| Submitted By: Raymonde Uy / National Association of Community Health Centers (NACHC) | |
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| Data Element Information | |
| Use Case Description(s) | |
| Use Case Description | Income is a well-documented factor related to health outcomes. For example, it is associated with lower life expectancy. Financial resource strain that results from insufficient income has been shown to lead to stress, depressed mood, self-rated poor health, smoking, and other substance abuse behaviors. Income is a significant determinant of health, impacting one’s ability not only to receive care but also from accessing the care they need |
| Estimated number of stakeholders capturing, accessing using or exchanging | All federally qualified health centers (FQHCs) gather data about income. This encompasses, in 2019, 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. The evaluation of social determinants of health, however, should be considered a required component of a patient-centered, value-based approach to care and therefore should be potentially relevant for any patient or care setting. |
| Healthcare Aims |
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| Maturity of Use and Technical Specifications for Data Element | |
| Applicable Standard(s) | ICD-10: Z59.5 Extreme poverty (100% FPL or below) Z59.6 Low income (200% FPL or below) Z59.7 Insufficient social insurance and welfare support Z72.4 Inappropriate diet and eating habits SNOMED-CT: 365553008 - Finding of household income (finding) 365556000 - Finding of pattern of income (finding) 365552003 - Finding of income details (finding) LOINC: 93025-5 - Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE] |
| Additional Specifications | http://build.fhir.org/ig/HL7/sdoh-cc/ http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/ https://confluence.hl7.org/display/GRAV/Implementation+Guide |
| Current Use | Extensively used in production environments |
| Supporting Artifacts |
Community Health Centers, Health Center Controlled Networks and Primary Care Associations routinely capture these data elements in different electronic health record systems |
| Number of organizations/individuals with which this data element has been electronically exchanged | 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders. |
| Supporting Artifacts |
Commercial vendors including Aunt Bertha, UNITEUS and NowPow consume PRAPARE data and use it to link individual patients to social interventions. |
| Potential Challenges | |
| Restrictions on Standardization (e.g. proprietary code) | None |
| Restrictions on Use (e.g. licensing, user fees) | The PRAPARE tool has very minimal licensing and user fees. |
| Privacy and Security Concerns | None |
| Estimate of Overall Burden | Low burden, especially for healthcare institutions that routinely cater to the target demographic and geographic catchment area. |
| ONC Evaluation Details Each submitted Data Element has been evaluated based on the following 4 criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI |
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| Maturity – Standards/Technical Specifications | Comment Level - May be represented by a vocabulary standard or an element of a published technical specification. |
| Maturity - Current Use | Comment Level - Used in limited test environments or pilots |
| Maturity - Current Exchange | Comment Level - Demonstrates limited exchange with external organizations, on same or different EHR/HIT systems |
| Breadth of Applicability - # Stakeholders Impacted | Comment Level - Used by few stakeholders, or for narrowly defined conditions or events |
Submitted by RUy on 2022-09-30
Income as SDOH data element under USCDI or ISA
NACHC would like to resupport this data element for consideration / inclusion to USCDIv3. All federally qualified health centers (FQHCs) gather SDOH data, which includes a focus on this data element through the PRAPARE screening tool. This data is relevant to and encompasses in 2019 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. If this data element is not considered for addition to USCDI, we would like to comment on it's addition to ISA as a coded data element under SDOH, with applicable standards and representation accross ICD-10-CM, SNOMED-CT and LOINC. Please see attached document supporting this.2022-09-30 NACHC USCDIv3 Letter of Support_10.pdf