Purpose

SDOHCC Observation Screening Response (OSR) is intended to represent question-answer pairs from Social Determinants of Health (SDOH) assessment instruments. An OSR that identifies a social risk or need can be referenced as evidence for an SDOHCC Condition. Sometimes, instead of representing a question that was answered directly on an assessment instrument, an OSR may be derived from one or more other OSRs (see SDOHCC Observation Response Hunger Vital Sign Question 3 Example). Additionally, an OSR may be addressed by, or be the outcome of, an SDOHCC Goal, or be the reason for an SDOHCC ServiceRequest or an SDOHCC Procedure. See the Data Modeling Framework for more detail on the relationships between OSR and other profiles in this IG.

An OSR can also group a collection of OSRs using the hasMember field. A OSR grouping, that provides the LOINC code of the assessment instrument from which the member OSRs were created, is especially useful when there is no QuestionnaireReponse, Paper Form, or PDF to support the association of the individual OSRs with an assessment instrument. Although an OSR grouping can also be created for OSRs produced from a QuestionnaireResponse, the grouping will be somewhat redundant when the member OSRs already reference QuestionnaireResponse using the derivedFrom field.

This IG focuses on responses to assessment instruments that are captured using QuestionnaireResponse. To facilitate querying and searching, it is best that individual responses from a QuestionnaireResponse be converted into Observations. The decision as to which responses from a QuestionnaireResponse should be converted into Observations will generally be driven by the clinical utility of each Observation. While clinical utility is subjective, the question codes in the preferred value sets in the Notes section below provide the questions that Gravity has vetted as face-valid. For more information on this topic and Observation grouping see Options for Representing Assessment Instrument Responses in FHIR.

In the future, to promote interoperability by ensuring consistency in Observations generated from an assessment instrument, a single StructureMap instance should ideally be provided for each assessment instrument.

Usage

Rather than offer a separate SDOHCC Observation Screening Response profile for each SDOH category (also called domain – e.g., food insecurity, transportation insecurity), this profile can support any SDOH category. For Observation.code and Observation.value, the minimum value set bindings are specified in the profile. Additionally, based on the code selected for the optional Observation.category slice, the Table in the Notes section below provides the Gravity-vetted, preferred value sets for Observation.code and Observation.value. Where a preferred value set contains a code to describe a needed concept, servers SHOULD use that code.

The preferred value sets in the Table are hosted in the NIH Value Set Authority Center (VSAC). The Gravity Project plans to continue to work with the HL7 Vocabulary WG to determine how best to represent and validate these preferred, category-specific value sets.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	SDOH screening questionnaire observations
status	S	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations.
subject	S	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	S	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	S	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	S	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result Slice: Unordered, Open by type:$this
value[x]:valueQuantity		0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept		0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes
dataAbsentReason	S	0..1	CodeableConcept	Why the result is missing
bodySite		0..0
specimen		0..0
Slices for hasMember		0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	S	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	S	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	S	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.status	required	SDOHCCValueSetObservationStatus
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM)
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC)

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	SDOH screening questionnaire observations
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations.
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.status	required	SDOHCCValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:SocialHistory	preferred	Pattern: social-history
Observation.category:Survey	preferred	Pattern: survey
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM)
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC)
Observation.dataAbsentReason	extensible	DataAbsentReason

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	SDOH screening questionnaire observations
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations.
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	ΣTU	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	SDOHCCValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:SocialHistory	preferred	Pattern: social-history
Observation.category:Survey	preferred	Pattern: survey
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM)
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC)
Observation.dataAbsentReason	extensible	DataAbsentReason
Observation.interpretation	extensible	ObservationInterpretationCodes
Observation.method	example	ObservationMethods
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes
Observation.component.code	example	LOINCCodes (a valid code from LOINC)
Observation.component.dataAbsentReason	extensible	DataAbsentReason
Observation.component.interpretation	extensible	ObservationInterpretationCodes

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	Observation	SDOH screening questionnaire observations
status	S	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	S	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations.
subject	S	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	S	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	S	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	S	0..1	Quantity, CodeableConcept, string, boolean, integer, Range, Ratio, SampledData, time, dateTime, Period	Actual result Slice: Unordered, Open by type:$this
value[x]:valueQuantity		0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept		0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes
dataAbsentReason	S	0..1	CodeableConcept	Why the result is missing
bodySite		0..0
specimen		0..0
Slices for hasMember		0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	S	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	S	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	S	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.status	required	SDOHCCValueSetObservationStatus
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM)
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	SDOH screening questionnaire observations
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations.
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.status	required	SDOHCCValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:SocialHistory	preferred	Pattern: social-history
Observation.category:Survey	preferred	Pattern: survey
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM)
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC)
Observation.dataAbsentReason	extensible	DataAbsentReason

