Episode 44: Advancing Data Standards with the Gravity Project

In this episode of the Informonster Podcast, Charlie Harp is joined by Sarah DeSilvey, DNP, FNP-C, Co-founder and Director of Terminology for the Gravity Project, to discuss the evolution of data standards supporting social determinants of health (SDOH). Together, they explore how Gravity’s collaborative work within HL7 is helping define and standardize social care data to improve interoperability and care coordination.

Sarah shares insights into the project’s origins, its impact on initiatives like USCDI and quality measurement, and the critical role of consensus-based data development. The conversation highlights how advancing SDOH data standards not only strengthens health data quality but also enables more equitable, person-centered care.

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Transcript

Charlie Harp (00:08):

Hi, I am Charlie Harp and this is the Informonster Podcast. And today on the Informonster podcast, I have the delightful Sarah DeSilvey. Sarah, welcome to the Informonster Podcast.

Sarah C DeSilvey, DNP, FNP-C (00:20):

Charlie, thank you so much for having me. I know we've planned a long time for this, so I'm very honored to be here.

Charlie Harp (00:25):

I know I've been on the wait list forever, going to an expensive restaurant in New York. I finally made it. We're going to talk about the Gravity Project, but first for the people that may not know, your fame has reached the four corners of the globe, but for those that have not heard of you, can you tell the listeners a little bit about who you are and how you found your way into healthcare and the things you do?

Sarah C DeSilvey, DNP, FNP-C (00:51):

I absolutely can. It is probably not your typical journey. I come from a long line of healthcare folk, and I think like any good child, I tried to resist the call to healthcare. My dad is in cardiology and my grandpa on my mom's dad, he was a pediatrician, and so it was kind of the family business, nurses and doctors. So I grew up in New England. I ran away to Montana after my philosophy degree and became an organic farmer, and I was a farmer and I taught farming at the University of Montana in Missoula for over a decade. And I did a lot of really lovely community work. I had the honor of knowing this titan in this community where I grew up named Bob Oaks who was part of a community development corporation. So I was a farmer teacher of farming and also this very grounded community organizer for about a decade plus and worked very deeply in food insecurity work as a farmer and community organizer and housing and transportation needs.

(02:12):

So I got kind of the first line view of the role of what we call the social determinants of health, which are the forces that work beyond the clinic level to shape outcomes and health. And they're driven, as we say, by structural forces and policy. So as a community level practitioner and farmer, it was all very clear to me that my neighborhood needed housing and we needed to improve food access, but I wasn't quite satisfied being a farmer. There was some itch I had yet to scratch. So it was actually at the birth of my son that I discovered nurses. I'd been so well, I hadn't met nursing and clinic settings and hospitals, and I was so impressed with the capable compassion and confidence and just competence of the career nurse who helped me. I was very, very sick when I gave birth to my son. And so we were in the hospital for quite some time and I literally, Charlie left that hospital and he's my firstborn. So I had another one after and I left that hospital and I looked at this nurse named Sonya as I was walking to my car and I said, I think I know what I'm supposed to be. And she said, I think you do too. And I was like, I think I'm supposed to be a nurse. And she went, go get it. And I was like, okay.

(03:49):

So within, I think I knew because of my family that I wanted to be in this longitudinal relationships. The primary care allows. I was lucky enough to know that. So I literally sold my farm and to a student, moved across the country and moved back home to my home state of Vermont and put myself and my two kids through graduate school to become a nurse practitioner.

(04:14):

And that was all driven really by from the get go. The first paper I wrote in every paper in my NP program was about the requirement, the moral clinical requirement to address food insecurity and social determinants and clinical practice. And I never stopped. So that was kind of my origin story with clinical practice. And then eventually it led to quality roles, my history and community organizing. I soon was the lead of my health service areas population health initiative because who better than a accustomed community organizer to sit at the table as my state tried to meet the value-based care aims. So I sat as a clinician appointed by my hospital convening all of the social care entities and public health entities in my health service area for six years. And that made me realize that we had a data missing problem. So Charlie, there's this evolution.

