Gravity Project FHIR IG

1a. Project Name Gravity Project SDOH Data Elements FHIR IG 1b. Project ID 1567 1c. Is Your Project an Investigative Project (aka PSS-Lite)? No 1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU? No 1e. Today's Date 1f. Name of standard being reaffirmed n/a 1g. Project Artifact Information 1h. ISO/IEC Standard to Adopt 1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption? 1j. Unit of Measure 2a. Primary/Sponsor WG Patient Care 2b. Co-Sponsor WG Vocabulary 2c. Co-Sponsor Level of Involvement Other Involvement. Specify details in text box below 2c. Co-Sponsor Involvement Updates at WG Meetings and technical reviews when the project needs additional assistance or guidance, especially in the area of creating "trial codes" that support testing, then "go away" and are replaced by permanent codes issued from the appropriate Code System. 2b. Co-Sponsor WG 2 Public Health 2c. Co-Sponsor Level of Involvement Other Involvement. Specify details in text below 2c. Co-Sponsor Involvement Updates at WG Meetings and technical reviews when the project needs additional assistance or guidance, especially in the area of creating bidirectional closed-loop referral requests between clinical environment and community-based organizations or public health programs. 2d. Project Facilitator Robert Dieterle 2e. Other Interested Parties (and roles) Structured Documents - FHIR Documents - where Resource Templates plug into C-CDA on FHIR documents Attachments - expanding Clinical Data Exchange to include SDOH data elements. PC (Care Plan Team) - Patient Centered Care Planning (how to use existing Patient-Centered Goal template, and outcome observation, use of Care Plan resource) Learning Health Systems - Care Team Member Roles CIMI - Modeling for profiled resources CBCP - Consent/Privacy&Security; where consent might fit into the use cases OO - Referral Orders and Tracking (mechanisms to do closed loop referrals) CIC - Registry Usage of the information (confirm data element content is valuable and appropriate for secondary use) CQI - Quality Measure usage of the information (confirm the element content is valuable and appropriate for quality measure uses) CDS - Clinical Decision Support. Patient Engagement 2f. Modeling Facilitator Monique Van Berkum 2g. Publishing Facilitator Lloyd McKenzie 2h. Vocabulary Facilitator Rob Hausam 2i. Domain Expert Representative Evelyn Gallego 2j. Business Requirements Analyst Evelyn Gallego 2k. Conformance Facilitator Lloyd McKenzie 2l. Other Facilitators IG Quality - TBD 2m. Implementers Data Integrator/HISP (MaxMD); Payer organizations, EHR vendor, Health IT Vendors interested in collecting SDOH data from Consumers; Community Based Organizations or Public Health organizations. 3a. Project Scope The Gravity Project creates and maintains a consensus-building community to expand available Core Social Determinant of Health (SDOH) Data for Interoperability and accelerate standards-based information exchange by using HL7 FHIR. Gravity Project is part of the HL7 FHIR Accelerator Program. Many of the recent innovations at scale in this area begin with the strategic collection of SDOH data. As examples, the Centers for Medicare & Medicaid Services Innovation Center (CMS Innovation Center) Comprehensive Primary Care Plus Model requires providers to assess patients’ social risks; and the CMS Innovation Center’s Accountable Health Communities Model developed a social risk assessment tool to help identify and address social risks across clinical and community-based settings. However, there is no consensus on the coding and standards-based modeling to facilitate the data uses envisioned for SDOH information. This project seeks to incrementally develop a framework FHIR IG that will support any compliant SDOH Survey covering one or multiple SDHO Domains (e.g. Food Insecurity, Housing Stability and Quality, and Transportation Access) Participation in Connectathon events will be conducted to build greater consensus on the framework. The goal is to define framework support for multiple SDOH survey instruments and SDOH domains. This project seeks to: (1) determine a minimal data set required to exchange valuable SDOH information for identified multiple domains and (2) develop a framework FHIR Implementation Guide, resource profiles, and necessary extensions to specify how to syntactically and semantically exchange that data between care settings, and work closely with Code System SDOs to address data coding needs. The project also