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	Observation	SDOH screening questionnaire observations
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for observation
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)	Fulfills plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)	Part of referenced event
status	?!SΣ	1..1	code	final | corrected | entered-in-error | unknown Binding: SDOHCC ValueSet Observation Status (required)
Slices for category		2..*	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:$this Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories.
category:SocialHistory	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: social-history
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:Survey	S	1..1	CodeableConcept	Classification of type of observation Binding: ObservationCategoryCodes (preferred): Codes for high level observation categories. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/observation-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: survey
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:SDOH	S	0..*	CodeableConcept	e.g., food-insecurity | transportation-insecurity Binding: SDOHCC ValueSet SDOH Category (required): Codes for high-level SDOH categories.
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: LOINCCodes (required): Codes identifying names of simple observations.
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the observation is about
focus	ΣTU	0..*	Reference(Resource)	What the observation is about, when it is not about the subject of record
encounter	Σ	0..1	Reference(Encounter)	Healthcare event during which this observation is made
effective[x]	SΣ	1..1		Clinically relevant time/time-period for observation
effectiveDateTime			dateTime
effectivePeriod			Period
issued	Σ	0..1	instant	Date/Time this version was made available
performer	SΣ	0..*	Reference(RelatedPerson | US Core Patient Profile | US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | US Core CareTeam Profile)	Who is responsible for the observation
Slices for value[x]	SΣC	0..1		Actual result Slice: Unordered, Open by type:$this
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
value[x]:valueQuantity	ΣC	0..1	Quantity	Actual result Binding: UnitsOfMeasureCaseSensitive (required): This is the entire UCUM code set.
value[x]:valueCodeableConcept	ΣC	0..1	CodeableConcept	Actual result Binding: LOINCCodes (preferred): This value set includes all LOINC codes
dataAbsentReason	SC	0..1	CodeableConcept	Why the result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
note		0..*	Annotation	Comments about the observation
method		0..1	CodeableConcept	How it was done Binding: ObservationMethods (example): Methods for simple observations.
device		0..1	Reference(Device | DeviceMetric)	(Measurement) Device
referenceRange	C	0..*	BackboneElement	Provides guide for interpretation
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
low	C	0..1	SimpleQuantity	Low Range, if relevant
high	C	0..1	SimpleQuantity	High Range, if relevant
type		0..1	CodeableConcept	Reference range qualifier Binding: ObservationReferenceRangeMeaningCodes (preferred): Code for the meaning of a reference range.
appliesTo		0..*	CodeableConcept	Reference range population Binding: ObservationReferenceRangeAppliesToCodes (example): Codes identifying the population the reference range applies to.
age		0..1	Range	Applicable age range, if relevant
text		0..1	string	Text based reference range in an observation
Slices for hasMember	Σ	0..*	Reference(Observation | QuestionnaireResponse | MolecularSequence)	References the child observations of a grouping observation Slice: Unordered, Open by profile:$this.resolve()
hasMember:SupportedHasMember	SΣ	0..*	Reference(SDOHCC Observation Screening Response)	For an Observation Grouping, the Observations generated from an assessment instrument
Slices for derivedFrom	SΣ	0..*	Reference(DocumentReference | QuestionnaireResponse | Observation)	Related measurements the observation is made from Slice: Unordered, Open by profile:$this.resolve()
derivedFrom:SupportedDerivedFrom	SΣ	0..*	Reference(SDOHCC Observation Screening Response | SDC Questionnaire Response)	Related questionnaire responses or observations that the observation is made from
component	Σ	0..*	BackboneElement	Component results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	1..1	CodeableConcept	Type of component observation (code / type) Binding: LOINCCodes (example): Codes identifying names of simple observations.
value[x]	Σ	0..1		Actual component result
valueQuantity			Quantity
valueCodeableConcept			CodeableConcept
valueString			string
valueBoolean			boolean
valueInteger			integer
valueRange			Range
valueRatio			Ratio
valueSampledData			SampledData
valueTime			time
valueDateTime			dateTime
valuePeriod			Period
dataAbsentReason	C	0..1	CodeableConcept	Why the component result is missing Binding: DataAbsentReason (extensible): Codes specifying why the result (Observation.value[x]) is missing.
interpretation		0..*	CodeableConcept	High, low, normal, etc. Binding: ObservationInterpretationCodes (extensible): Codes identifying interpretations of observations.
referenceRange		0..*	See referenceRange (Observation)	Provides guide for interpretation of component result
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Observation.status	required	SDOHCCValueSetObservationStatus
Observation.category	preferred	ObservationCategoryCodes
Observation.category:SocialHistory	preferred	Pattern: social-history
Observation.category:Survey	preferred	Pattern: survey
Observation.category:SDOH	required	SDOHCCValueSetSDOHCategory
Observation.code	required	LOINCCodes (a valid code from LOINC)
Observation.value[x]:valueQuantity	required	UnitsOfMeasureCaseSensitive (a valid code from UCUM)
Observation.value[x]:valueCodeableConcept	preferred	LOINCCodes (a valid code from LOINC)
Observation.dataAbsentReason	extensible	DataAbsentReason
Observation.interpretation	extensible	ObservationInterpretationCodes
Observation.method	example	ObservationMethods
Observation.referenceRange.type	preferred	ObservationReferenceRangeMeaningCodes
Observation.referenceRange.appliesTo	example	ObservationReferenceRangeAppliesToCodes
Observation.component.code	example	LOINCCodes (a valid code from LOINC)
Observation.component.dataAbsentReason	extensible	DataAbsentReason
Observation.component.interpretation	extensible	ObservationInterpretationCodes