(05:17):

So in doing that, I realized that we didn't have the actual data we needed to name what we saw. I called it telling critical stories. So that kind of is the lead in into where the work and gravity came from. But I started to become an informaticist, which is a data person, simply because of looking behind the curtains. It's like Wizard of Oz. It's like, where's the data for this measure? Where's the data for this one? How do I improve diabetes? What is the code that drives this? And so I just accidentally, I called myself the accidental terminologist became proficient in terms, codes and was driven to try to fix those problems. And so now I led into co-founding Gravity. We'll talk more about gravity in a bit, but then again, still I think because of that community organizing training and that population health perspective, I also eventually was given rules of leadership and the country to assist with health data policy even though it's not convening in 2025.

(06:25):

Yet I am the current co-chair of the Assistant Secretary for Technology policy health, health Information technical advisory committee or high tech. And I'm also the co-chair of the committee that determines the United States core data for interoperability or USCDI, which is a subset of high tech. So the long story short is that it's just a girl trying to figure out how to solve problems and eventually realizing, and I think realizing that as I wanted to improve the system of care and population health outcomes, there was a massive data missing problem. And that brings me here today.

Charlie Harp (07:08):

Well, what you're really saying is you came back to farming.

Sarah C DeSilvey, DNP, FNP-C (07:11):

I did farming, I'm a code farmer. That's right. You're a bit farmer. Sorry, that was the longest intro ever. But yes, I'm code farmer, and I forgot to say I still practice 50% primary care in a rural primary care setting. And I just do that really to keep me honest. I think it's very easy to get about to use a clinical word distal. It's easy to get far away from the why's in this work. And it's also easy if you're working in the area of data to overdevelop that's really beyond what is implementable and it's sitting in the seat of rural primary care, which is the farthest from any vendor solutions. I have a very honest seat at what is helpful and implementable, and it definitely helps grant my practice as a clinician and as a data person.

Charlie Harp (08:04):

Well first of all, thank you for being the type of person that steps up because when people say things like, one person can't make a difference, I can say something. Well, what about Sarah DeSilvey thing number one? Thing number two, you make a really, really good point. One of the things I've kind of grown up on the mean streets of informatics. I have no formal education. I learned it all by getting slapped around by EMR schemas and data in HL7 feeds. And I think one of the things people forget is there's the pragmatic reality of what you can do. And there's, I'll use the word academic, but I don't mean it pejoratively. I just mean that it's a very abstract way of, well, we'll just do this. And I think in the rural people sometimes it's like, we'll just let them eat cake. It's like they don't have cake. Let's start by getting 'em a glass of water. And maybe there

Sarah C DeSilvey, DNP, FNP-C (09:04):

Is no cake.

Charlie Harp (09:06):

There's no cake here. So keeping pie,

Sarah C DeSilvey, DNP, FNP-C (09:09):

Charlie, we have lots of pie. Well, I'm in.

Charlie Harp (09:14):

I like apple pie over cake any day. So I think that it's important what you really describe is being in a role where it seems like you're very well suited to be in those roles and we're lucky to have you. So tell us about the origin story of Gravity, where the name gravity came from and what were the goals and objectives of the project?

Sarah C DeSilvey, DNP, FNP-C (09:40):

Yeah, so I am happy to do that. I kind of laid breadcrumbs from my intro. It's hard to tell any story about how I got here without telling that. So as I was working in at that time, it was just clinical and social care integration strategies. We were just trying it for a long period of time to get clinicians to address social needs and clinical practice and use consider them, especially when we're trying to improve outcomes. It's hard to, one of the best ways to prevent a CHF, a heart failure readmission is something called a medically tailored meal. So you ensure that person is eating well at discharge, that way they don't get readmitted to the hospital. Same thing with good food and diabetes or housing and readmission. So we knew all these things from the literature, but we hadn't integrated them well into clinical practice. So I was working with my colleague and friend, dear friend Laura Gottlieb at the University of California San Francisco Social Intervention Research and Evaluation Network, UCSF SIREN on strategies to integrate clinical needs, social needs into clinical care.