will work with other FHIR Accelerator Projects where appropriate to leverage/share commons FHIR IG efforts and where possible to (3) add SDOH core data elements in their developing client and server reference implementations to validate the Implementation Guide, Profiles, and Extensions work in a software system, (4) develop automated test suites to validate data representation, and (5) build real world pilots that successfully demonstrate integration of SDOH information in new capabilities adopted in production. Attachments SDH Coding Collaborative Project Charter 051419.pdf 3b. Project Need The influence of social determinants on health outcomes is increasingly recognized in emerging payment reform programs, federal and state-based policies, and information technology initiatives. Social determinants of health (SDOH) are defined by the World Health Organization as the conditions in which people are born, live, work, and age. The growing awareness of how SDOH shape health has contributed to efforts to address actionable socioeconomic risk factors through the health care delivery system. Recommendations from national groups, including the American Academy of Pediatrics, American Academy of Family Physicians, Agency for Healthcare Research and Quality, National Quality Forum (NQF), and Institute for Health Care Improvement underscore the various roles the health care system could play in helping to reduce patients’ social risk factors. These national “calls to action” for health care systems have spurred the proliferation of innovations, including a wide range of social risk screening tools and practice-based interventions. Some of these innovations have helped to reduce social risks, improve health outcomes, and lower costs. The experimentation in this area has been bolstered by new value-based payment models and accountable care organizations (ACOs), which together offer an array of incentives to advance coordinated care between medical and social service organizations. However, many of the recent innovations at scale in this area begin with the strategic collection of SDOH data. As examples, the Centers for Medicare & Medicaid Services Innovation Center (CMS Innovation Center) Comprehensive Primary Care Plus Model requires providers to assess patients’ social risks; and the CMS Innovation Center’s Accountable Health Communities Model developed a social risk assessment tool to help identify and address social risks across clinical and community-based settings. Presently, clear shared definitions for these SDOH Core Data for Interoperability and FHIR based information exchange resources do not exist. SDOH covers a very broad space which is categorized and defined in many different ways. The Gravity Project aims to address only three SDOH areas from among the many identified SDOH domains. The project will create and maintain a consensus-building community to expand available SDOH Core Data for Interoperability for the Food Insecurity, Housing Instability, Transportation Barriers domains, and accelerate standards-based information exchange by using HL7 FHIR. 3c. Security Risk No 3d. External Drivers The shift to value based care and the growing recognition of the impact addressing SDOH issues can have on increasing the value of care, decreasing its cost, and improving care outcomes 3e. Objectives/Deliverables and Target Dates Our objective is to deliver an SDOH framework FHIR IG for ballot for STU1 in January 2021. This will cover multiple domains (using food insecurity as an exemplar use case) and provide specification for: 1) surveys (questionnaire/questionnaireResponse), 2) survey output as FHIR resources (Observations and Condition), 3) consent (Consent), 4) setting goals (Goals), 5) supporting careplan integration (CarePlan), 6) directory of community resources 7) exchange with community-based organizations (ServiceRequest), 8) tracking outcomes (Procedures), and 9) making data available for extended use. We will participate in multiple Connectathons to further develop the use cases, FHIR specifications and terminologies. domain. 3f. Common Names / Keywords / Aliases: "Gravity Project", "SDOH Data Elements", "SDOH Core Data for Interoperability", "Social Determinants of Health", "SDOH" 3g. Lineage This is the initial project PSS from the Gravity FHIR Accelerator Project 3h. Project Dependencies This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile we will request approval from US Realm SC, and provide the US Realm approved rationale for deviation in the implementation guide where applicable. Connectathon Testing will be incorporated within Connectathons driven by HL7 and Da Vinci. 