Background
The Biden-Harris Administration will host the White House Conference on Hunger, Nutrition, and Health on September 28, 2022. In addition to announcing a national strategy to address the intersections between food, hunger, nutrition and health, the Administration has issued a call for stakeholder commitments along five pillars, including the “integration of nutrition and health.”
We seek to better integrate nutrition information within a patient’s electronic health record (EHR) by accelerating a standards-based approach to implementing universal social needs screening. With the final CMS IPPS rule requiring hospitals to report on social determinants of health (SDOH) screening quality measures in 2024, along with similar requirements of MA SNPs and ACO REACH model participants in 2023, we believe a multi-stakeholder effort, which should also include Medicaid agencies and managed care plans, to advance an HL7 Fast Health Interoperability Resources (“FHIR”)-based approach to meet these “functional” requirements will significantly enhance the ability of providers to meet these CMS requirements.
Data Sharing Standards Gaps
For the past decade, the Office of National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) have worked to implement the HITECH Act, including provisions to ensure the safe, secure sharing of patient health information with consumers, and other stakeholders involved in their care. Across 2022 and 2023, EHR vendors will “certify and provide” health IT systems capable of modern, internet-based data sharing methods using a suite of HL7 FHIR Application Programming Interfaces (APIs).
While much work has been done to standardize the sharing of social needs screening assessment data, particularly on defining a set of data elements for inclusion within electronic health records systems, there remains a gap when screening is administered in different EHRs and/or in third party applications outside of a certified electronic health record.
The Commitment
Participants in the Sync for Social Needs Initiative commit to working on developing consensus on standards and piloting real-world testing of an HL7 FHIR-based approach for the collection and sharing of social needs screening results to meet upcoming CMS program requirements. This initiative will test and refine a standards-based approach for collecting and sharing social needs screening data across different vendor systems and settings. Specifically, we will test HL7 FHIR applications that incorporate the Regenstrief Institute’s LOINC FHIR Questionnaire representing the CMS AHC Tool and can provide a completed and scored assessment to any health IT systems supporting the SDOH functionality of the FHIR US Core Implementation Guide. While this initial effort will focus on the CMS Accountable Health Communities Tool to demonstrate the feasibility of HL7 FHIR-based exchange with a common, standards-based SDOH assessment, we will give particular focus to scalability of the approach to any standards-based instruments. We recognize there are many screening tools, none of which is specifically required via CMS regulation, and that the work is meant to be indicative of what is possible, not an endorsement. We envision stakeholders participating in screening within provider settings, in the community or via public agencies, and in sharing the results for use in clinical delivery reform. The Sync for Social Needs collaborative will look to share technical and implementation feedback that maximize sharing at the lowest administrative burden.
Committed Participants
If you are interested in participating in this initiative and would be willing to have your organization publicly mentioned in an ongoing list of committed participants, please email syncforsocial@HL7.org.