(10:59):

And we had a collective, like I mentioned, data missing revelation. There really was not sufficient data to use in population health strategies to use in value-based care reform to use in research. I didn't have the concepts to identify the problem like food insecurity. I didn't have the concepts to identify the intervention like food stamps or snap. And so we gathered international entities, including Sonoma International, HL7, National Library of Medicine, American Medical Association, we all gathered in Washington DC in 2017 and said, alright, we know we want to address the integration of social needs and social risks into clinical practice. We know there's no structured way to evaluate and create social data. What do we do next? And Gravity was the answer statement. They said, someone needs to develop a formal method to identify gaps in terminology to support specific domains and systematically in a consensus method, fill them.

(12:10):

So Bing! Gravity was born right, and it's been humming ever since. So our first domain was food insecurity in 2019, and now six years later, something of 26 domains. And what we're known for is integrating best in class evidence-based practices with the core requirements of developing standards within HL7 (Health Level Seven), just in case, which is an open consensus process that includes the ANSI requirements of lack of dominance balance. And so all of what we do is we convene experts who are experts in a domain and drive that expertise through the public process and develop terminology, requirements, terminology, value sets, and also the unbeknownst to ourselves when we first set out, we also, because we're an HL7 accelerator, we have our FHIR implementation guide we create as well. So I lead the terminology language making side, the value set side, and then we have our technical work stream, which works on the really critical work.

(13:28):

And when I say critical, I mean critical of developing pathways for exchanging information between clinical settings and human and social care settings. And this is where the beauty of fire and the promise of fire is really hopeful is when you don't have vendor based solutions, the utility and accessibility of fire is really important. And so certainly when we're talking about the human and social service partners that we need to collaborate with when we're addressing social needs, they're not going to have fancy platforms. And so building with fire and centering them and their voices within that process is a crucial part of the success of the mission. And that's how Gravity came about, the responding to the need for data missing and standard method for data creation.

Charlie Harp (14:20):

So can I ask some dumb questions?

Sarah C DeSilvey, DNP, FNP-C (14:21):

Ask a dumb question. There's no dumb questions, Charlie, but ask any question.

Charlie Harp (14:25):

Oh no, I feel I have to think about it. Years ago when the earth was new, I was at Zinc's Health and I worked with Pat Button and Ida Androwich on this electronic plans of care where you had the terminology about what's happening with the patient, all designed around interventions to achieve certain goals. Is that a part of the framework of gravity? The ability to articulate with terminology the condition, identify interventions and drive towards specific goals?

Sarah C DeSilvey, DNP, FNP-C (15:02):

Did you set me up for that one? Oh yeah. Okay. It fundamentally is Charlie.

Charlie Harp (15:09):

Okay. So

Sarah C DeSilvey, DNP, FNP-C (15:09):

Because of the origin story of Gravity being really in from a quality lens, again, fundamentally practically, I was unable to get the data I needed to support my hospital in leading population health initiatives. So in gravity, in Gravity was also related to my doctoral project is I have a doctorate in quality. So this was why it's

Charlie Harp (15:35):

Keep showing off. You know what? I didn't bring it on the podcast to brag. No, I'm just saying,

Sarah C DeSilvey, DNP, FNP-C (15:40):

Just bragging. I'm like, let's get really nerd. I'm sorry, I'm not a bragger. I'm just saying Absolutely. Yes, Charlie, because

(15:50):

We build every single, there's this throughput we imagine where you have risks identified with standardized instruments if they're available. There's not always standardized instruments that we have. And then you have the definition of the problem statement or the social risk, like food insecurity, right? So there's USDA, United States Department of Agriculture has the best in class instruments. So you have instruments, you have the social risk identified. We always, Charlie build goals for the purposes of person-centered and community-centered care planning. So there's always the goal you're heading to. And then the last set of data that we create is to support all the interventions that we know work. And so every core federal program to address a given social risk, we build a concept for that. And every community level program we do as well. And I think it's hard to imagine how odd it is sometimes if these things hadn't been encoded until Gravity stepped in.

