Overview

Social History is represented using Observation FHIR Resource. Observations are a central element in healthcare, used to support diagnosis, monitor progress, determine baselines and patterns and even capture demographic characteristics, as well as capture results of tests performed on products and substances. Most observations are simple name/value pair assertions with some metadata, but some observations group other observations together logically, or even are multi-component observations.

Each Observation has next elements:

a status
a category code of “social-history”
a code
a patient

Each Observation supports next elements:

a category code of ‘sdoh’
a time indicating when observation was made
who answered the questions
a value

Profile specific implementation guidance:

See the SDOH guidance page for how this profile can used to represent SDOH assessments.1
Observations that are formally derived from an assessment tool or survey should use the US Core Observation Survey Profile. However, simple assertion may be derived from a screening tool assessments and can reference them using Observation.derivedFrom.
The codes can be from LOINC or SNOMED CT.
Often the pattern for these types of observations that the Observation.code indicates a statement about findings and the Observation.value is present and “qualifies” the finding typically confirming or refuting it. For example:

code: Transport too expensive (SNOMED CT: 160695008)
value: true

This resource conforms to USCDI V2 profile for Observation - refer to US Core Observation Social History Profile. Observation response will be provided in JSON (refers to Capability Statement) format as per FHIR standard R4 version.

USCore Data Element	FHIR Resource Field
status	Observation.status
a category code of “social-history”	Observation.category
a code	Observation.code
a patient	Observation.subject
a category code of ‘sdoh’	Observation.category
a time indicating when observation was made	Observation.effective[x]
who answered the questions	Observation.performer
a value	Observation.value[x]

Must support elements, mandatory and optional search parameters

Observationmust support these elements:

status
Slices for category
- category:us-core/social-history
- category:sdoh
code
subject
effectiveDateTime
performer
value[x]
- valueQuantity
- valueString
- valueBoolean
- valueCodeableConcept

The following search parameters and search parameter combinations SHALL be supported:

The syntax used to describe the interactions is described [here](/reference/
/reference/us-core-guidance).

SHALL support searching for all Observations for a patient and category search parameters:
GET [base url]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history

SHALL support searching for all Observations for a patient and code search parameters:

including optional support for OR search on code (e.g.code={system|}|{code},{system|}|{code},...)
GET [base url]/Observation?patient={Type/}[id]&code={system|}|{code}{,{system|}|{code},...}}

SHALL support searching for all Observations for a patient and category and date search parameters:

including support for these date comparators: gt,lt,ge,le
including optional support for AND search on date (e.g.date={date}&date={date}&...)
GET [base url]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&date={gt|lt|ge|le}{date}{&date={gt|lt|ge|le}{date}&...}

The following search parameter combinationsSHOULD be supported (optional):

SHOULD support searching using the combination of the patient and category and status search parameters:

including support for OR search on status (e.g.status={system|}|{code},{system|}|{code},...)
GET [base url]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&status={system|}|{code}{,{system|}|{code},...}

SHOULD support searching using the combination of the patient and code and date search parameters

including optional support for OR search on code (e.g.code={system|}|{code},{system|}|{code},...)
including support for these date comparators: gt,lt,ge,le
including optional support for AND search on date (e.g.date={date}&date={date}}&...)
GET [base url]/Observation?patient={Type/}[id]&code={system|}|{code}{,{system|}|{code},...}&date={gt|lt|ge|le}{date}{&date={gt|lt|ge|le}{date}&...}

The response to any search operation is always a list of resources in a Bundle or an Operation Outcome.

Observation By Patient Id

Search for Observation by patient.

METHOD GET

[base url]/Observation?patient={Type/}[id]

PARAMS
[base url] - [FHIR base url](/reference/
/reference/service-base-urls)
[id] - Id for the Patient

HEADERS

The Authorization token SHALL be obtained during Authentication and Authorization process. Go to [Authentication and Authorization](/reference/
/reference/authentication-authorization) for further details.

Header	Type	Required/Optional	Value
Authorization	string	required	`Bearer <token>`

RESPONSES

Code	Description	Comment
200	OK	The request was processed successfully
400	Bad request	Invalid request parameters or FHIR operation outcome resource returned
401	Unauthorized	This code indicates that the client request has not been completed because it lacks valid authentication credentials for the requested resource
404	no Route matched with those values	The request was able to communicate with a given server, but the server could not find what was requested
500	Internal Server Error	The server has encountered a situation it doesn't know how to handle

EXAMPLE:

curl --location --request GET 'https://sandbox.fhir.elationemr.com/fhir/Observation?patient=Patient/c5137fa5-3216-b12a-cbbc-a0c6bef361g7' \
--header 'Authorization: Bearer fe1cd986-1ac7-4c26-b8b3-d632a48408fd'

Observation By Id

Get Observation by ID.

