See commenters Description:
The commenter is referring to this Observation Profile:
Resource Profile: US Core Screening Response Observation Profile
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This profile sets minimum expectations for the Observation resource to record, search, and fetch retrieve observations that represent the questions and responses to form/survey and assessment tools such as the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) Survey. This profile encompasses single, multipart, and derived responses. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile. These observations are distinct from observations representing individual clinical assessments made by an individual about a patient’s social history and not derived from an assessment tool or survey. These types of observations should use the US Core Social History Assessment Observation Profile instead.
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Each Observation must have:
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- a LOINC code, if available, which tells you the survey question
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US Core is a jurisdictional Implementation Guide whose stated goal is to defines the minimum set of constraints on the FHIR resources to create the US Core Profiles. It also defines the minimum set of FHIR RESTful interactions for each of the US Core Profiles to access patient data. In line with those goals this profile represents the SDOH Assessment data element in part as responses to survey instruments such as a form or questionnaire like PRAPARE or Hunger Vital Signs and others as individual question/answer pair or question/multiselect answers. As the commenter correctly points out it does define and extensible value set http://hl7.org/fhir/us/core/ValueSet/us-core-common-sdoh-assessments
which contains 25 of the the most common "risks" as defined by FindHelp.org, a provider of social service assistance tool used by several EHRs. These risks were subsequently mapped to LOINC codes. The intent was to provide the reader with a starter set of codes to provide minimal guidance and reference the ongoing and more complete set of codes being developed by the Gravity project in this section:
http://hl7.org/fhir/us/core/2022Jan/sdoh.html#assessment-codes
Prior Art
The SDOH Clinical Care IG enables Enabling Survey Instruments by standardizing the capture, coding and output of SDOH risk surveys. This guide provide the necessary framework for preserving "the context for the individual parts of a single screening instrument." It leverages the SDC guide to extract the specific survey results into FHIR Observation and other resources.
Reasoning
As we describe in the resolution for FHIR-34748
Based on ONC’s objectives, The CGP WG decided these functional requirements are in scope:
- Every US Core system SHOULD be able to represent multi-question SDOH surveys (e.g., instruments like PRAPARE)
- Every US Core system SHOULD be able to represent “check all that apply” SDOH questions (e.g., “In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? Check all that apply.”)
(https://confluence.hl7.org/pages/viewpage.action?pageId=90342002)
Specifically the Observation profile can represent a generic panel that contains both hasMember element for_ referencing other Observations to represent multi-question SDOH surveys. Therefore a set of starter concepts for survey panels should also be included included in a preferred survey valueset.
Proposed Changes
- Create a new non context specific survey Valueset : US Core Survey Codes . This is a preferred binding for the US Core Observation Survey Profile. This value set includes all LOINC values whose CLASSTYPE is SURVEY in the LOINC database (Refer to Appendix A of LOINC Users’ Guide)
- Add Panel Concepts for PRAPARE, Hunger Vital Sign, AHC-HRSN to the us-core-common-sdoh-assessments valueset This is a preferred binding in the US Core Observation SDOH Assessment Profile. These panels are mentioned in USCDI v2.
- Document that should defer to Gravity project to supply the full set of concepts for SDOH.
Refer to resolution for FHIR-34748 for how observations will represent multi-question SDOH surveys and “check all that apply” questions