Social Determinants: Our Statement with TJC, NQF Was Just the Start

February 23, 2023 · Andy Reynolds

Quality advocates curious about how digital quality measurement can advance health equity should read our statement (from NCQA, The Joint Commission and the National Quality Forum) about how Fast Healthcare Interoperability Resources (FHIR®) can integrate SDOH data across health records.

What does the statement mean for HEDIS®? Keep reading to find out!  And if you’re not familiar with FHIR, read FHIR for Dummies or the Forgetful.

We strongly urge including FHIR QuestionnaireResponse in future versions of the US Core. By improving exchange of social needs data, this standard reduces the need for multiple care providers and organizations to ask the same questions over and over. Including QuestionnaireResponse not only supports social needs screening and intervention, it also helps PROMs and other patient assessments used in quality improvement programs.

Backstory on “Sync for Social Needs”:
Our Social Needs Screening and Intervention Measure

NCQA is a member of the “Sync for Social Needs” coalition—a group seeking to standardize health data on screening for social risks like food insecurity, and collect and integrate the results into health and social care. The coalition’s goal is to help people get crucial social support that can improve their health outcomes.

This year, we added a measure to HEDIS—Social Need Screening and Intervention (SNS-E)—that aims to tackle unmet social needs of health plan members. The measure addresses food, housing and transportation, and measures screening for both a need for and the occurrence of an intervention.

Collecting and transmitting data electronically offers advantages over a paper-based approach, and SNS-E (specified here) aligns with Gravity Project standards for screening and intervention data. When reporting measure results to NCQA, health plans use our Electronic Clinical Data Systems (ECDS) reporting standard, which supports use of electronic data from multiple sources.

The May 2020 ONC Cures Act Final Rule supports exchange and use of electronic health information, and mandates the use of USCDI version 1. Earlier this year, Health Level Seven International (HL7) received approval to update the US Core January 2023 ballot to implement a single method to capture SDOH assessments using the FHIR Observation resource. (Hazy about FHIR resources? FHIR for Dummies or the Forgetful can clarify!)

The SNE-E HEDIS measure specification contains several FHIR resources, including Questionnaire, QuestionnaireResponse and Procedure. Resources were tested and reviewed to ensure that they meet the highest level of scientific soundness. The current SNS-E measure is specified in a FHIR-CQL format that aligns with the US Core profile. It’s based on FHIR Version 4.0, published by HL7, which in turn aligns with US Core Data for Interoperability (USCDI) v3.

FHIR Questionnaire and QuestionnaireResponse are NCQA’s preferred FHIR resources for social needs screening. We like the structure they provide to data originating in patient-reported outcome measurement (PROM) instruments, and we think they should be included in future versions of US Core. (QuestionnaireResponse is not currently planned for future versions.)

Next Steps

Undetected social needs affect people’s health. To improve health outcomes, we focus on addressing social needs using evidence-based, validated instruments. It’s important that detailed assessments can be tracked in medical records and made available across clinical and social providers to support and guide evidence-based interventions. There’s a variety of validated instruments in use—as US health care establishes which instrument is best, we support a data strategy that maps codes from distinct instruments and code sets to a common standard.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


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