Gravity Project Working to Standardize Data on Social Factors that Contribute to Health Outcomes

The Gravity Project collaborative is working to develop data standards to help providers, patients, community-based organizations, and other sectors across the health ecosystem collect and use social determinants of health (SDOH) data to improve health outcomes.

Mark Savage, Managing Director, Digital Health Strategy and Policy, Savage & Savage, LLC, recently provided an overview of the Gravity Project at the Connecting for Better Health coalition meeting. The Gravity Project is “a national public collaborative that develops consensus-based data standards to improve the use and sharing of information on social determinants of health (SDOH).”

The work of the Gravity Project, Savage said, is built around the important principle that having standardized data about certain factors that affect health risks and outcomes can help improve health. Standardized social determinants of health data can be used to identify vulnerable populations and contribute to a more-complete health profile of individuals and populations.

“The big picture for us and for the nation is that 20 percent of one’s health status is explained by factors in the health care setting, while 80 percent of one’s health status is explained by factors outside the health care setting,” Savage said. “Tracking the data, collecting it, and using it becomes very important for achieving better care, better health, better health equity, and better value.”

Social determinants of health include physical environment; socioeconomic factors such as education, job status, family support, income, and community safety; health behaviors such as tobacco and alcohol use and diet and exercise; and access to health care and quality of health care.

The Gravity Project started in 2018 with the primary goal to develop data standards to represent and exchange patient-level SDOH data documented across four clinical activities:

  • Screening
  • Assessment/diagnosis
  • Goal setting, and
  • Treatment/interventions.


The collaborative has three workstreams: creating terminology, developing technology, and testing implementations.

The process begins by selecting a domain, Savage said, such as food insecurity. The project then brings together subject matter experts on that domain including representatives of the community, providers, and experts from clinical care and public health.

“We think about the range of people who need to be around the table in order to look at a domain, to identify what are the proper things to track, what are the proper value sets,” he said.

The project then goes through an iterative process with the subject matter experts and with the public collaborative. Gravity has convened more than 2,000 participants from across the health and human services ecosystem including: clinical providers, patients and patient advocates, community-based organizations, standards development organizations, federal and state governments, payers, and technology vendors.

“We are thinking holistically about all of the people who are using this system because it’s designed to serve across the national ecosystem,” Savage said. “It’s a dynamic collaborative process, all for the greater good.”

Once there is a consensus vote from the public collaborative, the Gravity Project then submits the information to its coding stewards to decide whether to approve and publish it.

“Because we have an end-to-end design in mind, it’s not just clinical care to clinical care. We have developed a reference implementation that can be used by communities, community-based organizations, referral platforms, and even patients using smart phones and web apps,” he said.

In 2021, the Gravity Project tackled domains including material hardship, stress, social connection, elder abuse, and intimate partner violence. In the first part of 2022, the collaborative will focus on personal health literacy, the under insured and medical cost burden. The Gravity Project also is “beginning to look at racism, discrimination, and bias as a domain.”

On the technical side, Savage said, the collaborative is working on implementation that can be used for smartphone and web-based applications “to make sure that we actually have a form of connection for capture, exchange, and use across all of the important stakeholder groups in the ecosystem.”

Information on how stakeholders can support the important work of the Gravity Project can be found here.

While Gravity Project is a national endeavor, including SDOH also is critical to the vision of health information exchanges in CA. Connecting for Better Health believes that SDOH should carry the same weight as clinical and administrative data to help treat the whole person.


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