Health professional’s conclusions and working assumptions that will guide treatment of the patient.

Data Element

SDOH Assessment
Description (*Please confirm or update this field for the new USCDI version*)

Structured evaluation of risk (e.g., PRAPARE, Hunger Vital Sign, AHC-HRSN screening tool) for any Social Determinants of Health domain such as food, housing, or transportation security. SDOH data relate to conditions in which people live, learn, work, and play and their effects on health risks and outcomes.

Applicable Vocabulary Standard(s)

Applicable Standards (*Please confirm or update this field for the new USCDI version*)
  • Logical Observation Identifiers Names and Codes (LOINC®) version 2.70
  • SNOMED International, Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, March 2021 Release

Comment

CMS-CCSQ Recommends expanding SDOH element example domains

Recommendation: CMS CCSQ recommends the inclusion of health literacy, social isolation and transportation insecurity as additional example domains in the definitions for Social Determinants of Health (SDOH) data elements: SDOH Goals; SDOH Assessment; SDOH Problems/ Health Concerns; SDOH Interventions. Additionally, upgrade the SDOH data class from Level 0 to Level 2.

Rationale: CMS CCSQ appreciates the inclusion of health literacy as an example domain in the SDOH Assessment element and further recommends that ASTP/ONC include health literacy, social isolation and transportation insecurity as additional example domains in the definition for SDOH elements, since they are important domains that address social risks and are included in the Gravity Project SDOH elements. The Interoperability Standards Working Group (ISWG) supports ASTP/ONC’s collaboration with Gravity to include International Standards Atmosphere (ISA) pages for all Gravity domains, along with frequent updates to the USCDI SDOH element descriptions to assist implementers.
The World Health Organization estimates that SDOH accounts for 30-50% of health outcomes. In the case of transportation insecurity, patients may miss medical appointments, struggle to access rehabilitation services, or face difficulties with medication adherence, ultimately leading to worsened outcomes and higher healthcare costs. Similarly, social isolation can increase an individual’s risk of depression, anxiety, cognitive and functional decline, and frequent hospitalizations, all of which negatively impact patient outcomes and contribute to higher healthcare costs.  These reasons underscore the importance of including social isolation and transportation insecurity as key example domains for the SDOH data elements, in addition to the currently listed domains.
Therefore, promoting the SDOH data class to level 2 will further advance the goal of standardizing exchange of this data across the continuum of care, as a patient transitions through different health care facilities or settings. 

Supporting DEL data elements:
I. Transportation item – “Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed from daily living?”
    i. A1250  (IRF-PAI, LCDS, MDS, OASIS).
II. Social isolation item 
    i. D0700  (IRF-PAI, LCDS, MDS, OASIS).
Applicable Standards:
I. Social Isolation 
    i. LOINC code 93159-2.
    ii. Examples of standard codes that represent social isolation would be: 
        1. SNOMED-CT code 625891000000109 - "Social isolation."
        2. ICD-10 code Z60.2, "Problem related to living alone."
   
II. Transportation
    i. LOINC 93030-5  (OASIS). 
    ii. LOINC 101351-5  (IRF-PAI, LCDS, MDS).
Supporting IGs:
I. SDOH Clinical Care for Multiple Domains (v2.2.0: STU 2.2) based on FHIR (HL7® FHIR® Standard) R4 (IG Home - SDOH Clinical Care v2.2.0).
    1. See the following profiles: SDOHCC Condition, SDOHCC Observation Screening Response, SDOHCC Procedure, SDOHCC ServiceRequest, SDOHCC Goal.

NACHC Clinical Informatics…

NACHC Clinical Informatics supports the comment of Ann Phillips / IMO, and firmly believes that the collection of social determinants of health information is critical to support patient access and referral care systems that enable and optimize appropriate closed-loop social interventions.

 

We strongly support the use of the code systems and codes referenced by the Gravity Project submission to ensure proper representation of PRAPARE and other SDoH assessment screening tools to support interoperability of this data to connect CBOs and CCOs to EHRs.

 

Please see attached document for a detailed summary of our comments on SDoH

2022-04-30 NACHC USCDIv3 Letter of Support.pdf

Data Class: Assessment and Plan of Treatment, SDOH Assessment

IMO supports the inclusion of SDOH Assessment in the Assessment and Plan of Treatment Data Class in USCDI V3 and recommends that the Applicable Vocabulary Standard(s) category be expanded to include ICD-10-CM Z codes recently developed for Social Determinants of Health. 

However, we strongly caution against the inclusion of specific value sets to represent SDOH assessments without alignment to SDOH screening tools by domain that have a history of implementation in clinical care environments. 

 

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