 11:00 - 11:30)Track report-outs
May 151:30 to 2:15 pmParticipate in Care Coordination TrackParticipate in Care Coordination TrackCare Coordination overview and Gravity and PACIO tracks debrief
May 152:15 to 4:00 pmParticipate in Care Coordination TrackParticipate in Care Coordination TrackTest Scenes 1 & 9
May 154:30-4:45 pmGravity Report out (on main Go To line)

May 155:00 to 5:15 pm

Care Coord Scene 1 & 9 and 5:00 - 5:15 Report out (on main Go To line)
May 156:00 - 6:30 pm HL7 Wrap up (on main Go To line)HL7 Wrap up (on main Go To line)HL7 Wrap up (on main Go To line)

Related  Track Actors-Transactions-Payload Review 


Proposed Track Leads:

Lisa Nelson (Tech Lead)

Corey Smith

Matt Elrod

Lnelson@max.md

corey.smith@ama-assn.org

elrod@max.md


Track Orientation

Gravity SDOH FHIR Connectathon Participant Meetings

Meeting Schedule:

Wednesdays at 3:00pm ET

Multiple Sign-ups:



Participants

Add your feedback on SDOHCC Track: 

NameOrganization Zulip User NameRoleAdditional Notes/Interests
Lucy JohnsDirectTrust
Patient
Laverne PerlieONC
Documentarian
Abigail WatsonSymptomatic
Screening App/ Patient App
Anup Mahansaria



Michael CoxOnyx Health (NewWave)

mjcox422@gmail.com

PMEHR

Interested in testing the use of OAuth 2.0.  

GRAVITYAPI_Flow_RefDoc.docx

Ankit AgarwalOnyx Health (NewWave)ankit.agarwal@newwave.ioPMEHR
Theresa BessetteMaxMD
Support
Tanvi ShahMaxMDTanvi ShahSupport
Becky GradlAcademy of Nutrition and Dieteticsbgradl@eatright.orgSupport / where needed

Gravity Scenario 1 - Gather and Share Social Determinants of Health (SDOH) Information in a Clinical Encounter

Link to Social Determinants of Health (SDOH-CC) IG

System Roles

System Actor

Description of the Technical Role

PMEHR (Practice Management/EHR)

The system that initiates the task to request patients to be screened using a certain screening questionnaire.

Screening App/ Patient App

The system that receives the screening request and then initiates screening of patient through the Patient App. This system sends completed questionnaire responses to the intended recipient. (May be grouped with a Patient App). The system that enables a patient to complete a screening questionnaire. (SHALL be grouped with the Screening App)

Clinical Data R/R (Requester/Recipient)

A system that requests clinical information which may include SDOH information also gathered during clinical care encounters.

Other Participant Roles

Human Participant

Description of the Technical Role

Patient

A person who will operate a Patient App to complete a Screening Questionnaire. The person may request access to his or her own medical records.

Documentarian
  • Review progress across multiple scenes of use case
  • Capture evidence of accomplishment, document observations


Personas and Patient Stories

Review Gravity Personas and Patient Stories here: http://build.fhir.org/ig/HL7/sdoh-cc/GravityProjectPersonasandPatientStories.html

Care Coordination Patient Story download here


Actor Transaction Diagram

Use Case 1 - Sequence Diagram

Scenario 1: Use Case 1 Gather and use SDOH information in the clinical care setting

Use charts below to express the role(s) you intend to participate in


Scenario 1 

Scene 0

Thursday May 14 10:00 am -11:00 am ET



Human: Patient or DocumentarianFHIR EndpointQuestionnaire IDQuestionnaire Code
NameOrgZulip User nameRole (Choose one from above)


Lucy JohnsDirectTrustPatient



Laverne PerlieONCDocumentarian



Lisa NelsonMaxMDLisa NelsonPMEHR (Creates a questionnaire)

https://ehr-sandbox.directmdemail.com:8443/fhir/baseR4ko0

Questionnaire/b5bd0d9b-3d9c-4386-9fbd-a2962402870b

          "system""http://loinc.org",
          "code""88121-9",
          "display""Hunger Vital Sign [HVS]"

json example

xml example


Abigail WatsonSymptomaticAbigail WatsonScreening App/ Patient App
http://gravity.meteorapp.com/baseR4
GET http://gravity.symptomatic.io/baseR4/metadata

