According to the current specification, the use of SDOH information is reactive/retrospective rather than proactive/real-time. According to the "FHIR Modeling Diagram" the only source of SDOH information are QuestionnaireResponse resources. In reality, there is relevant information about SDOH like lack of housing, transportation, or nutrition collected and recorded during treatment, without the added burden of a retrospective questionnaire/form. Computed SDOH information can be learned more seamlessly from data EHRs record already. That information could be processed automatically and applied in real-time. If we rely on questionnaires only that means we're waiting until after no-show or cancelled appointment to find out what went wrong instead of avoiding that missed appointment with Lyft ride. The window of opportunity to address the issue may have closed already by the questionnaire is administered. According to the "FHIR Modeling/; diagram new Observation resources may be derived from the QuestionnaireResponse answers. Ideally. SDOH could be derived from existing resources health inforamation and used in real-time to create SDOH interventions (e.g. lack of transportation: Appointment.cancelationReason, lack of nutrition Observation or Condition, housing )

Proposed Wording:

In addition to QuestionnaireResponses, SDOH needs should be evaluated based on information gathered during regular treatment to avoid adding more burned on providers and patient. For example, if a patient cancels an appointment due to transportation issues, that issue should be evaluated d and corrected in real time and determine whether the patient should have access to a Lyft ride to avoid the canceled appointment. A lot of the Questionnaire questions are already part of the assessment, treatment, and evaluation. For example, if a patient cancels an appointment, the reason for cancelation (lack of transportation) is routinely recorded in the EHR. Ideally, that cancelation could be avoided if SDOH would be applied "proactively" instead "reactive" by "prescribing" a Lyft ride to the patient unable to keep an appointment rather than asking after the fact "tell us if transportation problems prevent you from attending to school, work, or medical appontments?".

(Comment 221 - imported by: Robert Dieterle)