This structure is derived from Observation

Summary

Mandatory: 4 elements
Must-Support: 13 elements
Prohibited: 2 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam)
• SDOHCC Observation Screening Response (http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse)
• SDC Questionnaire Response (http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse)

Slices

This structure defines the following Slices:

• The element Observation.category is sliced based on the value of value:$this
• The element Observation.value[x] is sliced based on the value of type:$this
• The element Observation.hasMember is sliced based on the value of profile:$this.resolve()
• The element Observation.derivedFrom is sliced based on the value of profile:$this.resolve()

General Guidance For Preferred Value Sets For SDOHCC Observation Screening Response

The minimum value set bindings for Observation.code and Observation.value are specified in the profile. However, for each SDOH category (domain) covered in this IG, there are also category-specific, preferred value sets. For an observation instance, selecting a category-specific code (e.g., food-insecurity, transportation-insecurity) from the SDOHCC ValueSet SDOH Category bound to Observation.category will determine the preferred, category-specific value sets for Observation.code and Observation.value. Where a preferred value set contains a code to describe a needed concept, servers SHOULD use that code.

Codes in the category-specific, preferred value sets are from LOINC-encoded assessment instruments that have been vetted as face-valid by the Gravity Project. For the list of assessment instruments from which Gravity has chosen questions, see the Social Determinants of Health Screening Assessments value set which is hosted in the NIH Value Set Authority Center (VSAC). For each Gravity-vetted assessment instrument, the questions are also vetted and only those that also meet Gravity criteria are included in the preferred value sets.

Guidance on Category-specific Preferred Value Set Naming Conventions, Content, and Usage

The table provides guidance on naming conventions, content, and usage for the category-specific, preferred value sets.

Note: For “Value Set Naming Pattern” below, is a placeholder for a specific SDOH category/domain (e.g., Food Insecurity).

Links to Category-specific Preferred Value Sets and Assessment Instrument Spreadsheets

Key for the “ValueSet for” Column: For readability, the formal names of these value sets in VSAC are shortened in the Table as follows:

• Panels and Questions = <Category-specific> Screening Assessments And Questions (Example: The formal name in VSAC for the Questions and Panels Value Set for Food insecurity is “Food Insecurity Screening Assessments And Questions”.)
• Panels = <Category-specific> Screening Assessments
• Questions = <Category-specific> Screening Assessments Questions
• Answers = <Category-specific> Screening Assessments Answers Value Set

Of note, Grouper VSAC value sets containing the members of all the category-specific value sets for Observation.code and Observation.value are available here:

• For Observation.code:
  • Social Determinants of Health Screening Assessments And Questions Value Set
  • Social Determinants of Health Screening Assessments Questions Value Set
  • Social Determinants of Health Screening Assessments Value Set
• For Observation.value: Social Determinants of Health Screening Assessments Answers Value Set

Guidance on Category-specific Assessment Instrument Spreadsheets

Each question (Observation.code) on an assessment instrument has a set of allowed answers (Observation.value). The allowed answers for a specific question may vary depending on the assessment instrument (LOINC panel) on which the question is presented (e.g., 88122-7 “Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]” has 4 possible answers on the Hunger Vital Sign (HVS) panel versus three possible answers on the American Academy of Family Physicians Social Needs Screening Tool). For this reason, the category-specific Assessment Instrument Spreadsheets provide additional information to link specific assessment instruments to questions and their allowed LOINC Answer Lists. LOINC also provides Answers Lists for questions from specific assessment instruments (panels).

​For additional information on fields in the Assessment Instrument Spreadsheets, see Assessment Instrument Spreadsheet Guidance on the Gravity Project Confluence site.