Human and Social Services Work Group Formation Proposal

We are unclear about the relationship between this proposed group and the Gravity Accelerator and its sponsoring workgroups (Patient Care and Public Health) - BR&R would like to see this clarified before we approve.

GD: 

From the PSS:

"Proposed Formal Relationships with other work groups and Accelerators: The Human Services Work Group will be intentional about identifying opportunities to cross collaborate. This work group may have work items that intersect and overlap with the following work groups: Patient Care, EHR, Public Health, Community Based Care and Privacy (CBCP), and others as identified over time.  The new work group will collaborate with other work groups on sub-domains of common interest. The goal will be to ensure ongoing communication and collaboration. The Human Services Work Group will purposely collaborate with the HL7 FHIR Accelerator, the Gravity Project, through sponsorship of upcoming Gravity use cases focused on local, state, Tribal, Territories, and federal based data capture and exchange."

We are not against the formation of this group.

1. Concern with a risk of not having the resources to support this work group. 

OO reviewed and has various questions before finalizing its vote:

• It is unclear how this new group would relate to Public Health Workgroup and Gravity Accelerator. GD: See in PSS and Below
• We expect a lot of use of existing resources to be profiled, rather than creating new ones. GD: We concur

We therefore seek clarification why this need to be a new workgroup rather than one or more projects within an existing workgroup.  Bandwidth of those workgroups could be a concern, but that challenge does not change and even may be more challenging having a separate workgroup that still needs the same volunteers to be successful.  One would assume this community would bring a number of new volunteers to that existing workgroup that could focus and manage that work.

Thus no concerns with the work, but rather with the need to have a new workgroup to achieve the work,

GD: This is a valid question and one the the HHS Administration for Children and Families considered. We feel the group itself will bring in "new blood" including those who have FHIR experience who work in this domain, have not heretofore been formally involved in HL7 (besides zulip) and will have more comfort in interactions and discussions and  "getting to done" than within the aforementioned groups

GD: From the PSS:

"Proposed Formal Relationships with other work groups and Accelerators: The Human Services Work Group will be intentional about identifying opportunities to cross collaborate. This work group may have work items that intersect and overlap with the following work groups: Patient Care, EHR, Public Health, Community Based Care and Privacy (CBCP), and others as identified over time.  The new work group will collaborate with other work groups on sub-domains of common interest. The goal will be to ensure ongoing communication and collaboration. The Human Services Work Group will purposely collaborate with the HL7 FHIR Accelerator, the Gravity Project, through sponsorship of upcoming Gravity use cases focused on local, state, Tribal, Territories, and federal based data capture and exchange."

1. Recommendation to represent an international aspects. Need international focus. 
2. Need to clarify how to work with PCWG and PHWG 
3. Concerns with the creation of social care and health care terminologies separately - this will be a hindrance to interoperability. Will need to work with PCWG and PHWG to avoid this issue GD: There is no intention to create separate terminologies/cos systems. Re-use wherever possible exists. However it is likely that new terms ay need to be requested from existing standard terminologies. The group will avoid inventing FHIR terms unless as temporary codes during the ballot process of projects undertaken
4. Bandwidth issues - will this group take on work that is being done by existing groups? The same group of people will be doing the same work. 

GD: 

From the PSS:

"Proposed Formal Relationships with other work groups and Accelerators: The Human Services Work Group will be intentional about identifying opportunities to cross collaborate. This work group may have work items that intersect and overlap with the following work groups: Patient Care, EHR, Public Health, Community Based Care and Privacy (CBCP), and others as identified over time.  The new work group will collaborate with other work groups on sub-domains of common interest. The goal will be to ensure ongoing communication and collaboration. The Human Services Work Group will purposely collaborate with the HL7 FHIR Accelerator, the Gravity Project, through sponsorship of upcoming Gravity use cases focused on local, state, Tribal, Territories, and federal based data capture and exchange."

The Patient Empowerment Workgroup met and approved an endorsement on the creation of the new Human and Social Services Workgroup.
 
However, several members brought up some food for thought:

• Several asked how does this related to CBCP - there seemed to be overlap
• As a group with a focus on patient empowerment, PE is concerned for the patients who are impacted by disparities so there is some overlap/potential for collaboration with PE there.
• Several wanted to know if this was international and should it be?
• One member asked should/could the scope include refugees such as climate refugees?
• There was a question about how social media and patient communities might fit in.

GD: Public Health Questions from email with co-chairs:

• Clarifying the definition/interpretation of “case management” since case management is also a process/function in public health, such as disease control at the individual level for public health threats such as highly infectious diseases.

• Case Management is defined and used for Child Welfare, Short and Long-term foster care for children, and Adoption from foster care. The Case Management process when Child Welfare is contacted, when there is concern for a child. A Case is opened, and the child/children in question are interviewed, housing situation is evaluated, parents are evaluated, etc. If the Case Manager feels the child/children are at risk, then the child/children will be placed in temporary foster care. After further evaluation, the child/children disposition is evaluated to determine if the parents and housing is adequate for the children to be returned. From a Child Welfare perspective, this is the desired outcome. Parents are given opportunities to address drug problems, parenting problems, work opportunities, counseling, etc.

• Clarifying the inclusion of well-child efforts and how that relates to care provided through public health, such as immunization services, pediatric health services, and other related programs, potentially including WIC.

• Again, the intent is for the welfare of the child/children. Typically, the child/children are sent to medical facilities for assessments, etc. Currently, this information is kept separately from the Case Management system. The Case Management system, built on FHIR is intended to ingest data, in a FHIR format, so that the Case Management system has access to all relevant data for a child/children.

• Clarifying how assessments might be treated and what types of assessments are in scope (such as, but not limited to, health risk assessments).

• As above, Case Management does not provide assessments per se, however, it will collect notes by the Case Manager, Social workers, etc., to ensure the safety of the children. Usually, the child/children are sent to a medical facility for assessment/treatment to receive the information highlighting the child/children, mental/physical health status.

• Providing specific examples of potential projects that would be in the workgroup’s domain instead of the CBCCP or Public Health workgroups.

• Typically, the case management capability is used for multiple purposes, such as the Unaccompanied Children arriving at the border. A similar process is used with Child Welfare as the primary goal. Multiple agencies are involved, for example (DHS, BP, and ICE), with different data collection processes and procedures, which complicates the accurate collection of information across the process. Community Care may be used, however it is usually a contracted process, which again has to be accounted for in the Case Management process, so that ACF Office of Refugee Resettlement (ORR), knows the status of each child brought into care.
• As should be clear, there is no overlap with current HL7 workgroups.