(16:56):

I mean the USDA Women Infant and Children Program, WIC has been around for a very long time. It is a fundamental part of my clinical care team as I work in Rural Family practice, every kid who's eligible is connected to WIC. Sure. Shooting because I know it works, right? There wasn't a program term or to identify WIC at all. I couldn't name them until we did that at Gravity. And the same thing is like a HUD housing agency or any of the programs that we know work. So our job is to think on that throughput again toward outcomes. Because if I'm the clinical practice person, Charlie, our co-founder at Gravity, Laura, she's the research gal. So she's over there taking the data and doing outcomes analysis research on it as well. But yes, a hundred percent Charlie, correct. Measurement is always in mind.

Charlie Harp (17:54):

I've had several moments in my career where I thought to myself, certainly somebody's thought of this. Somebody's done this. And you look around and you're like, how did they do this? If nobody did this, if nobody built something to track and understand what's going on, how on earth did they get it done? And usually it's a bunch of people with scratch pads and calculators in the back room somewhere. So what things have you accomplished with the Gravity Project that you think are super cool and you were very proud of?

Sarah C DeSilvey, DNP, FNP-C (18:28):

There's a lot of things. My first answer to that question is I think the community that we have created together, and that's the community of members. So as an HL seven accelerator, which is a project to address critical data gaps on use cases and problem statements. So we're an accelerator. It means we're member driven. So members come to the table and they support financially the mission. We have an amazing membership who's been committed for a very long time to support the mission of Gravity. So there's that part of our community just incredibly grateful that year to year national payers, the American Medical Association, the hema, American Health Information Management Association, come to the table really knowing how critical this data is for all of the different stakeholder reasons and they support the mission. We also have a designated membership model, though we're the only HL seven accelerator that allows you not to pay. And we did that because our critical voices, patients and community-based organizations, they can't afford to

(19:42):

be members. So we've built a spot for them. So there's that level of community. I'm proud of our members. I'm proud of the membership that drives everything that we do. I work for them, right?

Charlie Harp (19:54):

Sure.

Sarah C DeSilvey, DNP, FNP-C (19:55):

And they just incredibly grateful, EPIC us, find help. They're all at the table working on common solutions. We were just at CITAs conference a few minutes ago, they're also a member. And a few days ago, I should say, it's been a long week and openly to say on a national platform that they're investing in standards because they know standards are the best path forward for patients and communities. That's a lot, Charlie, like in 2025 for our members to say, we're investing in this because we know it matters. It might hurt our bottom line in the moment, but the mission is critical, like gratitude for these amazing folks. And beyond our membership, we also have our community members who come to our open consensus meetings. And over six years, we have quite an amazing robust set of community members as well, community participants. And after community, I would say, I think it's the quality of the work. Charlie, it's funny, I think this far along, I had this revelation. I keep on waiting for people to tell me what's not working.

(21:06):

And it seems to be working, our value sets are actually being implemented in national quality measures like the HEDIS NCQA SNSE measure. It just points to our value sets because NCQA knows they work and go use them, right? Or the fact that because of their role and health outcomes, they're included in United States core data for interoperability version two. That's because the system knows that these are core data that we need to address individual barriers, population health and the global and the national goal of value-based care and the aaa. So community and then the quality of what we do because it's really the quality that has us then get written into regulations and drivers. So I think those are the two things I'm proud of.

Charlie Harp (22:00):

Well, that sounds fantastic. When it comes to community, one of the things, and every now and then I say this kind of thing, but I don't want Carol Mac to get a big head.

Sarah C DeSilvey, DNP, FNP-C (22:13):

We love Carol.

Charlie Harp (22:17):

I think the people in healthcare that get involved in these types of things, yes. Are the huge nerds. Yes. Do I love that about them? Yes. But they're very passionate. They really care. A lot of times they're putting in their own time, their own blood, sweat and tears. And I don't know if the banking industry people roll up their sleeves and say, we got to figure out those interest rates. I don't know if that happens in their spare time. Take off your cumber bun, we got to get to work. But in our industry, the people that get together and do this kind of work, I've just started with this whole PIQI Alliance thing.

