February 20, 2023
Collecting and exchanging data on social determinants of health (SDOH) connects individuals, health care organizations and community-based organizations committed to achieving health equity. The National Committee for Quality Assurance, the Joint Commission and the National Quality Forum joined the Sync for Social Needs coalition with the aim of integrating digital SDOH data for standardized exchange across health records using a Fast Healthcare Interoperability Resources (FHIR®)-based approach. As leading quality organizations, we believe effective use of person-reported data to meet social needs is a health care quality priority, and that FHIR enables interoperable use of this information.
Many organizations are early in their journey to develop efficient, sustainable processes for social needs screening and intervention. Although there have been efforts to standardize screening, the health care industry uses a variety of screening instruments. In our view, screening instruments should be selected based on their ability to accurately identify social needs. Screening instruments used in health care settings and the community should be validated instruments, carefully selected based on their ability to accurately identify and update the social needs of individuals in a variety of contexts. No single standard instrument should be required at this time, but over time we should work to achieve a more limited set of valid and reliable instruments. Although many instruments are currently in use, it is possible to meet the immediate and urgent need for standardized exchange of social needs data.
Screening instrument standards are likely to evolve as the practice of assessing and addressing social needs matures. Through discussions with standards developers, patients, clinicians, health care organizations and technology providers, we have concluded that FHIR provides a flexible data model and exchange standard to support the use of social needs data, today and in the future. Specifically, the US Core Observation Screening Assessment Profile, which will be added to US Core 6.0.0 in May, enables exchange of findings on standardized instruments. It also provides guidance on Screening and Assessments, and defines a US Core Simple Observation Profile to communicate clinician-interpreted findings in the absence of patient-reported data.
The balance between flexibility and specificity defined in the US Core Observation Screening Assessment Profile will support multiple methods of data exchange and enable meaningful collaboration among organizations supporting persons with unique social needs. The US Core profile enables data to be shared consistently, efficiently and reliably with clinicians and other entities. We collectively urge the Office of the National Coordinator (ONC) to recommend FHIR US Core 6.0.0, for inclusion in the Standards Version Advancement Process.
We also recommend the ONC accelerate testing of the FHIR Questionnaire and QuestionnaireResponse and define an accelerated timeline for its inclusion in the US Core Data for Interoperability. As the use of patient-reported information expands to include gathering data on social needs, demographics and health status, standards will need to support exchange of results obtained through screening questions, and will need to be tracked and trended at the individual level.
Anticipating this need, the Gravity Project, an HL7 FHIR accelerator, developed the FHIR SDOH Clinical Care Implementation Guide. The guide profiles FHIR Questionnaire and QuestionnaireResponse, which enable calculation of responses to multiple screening questions. Calculating scores from a panel of questions is common in SDOH instruments and patient-reported outcome measures, and the guide provides a roadmap for meaningful exchange and use of these findings. We strongly encourage HL7 and ONC to adopt the HL7 FHIR SDOH Clinical Care Implementation Guide, specifically, the Questionnaire and QuestionnaireResponse profiles. Incorporating the profiles in FHIR US Core and supporting their use through sub-regulatory guidance from ONC will support greater adoption of social needs screening and intervention, and other person-reported information valuable for improving quality and equity.
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also Recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. The organization received the prestigious James W. Rouse Excellence in Diversity Award for demonstrating a commitment to promoting a diverse, healthy workplace. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can also be found at Twitter @ncqa, and on LinkedIn at linkedin.com/company/ncqa.