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Announcements


The Gravity Project launched May 2nd!  To join the project, sign up here.

  • To access Gravity Project meeting materials, click here.

The success of the Gravity Project depends on the contribution of volunteers who are eager to make rapid progress on the standardization of social determinants of health data. We need experts to contribute to and validate definitions for SDH related data elements and value sets.

Participants are asked to join the project either as a Committed Member or Other Interested Party as part of the HL7 Consensus Process.

Overview


The Social Interventions Research and Evaluation Network (SIREN), with funding from the Robert Wood Johnson Foundation and in partnership with EMI Advisors, LLC, is pleased to invite you to join the Gravity Project. Driven by the growing interest in capturing social risk and protective factor data in health care settings, the Gravity Project brings industry leaders together to identify and harmonize social risk and protective factor data for interoperable electronic health information exchange.

The Gravity Project will convene a public collaborative process from April to December 2019 to accomplish the following goals for the social domains of food security, housing stability and quality, and transportation access:

  • Develop use cases to support documentation for screening, diagnosis, treatment/intervention, and planning activities within EHR and related systems;
  • Identify common data elements and their associated value sets to support the uses cases;
  • Develop a consensus-based set of recommendations on how best to capture and group these data elements for interoperable electronic exchange and aggregation; and
  • Initiate development of an HL7® Fast Health Interoperability Resource (FHIR®) Implementation Guide based on the defined use cases and associated data sets that will be finalized in the next phase of work.

Project objectives will be accomplished through weekly one-hour virtual meetings and collaborative project product development through the HL7 project confluence page.


Upcoming Workgroup Meeting


Date

Time

Topic

Webinar Information

Thursday, May 23, 2019

4:00-5:00pm ET / 1:00-2:00pm PT

Gravity Project Workgroup Meeting

  • Use Case Kickoff and Use Case Review Process
  • Introduction of User Personas, User Stories, Assumptions and Use Case Template

Please log on before dialing in and enter the provided participant ID.  Please note:  this meeting will launch at 10 minutes before 4:00pm ET (1:00pm PT) and will be locked prior to that time.

URL:  https://emiadvisors.webex.com/emiadvisors/j.php?MTID=m9ec3c58b6940b23e068ac88e8a46c4ca

Dial-In:  (415)655-0003

Meeting ID:  738 112 808

Password (for app users):  gravity

Click here to access the Gravity Project Workgroup page for a full meeting schedule

Materials for Review Prior to Workgroup Meeting

Any working documents or materials that should be reviewed prior to the next workgroup meeting will be posted here.  Click on any of the links below to download the documents or access the wiki pages.  Comments are due by the Tuesday prior to the meeting date listed above.  Please submit brief comments using the button below.  If you have extensive comments or wish to share documentation, please email gravityproject@emiadvisors.net.


Gravity Project Steering Committee


Steering Committee meetings are currently held on the last Monday of each month.  

Steering Committee Members

NameOrganization

Lisa Bari

HHS Centers for Medicare & Medicaid Services (CMS) Innovation Center

Keri Christensen

National Committee for Quality Assurance (NCQA)

Chris Dymek

HHS Agency for Healthcare Research and Quality (AHRQ)

Margo Edmunds

Academy Health/ National Interoperability Collaborative
Tom GiannulliAmerican Medical Association

Cara James

CMS Office of Minority Health

Nafisa Jiwani

CMS Innovation Office (detail), Centers for Disease Control (CDC)

David Kendrick

MyHealth Network

Jessica Khan

McKinsey

Lisa Lehmann

Department of Veterans Affairs (VA)

Brenna Long

Department of Veterans Affairs (VA)

Sam Meklir

HHS Office of the National Coordinator (ONC)

Nancy Myers

American Hospital Association Center for Health Innovation

Tom Novak

HHS ONC

Pam Owens

HHS AHRQ

Michelle Proser

National Association of Community Health Centers (NACHC)
Duane ReynoldsAmerican Hospital Association Institute for Diversity and Health Equity
Sheila ShapiroUnitedHealthcare Clinical Services

Walter Suarez

Kaiser Permanente

Al Taylor

HHS ONC

Bill Winfrey

HHS Centers for Medicare and Medicaid Services (CMS)

