The objective of this project is to determine the best path forward for implementing FHIR-based solutions that need to address Social Determinant needs and work with organizations that provide those services while retaining the current FHIR capability to address clinical and behavioral concerns and activities. Because of this objective, a constraint of this project is any outcome presented must be backward compatible with the FHIR R5.0.0-ballot release.

This project will be driven by Use Cases, where different Approaches will be developed for each Use Case, and Evaluation Criteria will be applied to each Approach for each Use Case. This project, in collaboration with the Gravity Accelerator Project, will produce a Companion Guide to the SDOH Clinical Care Implementation Guide 2.1.0. 

The project will be driven by a set of Use Cases. The Use Cases will be scoped to Upstream and Midstream (pre-clinical) Use Cases as articulated by the Gravity Accelerator Project and the US Department of Health and Human Services. For more information, see SDOH-Action-Plan-At-a-Glance.pdf (hhs.gov).  The Use Cases may also include clinical or Downstream services that may also include social services as part of Whole Person Care (WPC).   

During the socialization of this project within the HL7 community, several Approaches have been recommended. This project will test different Approaches. At a minimum, there will be two Approaches tested. One will be enhancements to the FHIR Standard to enable Social Services and Social Determinates Centric semantics and relationships. The second Approach will be to use the present FHIR R5 published specification to address the Use Cases.

If there are additional resources available for the project, additional approaches will be considered such as developing new FHIR profiles and exploring the development of FHIR extensions for the Social Services and Social Determinates Centric approach.

Using the set of Use Cases, the project will develop an Implementation Guide with the following guidance:

• The Use Cases will use the Gravity Use Case Template. The template may be extended if required.
• The Use Cases will have documented Persona(s). 
• For the Use Cases, a baseline approach for each Use Case will be developed using the FHIR R5.0.0 Release with guidance from the SDOH Clinical Care Implementation Guide 2.1.0. 
• Alternative approaches will be investigated. Any additional approaches will also use the FHIR R5.0.0 Release with guidance from the SDOH Clinical Care Implementation Guide 2.1.0.
• Approaches developed will be evaluated based on the following evaluation criteria:
  o    Ease of use in exchanging digital information between FHIR-based systems and government agencies and other public-private organizations that do not use a FHIR-based system. Issues of consent and privacy that impact data fluidity are out of the scope of this project. Any potential barriers identified relating to issues such as consent and regulatory considerations will be documented and provided to the appropriate Working Group.
  o    Ease of use for implementing and using FHIR-based solutions by end-users such as care coordinators and care managers. Operations will include data capture, editing, and display. Of particular importance to the project are the relationships defined by families, households, tribes, and other social and cultural organizations. 
  o    Ease of use in developing modern analytical applications using machine learning and artificial intelligence applications.  Use Cases that require information in FHIR-based systems and non-FHIR government and public-private systems are considered within scope.
  o    Legal and Human Considerations: The approaches foster engagement of the social service and clinical providers while meeting the approval of the appropriate legal review and regulatory issues.

The project will use FHIR and other appropriate Connect-a-thons to provide concrete evidence and documentation of the approaches put forward.
 
This project will reuse profiles and value sets from Gravity. When existing Gravity profiles and value sets don't meet the new SD requirements, enhancement request will be submitted against the SDOH Clinical Care Implementation Guide.
 
This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will follow the Cross Group Projects WG's variance request process and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable.
 

All use cases, technical artifacts, minutes from scheduled program meetings, and other information will be accessible for the project from the HSS Home Page:

Enhancing FHIR to address Social Services and Social Determinants - Home - Human and Social Services - Confluence (hl7.org)].