METHOD GET

[base url]/Observation/{id}

or

[base url]/Observation?_id={id}

PARAMS

[base url] - [FHIR base url](/reference/
/reference/service-base-urls)
{id} - Id for Observation resource

HEADERS

The Authorization token SHALL be obtained during Authentication and Authorization process. Go to [Authentication and Authorization](/reference/
/reference/authentication-authorization) for further details.

Header	Type	Required/Optional	Value
Authorization	string	required	`Bearer <token>`

RESPONSES

Code	Description	Comment
200	OK	The request was processed successfully
400	Bad request	Invalid request parameters or FHIR operation outcome resource returned
401	Unauthorized	This code indicates that the client request has not been completed because it lacks valid authentication credentials for the requested resource
404	no Route matched with those values	The request was able to communicate with a given server, but the server could not find what was requested
500	Internal Server Error	The server has encountered a situation it doesn't know how to handle

EXAMPLE:

curl --location --request GET 'https://sandbox.fhir.elationemr.com/fhir/Observation/c5137fa5-3216-b12a-cbbc-a0c6bef361g7' \
--header 'Authorization: Bearer fe1cd986-1ac7-4c26-b8b3-d632a48408fd'

Observation by patient and category search parameters

Get Observations using the combination of the patient and category search parameters:

METHOD GET

GET [base url]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history

PARAMS
[base url] - [FHIR base url](/reference/
/reference/service-base-urls)
{Type} - Type for the Reference. Example: Patient
[id] - patient id
HEADERS

The Authorization token SHALL be obtained during Authentication and Authorization process. Go to [Authentication and Authorization](/reference/
/reference/authentication-authorization) for further details.

Header	Type	Required/Optional	Value
Authorization	string	required	`Bearer <token>`

RESPONSES

Code	Description	Comment
200	OK	The request was processed successfully
400	Bad request	Invalid request parameters or FHIR operation outcome resource returned
401	Unauthorized	This code indicates that the client request has not been completed because it lacks valid authentication credentials for the requested resource
404	no Route matched with those values	The request was able to communicate with a given server, but the server could not find what was requested
500	Internal Server Error	The server has encountered a situation it doesn't know how to handle

EXAMPLE:

curl --location --request GET 'https://sandbox.fhir.elationemr.com/fhir/Observation?patient=Patient/fe1cd986-1ac7-4c26-b8b3-d632a48408fd&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history\
--header 'Authorization: Bearer 1239b275-909e-4754-8f73-1e411fd6769e'

Observation by patient and category and date search parameters

Get Observations using the combination of the patient and category and date search parameters:

METHOD GET

GET [base url]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&date={gt|lt|ge|le}{date}{&date={gt|lt|ge|le}{date}&...}

PARAMS
[base url] - [FHIR base url](/reference/
/reference/service-base-urls)
{Type} - Type for the Reference. Example: Patient
[id] - patient id
{date} - observation effective date

HEADERS

The Authorization token SHALL be obtained during Authentication and Authorization process. Go to [Authentication and Authorization](/reference/
/reference/authentication-authorization) for further details.

Header	Type	Required/Optional	Value
Authorization	string	required	`Bearer <token>`

RESPONSES

Code	Description	Comment
200	OK	The request was processed successfully
400	Bad request	Invalid request parameters or FHIR operation outcome resource returned
401	Unauthorized	This code indicates that the client request has not been completed because it lacks valid authentication credentials for the requested resource
404	no Route matched with those values	The request was able to communicate with a given server, but the server could not find what was requested
500	Internal Server Error	The server has encountered a situation it doesn't know how to handle

EXAMPLE:

curl --location --request GET 'https://sandbox.fhir.elationemr.com/fhir/Observation?patient=Patient/fe1cd986-1ac7-4c26-b8b3-d632a48408fd&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&date=ge2018-03-14T00:00:00Z\
--header 'Authorization: Bearer 1239b275-909e-4754-8f73-1e411fd6769e'

Observation by patient and code search parameters

Get Observations using the combination of the patient and code search parameters:

METHOD GET

GET [base url]/Observation?patient={Type/}[id]&code={system|}|{code}{,{system|}|{code},...}

PARAMS

[base url] - [FHIR base url](/reference/
/reference/service-base-urls)
{Type} - Type for the Reference. Example: Patient
[id] - patient id
{system|} - system used to identify observation code
{code} - observation code

HEADERS

The Authorization token SHALL be obtained during Authentication and Authorization process. Go to [Authentication and Authorization](/reference/
/reference/authentication-authorization) for further details.

