Project makes early progress in trying to standardize SDOH data

As the healthcare industry looks to electronically capture, use and exchange social determinants of health data, an effort is underway to standardize medical codes to leverage SDOH information across care settings.

The Gravity Project, which held its kickoff meeting last May, is a multi-stakeholder initiative whose goal is the standardization of key data elements necessary for documenting and sharing SDOH-related screening, diagnosis and treatment information using modern coding and exchange standards.

“We are identifying data definitions and addressing coding gaps,” says Evelyn Gallego, founder and CEO of consultancy EMI Advisors, who serves as the program manager of the Gravity Project, which is funded by the Robert Wood Johnson Foundation and led by the Social Interventions Research and Evaluation Network (SIREN) at the University of California, San Francisco.

According to Gallego, the problem with current medical terminology standards is that they do not have the capacity to effectively capture, use and exchange the necessary data.

To address this challenge, the Gravity Project is initially focused on consensus-driven standards for three SDOH domains—food security, housing stability and quality, and transportation access. According to the Gravity Project website, so far the food insecurity dataset has been “consensus approved” by the community.

The project convenes a broad range of stakeholders—including more than 800 members drawn from providers, payers, government, health IT vendors and others—to collaboratively develop recommendations for how best to capture data about food, housing and transportation risks and needs, notes Gallego.

“We are a public collaborative—we bring multi-stakeholder groups together to a public forum to review and gather their input on data definitions for documenting SDOH within clinical settings,” she adds.


The collaborative will also study use cases to identify common data elements and set guidelines compatible with HL7’s Fast Healthcare Interoperability Resources (FHIR), an emerging standard for the interoperable electronic exchange of health information.

And, in the next phase of the project, work will be started to develop a FHIR implementation guide based on the defined use cases and associated data sets that will be finalized.

“There are two streams of work—a content or domain stream and, then, the FHIR implementation guide development stream,” Gallego observes.

In August, HL7 announced that the Gravity Project had become a part of its FHIR Accelerator Program, which helps to assist in the creation and adoption of FHIR implementation guides. Other projects within the Accelerator Program include Argonaut, CARIN Alliance and Da Vinci.

“Now, we have to align to and ensure coordination with all the other FHIR Accelerator projects—but, we always knew we would do that,” comments Gallego. “We reuse artifacts from other FHIR Accelerators and our work. Gravity implementation guides will reference FHIR profiles—especially the core ones developed through Argonaut—as well as other FHIR resources and profiles developed through the Da Vinci Project.”

A September report from the National Academies of Sciences, Engineering, and Medicine found that “interoperability and data sharing between healthcare and social care are hampered by the lack of infrastructure, data standards and modern technology architecture shared between and among organizations.”

To address the problem, the report’s authors called for the development of a strategic national vision, defined technology standards and significant resources to support the integration of healthcare and social care data to improve health outcomes and reduce disparities.

“One of the barriers that the report points out is the fact that everyone is documenting SDOH data differently,” concludes Gallego. “The report actually calls out and refers to the work that Gravity is doing to help solve that problem.”