3i. HL7-Managed Project Document Repository URL: https://confluence.hl7.org/display/GRAV/Gravity+SDOH+FHIR+IG 3j. Backwards Compatibility No 3k. Additional Backwards Compatibility Information (if applicable) 3l. Using Current V3 Data Types? Unknown 3l. Reason for not using current V3 data types? 3m. External Vocabularies Yes 3n. List of Vocabularies LOINC, SNOMED, ICD-10, CPT/HCPCS 3o. Earliest prior release and/or version to which the compatibility applies n/a 4a. Products FHIR Extensions, FHIR Implementation Guide, FHIR Profiles 4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to? FHIR R4 4c. FHIR Profiles Version US Core 3.0.x (for FHIR R4), C-CDA on FHIR (for FHIR R4) 4d. Please define your New Product Definition 4d. Please define your New Product Family 5a. Project Intent Implementation Guide (IG) will be created/modified 5a. White Paper Type 5a. Is the project adopting/endorsing an externally developed IG? No 5a. Externally developed IG is to be (select one) 5a. Specify external organization 5a. Revising Current Standard Info 5b. Project Ballot Type STU to Normative 5c. Additional Ballot Info Gravity Project is a FHIR Accelerator Project. 5d. Joint Copyright No 5e. I understand I must submit a Joint Copyright Letter of Agreement to the TSC in order for the PSS to receive TSC approval. no 6a. External Project Collaboration The influence of social determinants on health outcomes is increasingly recognized in emerging payment reform programs, federal and state-based policies, and information technology initiatives. Social determinants of health (SDH) are defined by the World Health Organization as the conditions in which people are born, live, work, and age. The growing awareness of how SDOH shapes health has contributed to efforts to address actionable socioeconomic risk factors through the health care delivery system. Recommendations from national groups, including the American Academy of Pediatrics, American Academy of Family Physicians, Agency for Healthcare Research and Quality, National Quality Forum (NQF), and Institute for Health Care Improvement underscore the various roles the health care system could play in helping to reduce patients’ social risk factors. These national “calls to action” for health care systems have spurred the proliferation of innovations, including a wide range of social risk screening tools and practice-based interventions. Some of these innovations have helped to reduce social risks, improve health outcomes, and lower costs. The experimentation in this area has been bolstered by new value-based payment models and accountable care organizations (ACOs), which together offer an array of incentives to advance coordinated care between medical and social service organizations. 6b. Content Already Developed Use Cases will be 98% developed by Gravity Project 6c. Content externally developed? No 6d. List Developers of Externally Developed Content The Use Case Package describing the Use Cases, Patient Story, and Personas relevant to Phase I of the Gravity Project's work on Food Insecurity, Housing Instability, and Transportation Barriers was developed by the Gravity Project Community. The finalized Use Case Package is available on the HL7 Confluence site. 6e. Is this a hosted (externally funded) project? No 6f. Stakeholders Quality Reporting Agencies, Payors, Other 6f. Other Stakeholders Clinicians, Community Based Organizations, Patients 6g. Vendors EHR, PHR, Health Care IT 6g. Other Vendors 6h. Providers Emergency Services, Local and State Departments of Health, Healthcare Institutions (hospitals, long term care, home care, mental health), Other 6h. Other Providers Community Based Organizations 6i. Realm U.S. Realm Specific 7d. US Realm Approval Date Oct 01, 2019 7a. Management Group(s) to Review PSS FHIR 7b. Sponsoring WG Approval Date Aug 24, 2020 7c. Co-Sponsor Approval Date Sep 26, 2019 7c. Co-Sponsor 2 Approval Date Oct 17, 2019 7c. Co-Sponsor 3 Approval Date 7c. Co-Sponsor 4 Approval Date 7c. Co-Sponsor 5 Approval Date 7c. Co-Sponsor 6 Approval Date 7c. Co-Sponsor 7 Approval Date 7c. Co-Sponsor 8 Approval Date 7c. Co-Sponsor 9 Approval Date 7c. Co-Sponsor 10 Approval Date 7e. CDA MG Approval Date 7f. FMG Approval Date Oct 02, 2019 7g. V2 MG Approval Date 7h. Architecture Review Board Approval Date 7i. Steering Division Approval Date Oct 22, 2019 7j. TSC Approval Date Nov 18, 2019