Gravity Project presentation prompts COSHI alignment questions at Colorado health IT work group

At a September meeting of the Health IT Data Governance Work Group of the eHealth Commission, Corey Smith, technical director for the Gravity Project, described the project’s consensus-driven data standards for documenting and exchanging social determinants of health (SDOH) data and discussed how Colorado’s COSHI proofs of concept might align with those standards.

The Gravity Project, Smith said, is “a collaborative initiative with the goal to develop consensus driven data standards to support the collection, use, and exchange of data to address the social determinants of health.” He outlined three work streams — terminology, technical (FHIR implementation), and implementation support — and noted Gravity’s recent technical milestone, the STU 2.3 implementation guide, and ongoing work toward a STU 3 ballot.

The presentation mattered to the work group because members are preparing COSHI components and regional proofs of concept that aim to share social health data across clinical and community systems. Karen, a work group staff member, said the contract for the COSHI system specifies alignment with Gravity Project standards and that the COSHI team is already “working on aligning FHIR components to those standards.”

Smith described how Gravity develops domain-specific value sets and codes across multiple terminologies (LOINC for assessments, SNOMED CT and ICD-10 for problem/diagnosis, and HCPCS/CPT for interventions) and publishes value sets in the National Library of Medicine’s Value Set Authority Center. He also described recent and upcoming terminology work: the fall 202X build focuses on food access, neighborhood safety and access to green space and Gravity’s development of a national, open program-classification vocabulary for social care navigation.

Participants raised practical questions about implementation. Tara Keane (Community Connections) asked for best practices when local or nonstandard SDOH assessments do not map neatly to LOINC or SNOMED. Smith recommended centralized mapping where possible and described a tiered approach to adoption: (1) adopt standardized terminology mappings; (2) exchange standardized terminology by whatever mechanisms are available; (3) implement full FHIR-based exchanges. Smith said, “All of Gravity’s assessment instruments are standardized in LOINC,” and noted that organizations such as New York State had adopted a standardized screening approach to improve statewide interoperability.

Attendees highlighted common barriers to adoption. Community-based organizations and some social-service providers often lack the technical infrastructure (HIE/FHIR capabilities) to exchange data, and many funders and payers require reporting in different, proprietary formats. One participant from a community provider noted that program names and service descriptions (for example, types of rides or food assistance variants) vary widely across regions, complicating standardization.

Several service and health system representatives described current or planned efforts. Matt Everhart (Denver Health) said Denver Health has invested time mapping local elements to standard terminologies and supports broader adoption. John, who identified himself from Boulder County Human Services, described long-running data efforts and asked about the lift required to migrate legacy systems and data warehouses to Gravity standards; Smith advised scoping the work into manageable tiers and said Gravity and implementation partners have supported pilots but that implementation timelines vary by organization and scope.

Smith outlined ways to engage with Gravity: the terminology work stream meets weekly (Thursdays 4:00–5:30 p.m. Eastern), the technical implementation guide work stream meets biweekly on Wednesdays 1:00–2:00 p.m. Eastern, and the implementation affinity group meets quarterly (next meeting scheduled in November). He also referenced collaboration convenings funded by the Robert Wood Johnson Foundation and an 11‑15 waiver in New York that is Gravity-aligned as examples of implementation partnerships.

COSHI staff said they will continue to align COSHI technical components and assessment mappings to Gravity standards and will share more specific updates and resources with the work group in future meetings. No formal votes or policy actions were taken during the session.

Links and materials from the presentation will be shared with the group after the meeting; public comment was invited and none was offered.