PUT http://gravity.symptomatic.io/baseR4/Questionnaire/:id
PUT http://gravity.symptomatic.io/baseR4/QuestionnaireResponse/:id
PUT http://gravity.symptomatic.io/baseR4/Task/:id
PUT http://gravity.symptomatic.io/baseR4/List/:id
PUT http://gravity.symptomatic.io/baseR4/CommunicationRequest/:id
PUT http://gravity.symptomatic.io/baseR4/Communication/:id

GET http://gravity.symptomatic.io/baseR4/Questionnaire/:id
GET http://gravity.symptomatic.io/baseR4/QuestionnaireResponse/:id
GET http://gravity.symptomatic.io/baseR4/Task/:id
GET http://gravity.symptomatic.io/baseR4/List/:id
GET http://gravity.symptomatic.io/baseR4/CommunicationRequest/:id
GET http://gravity.symptomatic.io/baseR4/Communication/:id

No OAuth required.  Need to include a Content-Type header of application/fhir+json; charset=utf-8




Hunger Vital Sign Questionnaire

          "system""http://loinc.org",
          "code""88121-9",

Ankit Agarwal, Michael CoxOnyx Health (NewWave)

ankit.agarwal@newwave.io

mjcox422@gmail.com

PMEHR (API endpoints for Questionnaire, QuestionnaireResponse reading and storing and updating on FHIR Server) 

GET https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/Questionnaire

GET https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/Questionnaire/<id>

POST https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/QuestionnaireResponse

GET https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/QuestionnaireResponse

GET https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/QuestionnaireResponse/<id>

GET https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/Task

GET https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/Task/<id>

PUT https://nw-sf-dev-uses0-safr2-safhirapim.azure-api.net/grav/api/Task/<id>

Questionnaire/d2ff1d83-f772-448c-b5df-04b66b5ef0f2

North Carolina DHHS Health Screening (SDOH Questionnaire)


Scenario 1 Scene 1: Gather Screening Information

Scenario 1 Scene 1 Step 1: Initial Screen Patients Task

Action: PMEHR initiates a task for screening patients via the Screening App FHIR API. PMEHR supplies the Questionnaire and Patient List for the requested screening task.

Precondition: PMEHR has a developed Questionnaire screening tool that conforms to SDC Questionnaire and has a means to determine the right list of patients to be screened. Establish the endpoint to be used by Screening App for workflow requests.

Success Criteria: Screening App receives the Task request, Questionnaire, Patient List, and any other needed resources such as the Organization requesting the task to be performed and the Endpoint where Consent and QuestionnaireResponses information should be returned.

Bonus point: Develop more than one type of SDOH Questionnaire using Coded questions and Answers using the LHC Form Builder Tool.

Link to guidance from the Structured Data Capture IG.

Day and Time: 
Thursday, May 14

 11:00 am - 12:30 pm ET

Client: PMEHR 

Server: Screening App/ Patient App


NameOrgZulip User nameRole (Choose one from above)FHIR end point
Ankit Agarwal, Michael CoxOnyx Health (NewWave)

ankit.agarwal@newwave.io

mjcox422@gmail.com

PMEHR:

API endpoints for Questionnaire, QuestionnaireResponse & Task FHIR resources for reading, storing and updating on FHIR Server. Can be accessed with any REST app like Postman. We will be sharing a couple personas for our authentication/authorization for our APIs such that our custom OAuth flow for the FHIR platform is in play.


Lisa NelsonMaxMDlnelson@max.md
















Scenario 1 Scene 1 Step 2: Perform Screen Patients Task

Action: Screening App interacts with Patient App to initiate consent to share SDOH questionnaire responses and, if agreed, administers the questionnaire and gathers the responses. Upon receiving a submitted questionnaire response, the Screening App returns the Consent and  QuestionnaireResponse to the endpoint indicated in the Questionnaire. 

Precondition: PMEHR endpoint for processing QuestionnaireResponses and Consent Resources was indicated in the Questionnaire using the SDC Questionnaire extension to support this element (sdc-questionnaire-endpoint)

Success Criteria: Patient's Consent and QuestionnaireResponse can be accepted, stored (associated with the correct patient), and viewed on the PMEHR.

Bonus point: Process more than one patient in a single task.

Day and Time: 

Thursday, May 14

 11:00 am - 12:30 pm ET

Client: Screening App/ Patient App

Server:  PMEHR


NameOrgZulip User nameRole (Choose one from above)FHIR end point
Ankit Agarwal, Michael CoxOnyx Health (NewWave)

ankit.agarwal@newwave.io

mjcox422@gmail.com

Using REST process, we will be able to submit a QuestionnaireResponse to FHIR server.




















