The Standard

In its SDOH Playbook, “US Playbook to Address the Social Determinants of Health,” the White House explained that supporting flexible funding to address social needs, such as those offered through health-related social needs (HRSN) reimbursement programs, improves health outcomes: “Increasing funding flexibility and offering technical assistance that empowers organizations to utilize funding from a variety of sources will better equip them to address unmet social needs.”

The success of these reimbursement programs requires the existence of exchange and data standards that serve the interests of all stakeholders. Payers and community-based organization (CBOs) currently experience complexities and pain points that have presented challenges and made it difficult to meet the HRSN reimbursement programs’ full potential exist as these benefits roll out today.

As momentum has grown among states and payers for the reallocation of healthcare funds to address HRSNs, Gravity Project decided to undertake a discovery effort to understand and define the existing landscape for CBO reimbursement and identify the components of the CBO reimbursement process and where national standards play a role. 

"Unite Us is proud to work with the Gravity Project. Together, we are making it easier for community-based organizations to participate in Medicaid reimbursement programs, expanding the availability of these benefits to more individuals seeking care,” Emily Anders, director of payments strategy for Unite Us, said.

"Our response to interoperability isn’t just about managing data—it’s about building the future of healthcare through open standards." - Dan Vreeman, DPT, Chief Standards Development Officer, HL7 International

Last week at Civitas 2024 in Detroit, HL7 International/s Chief Standards Development Officer,Dan Vreeman, DPT, led an insightful panel session on how HL7® Fast Healthcare Interoperability Resources (FHIR®) is revolutionizing interoperability. As data sharing becomes increasingly critical, HL7 is at the forefront, driving collaboration with over 45 organizations and developing 35-45 new FHIR implementation guides annually! Dan was joined by leaders from the Da Vinci Project, FAST, Gravity Project, and Helios, to discuss their HL7 FHIR Accelerator projects, including objectives and progress made to date in advancing open data standards development and interoperability.

April 25 Session Focuses on the Observation Screening Response Profile

Join us on April 25, 2024, at 2:30 – 4 p.m. ET for the next Gravity Project Implementation Affinity Group meeting, which features more real-world implementations and a key to their success: the Observation Screening Response profile.

Bringing Observation Screening Response into Focus for Gravity Implementers

Building upon the implementation approach and presentation by New York State Qualified Entities in February, this month’s Gravity Implementation Affinity Group session focuses on more real-world implementations and a key to their success: the Observation Screening Response profile.

The benefits of using this profile include explicit categorization of question/answer pairs by social determinants of health (SDOH) domains, flagging of positive findings, and using a common language (Gravity standardized terminology) to share and communicate these findings.

This session will highlight Observation Screening Response, including guidance on using key elements (e.g., Observation.category and Observation.interpretation) and using Observation Screening Response to create Observation Groupings.

Opportunity in partnership with Kaiser Permanente, HL7 and others!

As grounding, the Gravity Project is a national consensus project that develops and tests data standards to represent and exchange social risk data in electronic systems. Together, with a broad collective of stakeholders, Gravity Project defines the language needed to comprehensively address social risks in clinical and community-based settings. To date, the terminology team has completed 17 social risk domains. This has included building critical screening, diagnosis, goal, and intervention concepts for food insecurity, housing instability and homelessness, transportation insecurity, and beyond. In addition, Gravity data standards are included in the United States Core for Data for Interoperability (USCDI), and their value sets serve as a reference for emerging social risk quality measures. (relevant press releases and publications)

Highlighted here is a preview of what’s on the horizon as the Gravity Project matures and
recent examples of Gravity standards integration.

The Gravity Project®, an HL7® FHIR Accelerator, is evolving the way it advances social care data integration as a strategy to promote health equity while maintaining continuity with the mission and consensus-based processes that are core to the project. The project is a national public-private collaborative developing, testing, and implementing consensus-based social determinants of health (SDOH) data standards for use across the health, social services, public health, and research sectors. The Gravity community embodies a truly inclusive representation of over 2,500 stakeholder members of its public work groups and governance committees across the healthcare, health IT, community-based, federal and state agency, payer, academic, and patient/ consumer advocacy sectors.