Header	Type	Required/Optional	Value
Authorization	string	required	`Bearer <token>`

RESPONSES

Code	Description	Comment
200	OK	The request was processed successfully
400	Bad request	Invalid request parameters or FHIR operation outcome resource returned
401	Unauthorized	This code indicates that the client request has not been completed because it lacks valid authentication credentials for the requested resource
404	no Route matched with those values	The request was able to communicate with a given server, but the server could not find what was requested
500	Internal Server Error	The server has encountered a situation it doesn't know how to handle

EXAMPLE:

curl --location --request GET 'https://sandbox.fhir.elationemr.com/fhir/Observation?patient=Patient/fe1cd986-1ac7-4c26-b8b3-d632a48408fd&code=http://loinc.org|76690-7 \
--header 'Authorization: Bearer 1239b275-909e-4754-8f73-1e411fd6769e'

Observation by patient and code and date search parameters

Get Observations using the combination of the patient and code and date search parameters:

METHOD GET

GET [base url]/Observation?patient={Type/}[id]&code={system|}|{code}{,{system|}|{code},...}&date={gt|lt|ge|le}{date}{&date={gt|lt|ge|le}{date}&...}

PARAMS
[base url] - [FHIR base url](/reference/
/reference/service-base-urls)
{Type} - Type for the Reference. Example: Patient
[id] - patient id
{system|} - terminology system used to identify observation code
{code} - observation code
{date} - observation effective date

HEADERS

The Authorization token SHALL be obtained during Authentication and Authorization process. Go to Authentication and Authorization for further details.

Header	Type	Required/Optional	Value
Authorization	string	required	`Bearer <token>`

RESPONSES

Code	Description	Comment
200	OK	The request was processed successfully
400	Bad request	Invalid request parameters or FHIR operation outcome resource returned
401	Unauthorized	This code indicates that the client request has not been completed because it lacks valid authentication credentials for the requested resource
404	no Route matched with those values	The request was able to communicate with a given server, but the server could not find what was requested
500	Internal Server Error	The server has encountered a situation it doesn't know how to handle

EXAMPLE:

curl --location --request GET 'https://sandbox.fhir.elationemr.com/fhir/Observation?patient=Patient/fe1cd986-1ac7-4c26-b8b3-d632a48408fd&code=http://loinc.org|76690-7&date=ge2018-03-14T00:00:00Z\
--header 'Authorization: Bearer 1239b275-909e-4754-8f73-1e411fd6769e'

Observation by patient and category and status search parameters

Get Observations using the combination of the patient and category and status search parameters:

METHOD GET

GET [base url]/Observation?patient={Type/}[id]&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&status={status_system}|{status}{,{status_system}|{status},...}

PARAMS
[base url] - [FHIR base url](/reference/
/reference/service-base-urls)
{Type} - Type for the Reference. Example: Patient
[id] - patient id
{status_system} - terminology system used to identify observation status
{status} - observation status

HEADERS

The Authorization token SHALL be obtained during Authentication and Authorization process. Go to [Authentication and Authorization](/reference/
/reference/authentication-authorization) for further details.

Header	Type	Required/Optional	Value
Authorization	string	required	`Bearer <token>`

RESPONSES

Code	Description	Comment
200	OK	The request was processed successfully
400	Bad request	Invalid request parameters or FHIR operation outcome resource returned
401	Unauthorized	This code indicates that the client request has not been completed because it lacks valid authentication credentials for the requested resource
404	no Route matched with those values	The request was able to communicate with a given server, but the server could not find what was requested
500	Internal Server Error	The server has encountered a situation it doesn't know how to handle

EXAMPLE:

curl --location --request GET 'https://sandbox.fhir.elationemr.com/fhir/Observation?patient=Patient/fe1cd986-1ac7-4c26-b8b3-d632a48408fd&category=http://terminology.hl7.org/CodeSystem/observation-category|social-history&status=final\
--header 'Authorization: Bearer 1239b275-909e-4754-8f73-1e411fd6769e'