Carlos Villarreal

Blue Cross Blue Shield Association

Project Timeline


Project Contacts


Name

Title

Organization

Email

Evelyn GallegoProgram ManagerEMI Advisors, LLCevelyn.gallego@emiadvisors.net
Lynette ElliottProject ManagerEMI Advisors, LLClynette.elliott@emiadvisors.net
Resham SaeedProject AnalystEMI Advisors, LLCreshamsaeed@emiadvisors.net
Lisa NelsonValue Sets Subject Matter ExpertEMI Advisors, LLClnelson@max.md
Linda HydeValue Sets Subject Matter ExpertEMI Advisors, LLChydela@charter.net
Caroline FichtenbergManaging DirectorSIRENcaroline.fichtenberg@ucsf.edu
Laura GottliebDirectorSIRENlaura.gottlieb@ucsf.edu

Comments


Comment(s)

Thank you for leading this important work. I wonder about the "out of scope" disclaimer about not getting into the actual social needs screening instruments and items. The question is can you standardize the answers without standardizing the questions? Anyway, that is the topic I'm most interested in and am actively engaged in with Epic, and would be happy to participate/contribute as appropriate.
Greetings! Great start on the work related SDOH that is on the Confluence page. The following should be considered to be added:

Medicaid Information Technology Architecture (MITA)
https://www.medicaid.gov/medicaid/data-and-systems/mita/mita-30/index.html

Homeless Management Information System (HMIS)
https://www.hudexchange.info/resource/3824/hmis-data-dictionary/

Open Referral - I can introduce you to their Executive Director Greg Bloom
https://openreferral.org/

Among the uses for standardized SDOH data, regulatory reporting was not mentioned. Obviously there are limited regulatory reporting requirements (in part due to the limited standardization of data). It could be beneficial to develop the standard in a way that makes the data easy to be consumed by future regulators with minimal/zero click reporting involvement by provider staff. We can take inspiration from the approach to the XBRL data standard used by Australia and the Netherlands to automate corporate reporting.

https://www.xbrl.org/the-standard/how/getting-started-for-regulators/

Hope this helps!
Matt
Excited to be a part of the collaborative! From a community mobilization and engagement perspective, the materials offered on The Gravity Project Website (charter, glossary and standards/initiatives) provide a clear grounding of the project for members, define the parameters of the project and set the stage for next steps.
In addition to the use cases described in step 1 of the Scope Statement, it would be helpful to keep the six uses described the NAM 2014 Phase 2 report in mind to ensure that the data will meet multiple cases.
Institute of Medicine (2014) Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. National Academies Press, Washington DC.
About 1,095 SDH codes have been highlighted via the SIREN Social Risk Codes review (relating to 20 social risk domains). This is a very comprehensive amount, but may be somewhat confusing. It will be interesting to see how we will narrow down such a vast amount of codes. Will we focus on ICD-10, LOINC, SNOMED, and CPT all together, or start with just one of these code types initially?
I recommend adding the Homeless Management Information System (HMIS) to the "Relevant Work in Social Determinants of Health" resource page.
https://www.hudexchange.info/programs/hmis/

Think that it is helpful to keep in mind HUD's definitions of homelessness and housing instability when developing SDoH housing instability data element definitions
https://www.hudexchange.info/trainings/courses/recording-and-documenting-homeless-status/
Minor comment on charter - in the first paragraph of 5.2.19 V 1.4 of charter - I think you mean National Quality FORUM (not National Quality Framework)
suggested additions to list of materials -
(1) Another standard SDH code set is contained in the International Classification of Primary Care, 2nd edition, in its Chapter Z. ICPC-2 is the primary medical care coding and classification standard for several countries, is mapped to ICD-10 (11), and to a defined subset of SNOMED CT, the SNOMED GP-FP Reference Set.
(2) Can add to list of vendors with SDH capabilities RiverStar Software, which offers a Community Care Hub product that combines SDH screening with community service agency referral support and tracking. Can see at: https://www.riverstar.com/community-care/
Relative Standards and Initiatives -
HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Nutrition, Release 1
This Implementation Guide is clinical inpatient oriented however the care plan component is worth evaluating as a pattern and part of a use case where at risk patient needs.
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1 Comment

  1. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper 

    https://annals.org/aim/fullarticle/2678505/addressing-social-determinants-improve-patient-care-promote-health-equity-american