In 2021, HL7 was awarded a cooperative agreement with the Office of the National Coordinator for Health Information Technology (ONC) to prioritize and expedite the development of standards specific to five gap areas including SDOH. Under this collaborative agreement, the Gravity Pilots Affinity Group was launched in September 2022 as a peer-to-peer learning forum for real-world testing of Gravity terminology and technical standards. Pilot sites are invited to demonstrate the use of social care coded terminologies (e.g., LOINC®, SNOMED-CT®, ICD-10®) and/or the HL7 SDOH Clinical Care FHIR Implementation Guide (SDOH CC IG), share implementation lessons learned with other pilot participants, seek/find partnerships for testing, and gain real-world experience.

On behalf of the HL7 US Realm Steering Committee (USRSC), we are pleased to share an update on last year's priorities and highlight our focus for 2022.

2021 Highlights

Visibility was a key theme of our work in 2021 and included supporting pilot work on a standards dashboard, tracking accelerator activity and promoting key ballots.

Before we dive into 2022, we want to highlight a few key points for all US Realm (USR) members.

• SMART v2: published new guidance on granular controls
• Bulk Data v2: published with numerous new features 
• Errata release of Consolidated CDA (C-CDA): companion guide to support January 2022 ballot  
• C-CDA Companion Guide: January 2022 ballot to add USCDI v2 guidance
• US FHIR Core - January 2022 ballot: to add USCDI v2 guidance
• Hosted reviews on HL7 Standards Dashboard Prototype
• C-CDA Web Publishing Trial Draft using FHIR Structure Definition
• Facilitated US@ project with ONC team

Sessions at HIMSS21 Offer Glimpses into Progress, Potential New Uses for the Standard

After a hiatus of nearly 18 months, a slimmed-down, COVID-sensitive HIMSS 2021 Conference still managed to provide extensive insights into several major trends within the healthcare IT industry.

Along the dual tracks of federal regulations forbidding information blocking and the need for improved data exchange to facilitate, there were many discussions about the capabilities of HL7® Fast Healthcare Interoperability Resources (FHIR®) to support the industry.

The HL7 FHIR community had opportunities at the conference’s Interoperability Showcase to update the industry on dramatic progress by its accelerator groups to advance the use of FHIR in areas where data exchange is essential.

Social Determinants of Health Data Matter for National COVID-19 Response Efforts

The Gravity Project is pleased to announce the publication of its consensus recommendations for food insecurity, housing instability and homelessness data elements. The Gravity Project is a national cross sector grassroots informed collective charged with building consensus data elements and data standards for the capture, exchange, and use of social determinants of health (SDOH) information. The Gravity food insecurity and housing data elements are the result of a year of development with input from its over 1,000 participants with intentional representation from key stakeholders such as patients, providers, community based organizations, payors, technology vendors, and federal and academic food insecurity and housing subject matter experts.

Social determinants of health—the circumstances in which we are born, grow, live, work and age—are estimated to account for 80-90% of health. There is growing interest from the healthcare sector to integrate social risk evaluation and intervention to advance the triple aim: improved health outcomes and quality of care while containing costs. In 2018, Gravity founders University of California San Francisco (UCSF) Social Interventions Research and Evaluation Network (SIREN) conducted an assessment of existing SDOH data and found much work was needed to advance the documentation and use of this data. Enter, the Gravity Project. The Office of the National Coordinator for Health Information Technology (ONC), a Gravity Project sponsor, noted the growing recognition across healthcare that by capturing and accessing SDOH data during the course of care, providers can more easily address non-clinical factors, such as food, housing and transportation insecurities, which can have a profound impact on a person’s overall health.