Scenario 1 Scene 1 Step 3: Notify Task Initiator that Task is Completed

Action: Screening App sends message to PMEHR (task initiator) to indicate the requested task has been completed.

Precondition: Establish the endpoint to be used by PMEHR for workflow updates. Task has an expiration date/time set so task completion can be established when responses have been received from all requested patients on the list or when the task expiration date is reached.

Success Criteria: PMEHR App can display the status of the Task, and it shows as completed. (Dashboard previously showed "active")

Bonus point: At the point of receiving the Task completed message, and based on received QuestionnaireResponses, PMEHR computes what portion of the requested list of patients completed the screening task.

Day and Time: 

Thursday, May 14

 11:00 am - 12:30 pm ET

Client: Screening App/ Patient App

Server:  PMEHR


NameOrgZulip User nameRole (Choose one from above)FHIR end point
Ankit Agarwal, Michael CoxOnyx Health (NewWave)

ankit.agarwal@newwave.io

mjcox422@gmail.com

Confirmation to the provider via updating the Task resource used for the screen order via HTTPS (Postman, etc)




















Scenario 1 Scene 2: Perform the patient visit

Scenario 1 Scene 2 Step 4: Complete a Patient Encounter that includes viewing results from a prior screen

Action: PMEHR actor initiates a patient encounter and gathers medical as well as sdoh related information. The gathered information can be exchanged via a Progress Note for the Patient following the visit.

Precondition: PMEHR has previously received the patient's screening results and consent to share them with the PMEHR.  That screening is linked to the patient's medical record to allow the physician to easily review and potentially incorporate the screening information into the documentation of the visit.

Success Criteria: PMEHR gathers documentation during the encounter and records SDOH information in the same system using consistent mechanisms to permit the SDOH information to be part of the visit "SOAP NOTE" documentation.

Bonus point: Use the CDS on-patient-view hook to enable the clinician to view and select information from the screening results to be added to the current visit documentation.

Day and Time: 
Thursday, May 14

 1:30 pm - 3:00 pm ET

Client: PMEHR

Server: Screening App/ Patient App


NameOrgZulip User nameRole (Choose one from above)FHIR end point
Lisa NelsonMaxMD






















Scenario 1 Scene 3: Notify Task Initiator that Task is Completed

All systems need to register for Scene 3: Register for Aegis Testing 

For assistance, review: Touchstone Onboarding_GravityProject.pdf

Scenario 1 Scene 3 Step 5: Request a Progress Note Document Generated Following the Clinical Encounter

Scenario 1 Scene 3 Step 6: Communicate a Progress Note Document Generated Following the Clinical Encounter

Action: Clinical Data Requestor/Recipient communicates a request to the PMEHR for a Progress Note for the Patient following the visit.

Precondition: PMEHR gathered documentation during the encounter and recorded SDOH information in the same system using consistent mechanisms to permit the SDOH information to be part of the visit "SOAP NOTE" documentation.

Success Criteria: PMEHR receives and processes the request then returns a solicited Communication that includes the requested document.

Bonus point: Use the RESTful data processing mechanisms defined by CDex to query for the Patient's Food Insecurity Observation.

Link to Clinical Data Exchange (CDex) IG.

Link to Prior CDex Connectathon Track guidance.

Day and Time: 
Thursday, May 14

3:30 - 5:00 pm ET

Client: Clin Data R/R

Server: PMEHR


NameOrgZulip User nameRole (Choose one from above)FHIR end point


























Data Representation Reference Information

Structured Document Clinical Note Types

Use this information to request clinical note(s) (DocumentReference or Composition, DiagnosticReport, CarePlan).

The Pull (Solicited Request) information exchange mechanism enables Information Request Sender to request a general type of document and permits the Information Request Recipient to respond with any of the more specific document types defined to be in that note type category.

The Pull (GET) information exchange mechanism requires the Information Client to use specific codes when querying the Information Source. 

Reference the various types of clinical note types via the concepts in the associated value sets.

