This page is part of the SDOH Clinical Care for Multiple Domains (v2.0.0: STU 2) 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

Support for Multiple Domains

Code Systems and Value Sets

SDOH Clinical Care Implementation Guide is intended to support multiple SDOH domains and use domain specific value sets as they are created and approved by the Gravity Project. The Gravity Confluence Terminology Workstream describes the terminology identification and creation process. To enable this, we are taking the following approach regarding terminologies and value sets related to profiles defined by this IG.

Each profile element that defines specific SDOH coded concepts will reference the entire code system or in some cases multiple codes systems from which the domain specific values (value set) will be defined. It is our intent to define the specific value sets for each domain in the NIH Value Set Authority Center (VSAC) database (as they are created and validated) and the survey instruments in LOINC. The Gravity Project will publish guidance for each of the SDOH elements in a separate supplemental guide and update the guide at least twice a year. Use of the supplemental guide is optional, but highly recommended. Consensus based values are indicated in the supplemental guide along with values that are more general or commonly used but may be deprecated as the Gravity Project terminology work progresses.

The Gravity Project plans to work with the HL7 Vocabulary WG to determine how best to represent the domain specific value sets in each of the relevant resources and to establish appropriate methods to validate the consistent use of the correct domain specific codes. Future versions of this IG will include the logic to select specific value sets based on the SDOH domain.

In this IG, the exchange of the following activities is supported with specific SDOH profiles on either the base resources or on the respective US Core Profile . A complete listing of the resources used is contained in the FHIR Artifacts Overview page. The following is a brief summary focused on the specific activities:

• Assessments
  • Observation profile based on the Survey process defined in this IG uses LOINC codes. Each of the supported survey instruments are defined as Survey Panels in the LOINC database.
  • Observation profile based on an interaction between a caregiver and the patient uses both LOINC and SNOMED CT codes to describe SDOH conditions.
• Health Concerns / Problems
  • Condition profile that uses both SNOMED CT and ICD-10 codes generated by the Survey process defined in this IG. The Gravity Project recommends defining the relevant codes in the mapping instructions for each Survey instrument utilizing the consensus values defined by the Gravity Project terminology workstream.
• Goals
  • Goal profile that uses both LOINC and SNOMED CT codes for patient goals, and domain specific goals.
• Interventions/Referrals
  • Service Request profile and Procedure profile use a combination of terminologies (SNOMED CT Procedure Codes, HCPCS II, CPT, and occasionally LOINC ) to define specific referrals and interventions that may be domain specific, cross domains or reflect a subset of a domain specific health concerns, problems, and goals.

External Value Set Guidance

Servers SHOULD use the following SDOH value sets when a code exists that describes the concept. The value sets are maintained in the Value Set Authority Center (VSAC). The following group value sets are for health conditions, goals, service requests and procedures respectively.

· Social Determinants of Health Conditions Value Set

· Social Determinants of Health Goals Value Set

· Social Determinants of Health Service Requests Value Set

· Social Determinants of Health Procedures Value Set

The Figure below illustrates how the SDOH group value set is structured for the Condition Profile. When recording SDOH data servers SHOULD use the SDOH value sets.

Example of VSAC SDOH Group Value Set for Condition.Code

The following SDOH profile elements SHOULD use values from the associated VSAC group value set for the specific SDOH domain when a relevant value is defined.