Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.

Data Element
Social History Observation
Submitted By: Al Taylor / ONC
Data Element Information
Use Case Description(s)
Use Case Description Collection of social, psychological and behavioral data is important to whole person care, identifying risk factors and opportunities for interventions that do not consist of strictly clinical interventions or care, but whose provision can significantly affect the quality of care, patient satisfaction, and outcomes.
Addressing these factors are required in certain settings, including participation in alternative care and payment models such as Primary Care Medical Home and others.
Estimate the breadth of applicability of the use case(s) for this data element The collection of these observational data elements are not required in all settings, but they are increasingly so.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) In CCDA 2.1, the Social History Section and Observations recommend use of SNOMED CT codes that are members of the Social History Type Set Definition 2.16.840.1.113883.3.88.12.80.60 Value Set, but there are many other potential codes and code sets to represent values associated with Social Risk Factor assessment, observations, diagnoses and interventions.
Additional Specifications The Gravity Project https://confluence.hl7.org/display/GRAV/The+Gravity+Project is developing a FHIR IG to create additional codes constructs
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts The Social History Section of several CCDA templates that are required for conformance to several CCDA based ONC certification criteria including §170.315(b)(1) Transitions of care for which 512 out of 921 possible certified health IT products or modules have certified to this criteria alone, which requires the use of conformant CCDA templates Continuity of Care Document (CCD), Discharge Summary (V3), and Referral Note (V2).
Extent of exchange 1
Supporting Artifacts The Gravity Project https://confluence.hl7.org/display/GRAV/The+Gravity+Project is developing a FHIR IG to create additional codes constructs
https://confluence.hl7.org/display/GRAV/The+Gravity+Project
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) Consensus on the manner of exchange using the FHIR 4/US Core standard has not been established yet, although significant efforts are underway to achieve this.
Restrictions on Use (e.g. licensing, user fees) Variable. Use of SNOMED, LOINC and ICD-10 generally have use agreements/licensing, but not fees. Other possible code systems which may be used, such as CPT-4, may require fee-based licensing.
Privacy and Security Concerns No unique privacy/security concerns, although some consider certain elements of Social History to be of elevated sensitivity with respect to access or exchange.
Estimate of Overall Burden The variability and/or lack of standardization of FHIR based exchange and emerging elements of CCDA based exchange create an overall burden to implement.
Other Implementation Challenges Feedback requested
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 1 - Data element is captured, stored, or accessed in at least one production EHR or HIT module.
Criterion #3
Maturity - Current Exchange		 Level 1 - Data element is electronically exchanged between two production EHRs or other HIT modules using available interoperability standards.
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.
Evaluation Comment This data element represents a specific type of Health Status Assessment.

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