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  1. FHIR Specification Feedback
  2. FHIR-34752

Assessment codes for individual components of existing assessments too limited and superfluous

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Details

    • Change Request
    • Status: Published (View Workflow)
    • Highest
    • Resolution: Persuasive with Modification
    • US Core (FHIR)
    • 4.1.0
    • Cross-Group Projects
    • STU
    • USCoreObservationCode
    • 2.6.3.3
    • Hide
      • Background

      See commenters Description:

      The commenter is referring to this Observation Profile:

      Resource Profile: US Core Screening Response Observation Profile

      ...

      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.

      ...

      Each Observation must have:

      1. ...
      2. LOINC code, if available, which tells you the survey question
      3. ...

       

      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:

      1. Every US Core system SHOULD be able to represent multi-question SDOH surveys (e.g., instruments like PRAPARE)
      2. 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

       

      1. 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)
      2. 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.
      3. 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

      Show
      Background See commenters Description: The commenter is referring to this Observation Profile: Resource Profile: US Core Screening Response Observation Profile ... 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. ... Each Observation must have: ... a  LOINC  code, if available, which tells you the survey question ...   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
    • Floyd Eisenberg / Bob Dieterle: 8-0-2
    • Enhancement
    • Compatible, substantive

    Description

      2.6.3.3 Assessment Codes value set http://hl7.org/fhir/us/core/ValueSet/us-core-common-sdoh-assessments:
      Please explain why US Core should be developing a separate value set for SDOH assessments when they already exist in the terminology. These items are component observable entities from existing evaluation tools (such as the US Household Food Security Survey Module.H3) with normative answer lists developed by the USDA (example LL5586-4). For example, 88123-5 is a member of 5 existing panels. Each of those panels contain additional items. It might make more sense to list a subset of common appropriate panels for obtaining appropriate information rather than single observations that, on their own, may have more limited value.
      see also comments in BALLOT-26867.

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              feisenberg Floyd Eisenberg
              Floyd Eisenberg
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                Updated:
                Resolved: