Data Element
Income
Description

This data element captures the combined income of the patient and the family members he/she lives with.
Submitted By: Raymonde Uy / National Association of Community Health Centers (NACHC)
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
Estimate the breadth of applicability of the use case(s) for this data element 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
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
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
Extent of exchange 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 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
Criterion #1
Maturity - Current Standards		 Level 0 - Data element is not represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 0 - Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
Criterion #3
Maturity - Current Exchange		 Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.

Comment

Submitted by nedragarrett_CDC on

CDC's comment on behalf of NACHHO for USCDI v5

Standardized SDoH information would provide value to LHDs by reducing the time gap between when the data is collected and when it is available for LHDs to use in their programing. These data elements should follow the consensus-based terminology developed by the Gravity Project.

Submitted by RUy on

Reaffirming support for SDOH data elements

The National Association of Community Health Centers (NACHC) remains steadfast in its commitment to advocating for and prioritizing Social Determinants of Health (SDOH) data elements. Recognizing the critical role that these factors play in shaping the clinical outcomes of community health center patients, NACHC continues to emphasize the need for comprehensive, accurate, and interoperable SDOH data. By reaffirming our support for these essential elements, we aim to drive informed decision-making, policy development, and targeted interventions that address the root causes of health disparities. This underscores NACHC's belief in the transformative potential of SDOH data in building healthier, more equitable communities.

See attached letter of support containing comments on data elements across USCDI submissions and versions.

2023-09-20 NACHC USCDIv5 Letter of Support_7.pdf

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

We provide recommendation for a core set of priority SDOH coded terminologies be required in USCDI v5. This core set is needed in order for these elements to be included in standard build for improved data capture and interoperability. These should be separate from the current four SDOH elements (of assessment, goals, interventions and problems) which represent broad categories and allow optionality of hundreds of coded terminologies. The base set of required SDOH international standard data elements (coded terminologies) will advance priority SDOH initiatives of the White House, department and agency missions, for partners and the public, and within the clinical setting. They are aligned with policy, programs, and evaluation and clinical tools for improved data assets and evidenced based decision making benefiting patients and populations. 

Submitted by RUy on

Income as key SDOH data element that impacts care and outcomes

Standardizing data related to income, which is a key social determinant of health, and can have a significant impact on a person's access to healthcare, nutrition, and other basic needs. By collecting and sharing information on a patient's income, healthcare providers can better understand the social context of their patients' lives and provide more effective care that is tailored to their individual needs and forward them to CBOs and other organizations that can help alleviate income problems.

Examples of these would be SNOMED-CT code 840539006, "Low income", and ICD-10 codes Z59.5, "Extreme poverty", and Z59.6, "Low income". Incorporating these codes into standardized data elements for interoperability across EHR systems can help healthcare providers to identify patients who may be at increased risk for health disparities and develop interventions to address these issues. By recognizing the importance of income as a social determinant of health and standardizing its collection and sharing, we can improve healthcare equity and promote better health outcomes for all patients.

Submitted by RUy on

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

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