Clinical Note Type

General Code

(LOINC)

Specific Types Value Set Name

Value Set Reference (available in VSAC)

History and Physical Note34117-2HPDocumentType2.16.840.1.113883.1.11.20.22
Progress Note11506-3ProgressNoteDocumentTypeCode2.16.840.1.113883.11.20.8.1
Referral Note57133-1ReferralDocumentType2.16.840.1.113883.1.11.20.2.3
Consultation Note11488-4ConsultDocumentType2.16.840.1.113883.11.20.9.31
Procedure Note28570-0ProcedureNoteDocumentTypeCodes2.16.840.1.113883.11.20.6.1
Care Plan18776-5Care Plan Document Type2.16.840.1.113762.1.4.1099.10
Continuity of Care Document34133-9N/AN/A


Helpful Communication Request Recipient Organization Endpoint format codes (this is only relevant for the Request (Solicited Communication) Information Exchange mechanism

Profile

Format Code

Media Type

When to use

HL7 C-CDA R2.1 using a structured bodyurn:hl7-org:sdwg:ccda-structuredBody:2.1text/xmlTo receive document bundles that contain C-CDA R2.1 structured documents
HL7 C-CDA R2.1 using a non-structured bodyurn:hl7-org:sdwg:ccda-nonXMLBody:2.1text/xmlbinary resource 
HL7 C-CDA-On-FHIR using a structured Composition
text/xml
HL7 C-CDA-On-FHIR using a structured Composition
text/json
HL7 C-CDA-On-FHIR using a non-structured body
text/xml
HL7 C-CDA-On-FHIR using a non-structured body
text/json


Sample Structured Data Codes

Note: there are many search parameters and other details for the FHIR search API.  Refer to the FHIR specification for details.

Data Element DescriptionC-CDA Entry TemplateC-CDA data codingFHIR ResourceFHIR Resource data coding
What are the A1C results after 2018-01-01 for this patient?
FHIR Query String: 
  • Observation?patient=[the patient's id]&date=ge2018-01-01&code=4548-4
Test Result: A1C
4548-4 Hemoglobin A1c/Hemoglobin.total in Blood (LOINC)

What are the patient's vital sign measurements in reverse chronological order?

FHIR Query String:

  • Observation?_sort=-date&patient=[this patient's id]&category=vital-signs
Vital Sign: weightVital Sign Observation29463-7 Weight (LOINC)

Vital Sign: heightVital Sign Observation8302-2 Height (LOINC)

Vital Sign: BMIVital Sign Observation39156-5 Body Mass Index (BMI)

What are the patient's active conditions?

FHIR Query String:

  • Condition?patient=[this patient's id]&clinicalstatus=active
Condition/Diagnosis: Type II DiabetesProblem ConcernE11 (ICD-10) Type 2 diabetes mellitus

Condition/diagnosis: Amputated left footProblem Concern

Z89.432 Acquired absence left foot (ICD-10)

Condition
Condition/diagnosis: HypertensionProblem ConcernI10 (ICD-10)Condition
What is the patient's current smoking status?
  • Observation?patient=1032702&code=72166-2&_sort=-date&_count=1
Social History: Smoking StatusSocial History Observation
72166-2 Tobacco Smoking Status (LOINC)


What medications is the patient taking?
  • MedicationStatement?patient=[this patient's id]

Medication Activity


Medication:Medication Information316151 Lisinopril  10 MG (RxNorm)


Indication38341003 | Hypertensive disorder, systemic arterial (disorder) (SCT)

What devices does the patient have?
  • Device?patient=[this patient's id]
Device: Wheel chair

Non-medicinal Supply/product instance

58938008 | Wheelchair device (physical object) | (SCT)

Device: CrutchesNon-medicinal Supply363753007 | Crutches (physical object) | (SCT)

Device: Prosthetic left footNon-medicinal Supply449694008 | Implantation of prosthetic device of lower leg (procedure) | (SCT)

What procedures has the patient had?
  • Procedure?patient=[this patient's id]
ProceduresDiabetic Retinal Exam67028 Diabetic Retinal Exam (CPT)

Procedures:Procedure activity Procedure46786008 | Fitting of prosthesis or prosthetic device of leg below knee (procedure) | (SCT)

Procedures:
Implantation of prosthetic device of lower leg (CPT)

Who is the patient's Primary Care Provider?
  • Patient/this patient's id    (note: parse the generalPractitioner field)
Primary Care Provider for PatientPerformer or ResponsibleParty functionCode

446050000 Primary Care Provider (SCT)

or PCP Primary Care Provider (ParticipationFunction)



What type of health insurance does the patient have?
  • Coverage?patient=[this patient's id]&status=active    (note: parse coverage resource to get the fields you need.)
Coverage: Health Insurance typeCoverage Activity / Policy ActivityNeed help

TestScript(s)

Indicate any test scripts that will be used to help verify system behavior. TBD.

Security and Privacy Considerations

Identify any expectations around security (e.g. will TLS, mutual-TLS, OAuth, etc. be required to participate


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