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  1. FHIR Specification Feedback
  2. FHIR-34550

SDOH Category Codes section could call out that categorization is fuzzy for SDOH

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    • Change Request
    • Status: Published (View Workflow)
    • Medium
    • Resolution: Persuasive with Modification
    • US Core (FHIR)
    • current
    • Cross-Group Projects
    • STU
    • Social Determinants of Health (SDOH)
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      Update the assessment and screening profiles to be  1) a general purpose profile that does not require an SDOH category 2) and an SDOH profile that has an 0..1 MS SDOH category and specific preferred SDOH terminology. This actually aligns with how SDOH conditions, goals, and interventions (the profiles are not SDOH specific) are treated and aligns with  Gravity's SDOH Observation Profile.

      Update the SDOH And Purpose and Intent section to communicate that SDOH assessment and screening information may be available in a variety of resources such as Coverage, Patient (race/ethnicity), ODH profiles (employment), Smoking History profiles, etc.  The screening and assessment profiles defined in US Core are just meant to augment the other existing resources for SDOH assessment and screening data that does not fit into one of those locations.

      The point is that a requester should not expect to get a complete picture of SDOH assessment and screening data by inspecting only the Observation and/or QuestionnaireResponse (specific resources TBD based on other discussions).  A responder would not be expected to represent (for example) race/ethnicity or health insurance in Observation/QuestionnaireResponse.

      Update the Category Codes section:

      Current:

      The LOINC “grouping” code: LG41762-2 “Social Determinants Of Health” is used to categorize SDOH for Assessments, Problem, and Service Requests. This concept enables API consumers to be able to separate out SDOH data when accessing patient information. Alternatively, clients may find it more efficient to query based on a specific codeor set of codes (for example, Condition.code) or request all of a patient’s resources for a particular type and filter by code(s) to access items of interest.

       

      Proposed:

      The LOINC “grouping” code: LG41762-2 “Social Determinants Of Health” may be used to categorize SDOH for Assessments, Problem, and Service Requests. This concept enables API consumers to understand what SDOH data has been specifically categorized as such by the responder.  Requesters should understand what specific SDOH data is needed for their use case, and not rely on responder categorization.

      Alternatively, clients may find it more efficient to query based on a specific code or set of codes (for example, Condition.code) or request all of a patient’s resources for a particular type and filter by code(s) to access items of interest.

       

       

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        Update the assessment and screening profiles to be  1) a general purpose profile  that does not require an SDOH category 2) and an SDOH profile that has an 0..1 MS SDOH category and specific preferred SDOH terminology. This actually aligns with how SDOH conditions, goals, and interventions (the profiles are not SDOH specific) are treated and aligns with  Gravity's SDOH Observation Profile. Update the SDOH And Purpose and Intent section to communicate that SDOH assessment and screening information may be available in a variety of resources such as Coverage, Patient (race/ethnicity), ODH profiles (employment), Smoking History profiles, etc.  The screening and assessment profiles defined in US Core are just meant to  augment the other existing resources for SDOH assessment and screening data that does not fit into one of those locations. The point is that a requester should not expect to get a complete picture of SDOH assessment and screening data by inspecting  only  the Observation and/or QuestionnaireResponse (specific resources TBD based on other discussions).  A responder would not be expected to represent (for example) race/ethnicity or health insurance in Observation/QuestionnaireResponse. Update the Category Codes section: Current : The LOINC “grouping” code:  LG41762-2  “Social Determinants Of Health” is used to categorize SDOH for Assessments, Problem, and Service Requests. This concept enables API consumers to be able to separate out SDOH data when accessing patient information. Alternatively, clients may find it more efficient to query based on a specific codeor set of codes (for example,  Condition.code ) or request all of a patient’s resources for a particular type and filter by code(s) to access items of interest.   Proposed : The LOINC “grouping” code:  LG41762-2  “Social Determinants Of Health” may be used to categorize SDOH for Assessments, Problem, and Service Requests. This concept enables API consumers to understand what SDOH data has been specifically categorized as such by the responder.  Requesters should understand what specific SDOH data is needed for their use case, and not rely on responder categorization. Alternatively, clients may find it more efficient to query based on a specific code or set of codes (for example,  Condition.code ) or request all of a patient’s resources for a particular type and filter by code(s) to access items of interest.    
    • Floyd Eisenberg / Bob Dieterle: 8-0-2
    • Enhancement
    • Compatible, substantive

    Description

      The SDOH Category Codes section talks about a grouping code, but doesn't really call out that grouping and categorization of SDOH stuff is very fuzzy.  It might be useful to indicate that the some data that could be considered SDOH may not be categorized as such, so clients should not rely on the server-provided categorization to identify SDOH concepts.

      And I say "server-provided", but really the categorization would be end-user-clinician provided.  What I want to make clear is that we (EHRs) cannot force end users to accurately categorize data like Goals and Conditions as SDOH.

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              cooper.thompson Cooper Thompson
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                Updated:
                Resolved: