FHIR Human Services Directory
1.0.0 - STU1
FHIR Human Services Directory
1.0.0 - STU1
This page is part of the FHIR IG Human Services Directory (v1.0.0: STU1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
| Page standards status: Informative |
This page contains miscellaneous information on FHIR implementation. This content is primarily directed at implementers of the Human Services Directory.
The Human Services Data Specification (HSDS) model is mapped to corresponding elements in the FHIR profiles contained within this Implementation Guide (Organization, Location, HealthcareService).
The primary focus of this implementation guide is a RESTful API for obtaining data from a FHIR-enabled Human and Social Service Resource Directory. This API currently only supports a one-directional flow of information from a FHIR-enabled Human Services Directory into local environments (i.e., HTTP GETs). A RESTful API is an interface that allows computer systems to exchange information securely over the internet. REST stands for Representational State Transfer. This means that when a client requests a resource using a REST API, the server transfers back the current state of the resource in a standardized representation.
An implementation that is conformant to this IG:
The conformance verbs (SHALL, SHALL NOT, SHOULD, MAY) used in this guide are defined in FHIR Conformance Rules.
A conformant Human Services Directory SHALL NOT require a directory mobile application to send consumer identifying information in order to query content. A directory mobile application SHALL NOT send consumer identifiable information when querying a Human Services Directory.
When querying the Human Service Resource Directory Profiles defined in this IG, Must Support on any profile data element SHALL be interpreted as follows:
Each profile in this guide requires that the lastUpdated timestamp be provided as part of the profile’s data content. Clients that cache query results can track additions or modifications to directory content through queries that filter content using the _lastUpdated search parameter. Clients should periodically check that data cached from past queries has not been deleted by querying for the same elements by _id.
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By default, the FHIR search result response invoked by the API only includes a FHIR Bundle resource containing resources that match the search criteria. These resources include references and full Uniform Resource Locators (URL) to other related resources so the consuming application can request additional related resources (e.g., querying Organization and Location resources associated with a HealthcareService resource). This results in a “chatty” interface since the consuming applications have to make several queries to get all of the information required for social care referrals. The FHIR specification supports _include as part of the search parameter to request that the server include the related resources specified by the _include. This means the _include has to specify each related resource linkage. Instead of taking that approach, this Implementation Guide suggests that FHIR servers respond with a FHIR bundle that includes the requested resource and all its related resources simultaneously. This allows consuming applications to perform a single query in order to receive all relevant data. In addition, this approach mimics the ‘/complete’ parameter supported by the Human Services Data (HSDA) APIs.
A key objective for the FHIR IG for Human Services Directories is to advance interoperability in the human and social services domain by enabling human services directory data that is that mutually understandable to be exchanged between two or more systems. Several levels of interoperability are pertinent in the context of information technology, syntactic (also known as foundational) and semantic interoperability.
Syntactic interoperability focuses on compatibility for the seamless exchange of data between systems. This involves standardizing data formats and protocols that enable data transmission. Examples include standard message formats such as HL7 Version 2, CDA and FHIR as well as communication protocols like TCP/IP and RESTful APIs for data exchange.
Sematic interoperability helps to ensure that the data being exchanged can be understood and interpreted correctly by different systems. This requires the use of common terminologies, codes, and data models to enable a shared understanding of the information being exchanged. Vocabulary standards such as SNOMED CT, ICD-10-CM & ICS-10-PCS, CPT & HCPCS, LOINC, and RxNorm are used in U.S. healthcare exchange standards to support semantic interoperability by providing consistent representation of clinical concepts. In the approach to creating this implementation guide, the Human Services Data Specification (HSDS) v.2.0.1 was used as the foundation for information requirements to ensure that data commonly represented in human and social services directories was available and could be mapped to the relevant FHIR profiles chosen for use in this guide. These FHIR profiles and APIs are to be used by FHIR enabled applications for the purpose of searching community-based directories for social services that community-based organizations provide to help address social needs of individuals, whether within the context of social care referrals, or for directory lookups in FHIR-enabled consumer applications. This implementation guide provides a map between local directory data and the FHIR profiles within this guide to implementers familiar with their local data and HSDS to facilitate implementation.
HSDS is agnostic with respect to terminologies/taxonomies and acknowledges the variations in human services taxonomies that are currently being used by referral management systems, regional home-grown platforms, and for reporting requirements. Patient/client outcomes are an additional consideration that needs to be met for the development and endorsement of an open-source, universal taxonomy for human and social services.
This version of the IG (STU 1) supports but does not require, the use of any standard social services taxonomy. The guide has been tested under two separate Reference Implementations using directory data encoded using the 211 Human Services Indexing System (211 LA) and the Open Eligibility taxonomy. As currently defined, this version of implementation guide (STU 1) can support the use of these vocabulary standards, any other data standardization efforts that support community services (e.g., the CMS Home and Community-Based Services (HCBS) taxonomy, U.S. Department of Housing and Urban Development (HUD) Homeless Management Information System (HMIS) Data Dictionary, and local directory codes).
Given this complexity, this version of the IG only provides an example of how a common taxonomy could be used to search directories and to identify services. The issue of semantic interoperability may be addressed in a future, balloted version of this Implementation Guide.
| Search | Example | Focal Resource and Field | Qualifications of Search |
|---|---|---|---|
| General Search | Any Service | HSDHealthcareService.category, HSDHealthcareService.type | HSDLocation |
| Service, by Name | Whistlestop Transportation Services | HSDHealthcareService.name | HSDLocation |
| Organization by Name | Redwood Food Bank | HSDOrganization.name | HSDOrganization |
Examples of the canonical use of the profiles are provided in the Examples section of this IG to help implementers consistently use the profiles to enable third-party applications to access human services directories. The method for searching human services directories based on these patterns is provided in the SearchParameters section.
The HSDS model does not include a ‘status’ element to represent whether an organization is “active” in directory data.
The HSDS service table includes the field ‘status’ to indicate the current status of the service. Possible values include ‘active’, ‘inactive’, ‘defunct’, and ‘temporarily closed’. If HSDS service.status = ‘active’, then FHIR HSDHealthcareService.active is set to ‘true’; otherwise HSDHealthcareService.active = ‘false’ as all values other than ‘active’ are considered ‘inactive’ with respect to mapping to FHIR.
It is therefore assumed that any organization associated with active services are active organizations as well. As the result, mapping between the HSDS organization table to FHIR profile HSDOrganization.active is fixed to the value = true because the Organization.active element in the FHIR USCore profile (upon which HSDOrganization is based) is a required element (cardinality = 1..1).
A sample query to search for a currently active HSDHealthcareService:
GET [base]/HSDHealthcareService?_filter=active=true
(Replace [base] with the base URL of the FHIR server)
The first type of search starts from HSDHealthcareService.category and/or HSDHealthcareService.type, so it is essential that each organization’s services are supported by an appropriate set of HealthcareService instances.
Human Services are typically provided by community-based organizations. These services are linked to a set of locations where each service is provided (or is identified as a virtual service using a set of virtual modalities).
These examples illustrate organizations that provide distinct human and social services related to nutrition and transportation delivered at the locations in which they are provided. Community-based organizations should define and maintain up-to-date information on the set of Human and Social HealthcareServices they provide.
The HSDHealthcareService.category and HSDHealthcareService.type fields generally represent the highest levels of classification of services that are provided by community-based organizations.
Relevant examples:
| Scenario | Example Instances |
|---|---|
| Food Bank Services | Redwood Foodbank |
| Home-Delivered Meals | Meals on Wheels |
| Transportation Services | Whistlestop Transportation Service |
| Crisis and Domestic Hotline | SF Crisis And Domestic Violence Services |
Location instances provide information about the locations where organizations provide various services. Location information includes contact information, physical address, accessibility options, and hours of operation, as well as position (longitude and latitude). Locations can be used to represent regions using an associated or attached GeoJSON object.
Relevant examples:
| Scenario | Example Instances |
|---|---|
| Food Bank Location | Redwood Foodbank Location |
| Meals Delivery Service Location | Meals On Wheels Location |
| Transportation Services Location | Whistlestop WheelsLocation |
| Crisis Services Location | SF Crisis Intervention Location |
Organization instances provide specific information about a commmunity-based organization including its name, alias (alternate name), organization type, address and contact information.
| Scenario | Example Instances |
|---|---|
| CBO providing food | Redwood Food Bank |
| CBO providing transportation | Whistlestop Wheels |
| CBO providing crisis services | SF Crisis Hotline |
An Endpoint instance provides the technical details of an endpoint that can be used for electronic services, such as a portal or FHIR REST services, messaging or operations, or DIRECT messaging. The Endpoint resource/profile is not currently supported by HSDS and therefore has not been included in the mapping between HSDS and FHIR, so Endpoint can be ignored.
IG © 2023+ HL7 Human and Social Services Work Group. Package hl7.fhir.us.hsds#1.0.0 based on FHIR 4.0.1. Generated 2023-10-04
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