Sarah C DeSilvey, DNP, FNP-C (22:57):

Oh yeah. The quality, the

Charlie Harp (22:57):

First foray into that. And it's very humbling and gratifying to have so many smart people come in and not necessarily come in to throw rocks, but come in to try to make it better. And when you see that something that's important to you is important to other people, I don't know. It's a very energizing thing. So I totally get the community thing. And the quality of the work too is the quality of the work is not good then you would know because nobody would use it.

Sarah C DeSilvey, DNP, FNP-C (23:35):

Yes.

Charlie Harp (23:36):

Clinical Architecture every year we do this quality survey and it's subjective. We get a decent response, not as well as I would like, but one of the things we ask about is what's the quality of your data? Does the quality impact what you do? And we kind of get into the weeds a little bit and we talk about the different types of data, drugs, labs, and we call out what is the quality of SDOH data. And pretty much every year we've done it for three years in a row. And SDOH data is one of those things where people really struggle with, they struggle with getting it and everybody wants it. But I think the industry still struggling with how to get it and how to move it. And I think that you don't have to be a rocket science. Maybe you have to have a PhD in quality, but you don't have to be a rocket science to see that these determinants of health, these things like food insecurity are fundamental. Especially if as a nation, you want to move the needle on health. You can't move the needle on health if people can't get the basic things they need to make it through the day.

Sarah C DeSilvey, DNP, FNP-C (24:53):

I know. And I think that's where just echoing it's true. It's like whatever lens you look at it, there are these core, you can't complain that someone's not achieving physical therapy outcomes if they literally can't get to the physical therapist. Right. Diabetes poor control is really hard. If you're only eating Kraft , macaroni and cheese, all you can afford nothing on Kraft mac.

Charlie Harp (25:20):

Wait, you're saying that's bad?

Sarah C DeSilvey, DNP, FNP-C (25:22):

I know. I'm like

Charlie Harp (25:24):

Rethink everything on the mac and cheese diet

Sarah C DeSilvey, DNP, FNP-C (25:28):

I know I do love, but I think this is partly yes. And I think one of the things that I bemoan just thinking about the quality of the data part is that I'm so in the toolmaking phase right now and I still am keeping 50% primary care that I'm not able to do the implementation science supports anymore. Say I'll get back maybe and be able to assist in creating clinical decision support stuff to enable the kind of documentation that we know would be really helpful someday. For right now, I'm still making Legos over here, Charlie. Alright.

Charlie Harp (26:10):

I have a question because we'll go viral. If I say artificial intelligence all of a sudden,

Sarah C DeSilvey, DNP, FNP-C (26:17):

Okay,

(26:17):

Say it. Woo woo.

Charlie Harp (26:19):

What are your thoughts? For me, one of my big drivers, well not one of my big drivers, but I'm happy that it's happening because AI has finally made people seem to care about quality. I've been doing the soil and green thing for decades saying the data quality needs to improve and nobody really seemed to care. And I think that AI driving data quality is important. And I would think that the data that you're talking about is also critical. If you're really trying to take care of the whole patient and you're involving AI, you have to fill in those pixels in the picture, right?

Sarah C DeSilvey, DNP, FNP-C (27:03):

Yes. And I think, again, our members probably said this better than I, but that was a question that came up at a HIMSS panel for Gravity a couple years ago. And AI is good at many things and has many opportunities. What it is good at is finding out what's not happening.

(27:24):

It's very good at analyzing things that are happening and see what's not happening and what's not happening. The patient appointments that are not being met, the screenings that are not occurring, that the connections that are not being made, there's usually a barrier there. And this is where I really think the power of AI can be helpful is exploring identifying barriers that in our normal practice of care are hard to see. Showing the care manager all of the patients who did not make it up, and what's the capacity to give them a non-emergency medical transportation voucher or a program to get them to appointments. So I do feel the possibility of AI there very clearly. And then we're already thinking, I'm already thinking ahead to how to make it helpful in identifying things that are there that aren't seen because as evidence-based work, and I'm going to get you thought I was nerdy before Charlie, I'm going to get super nerdy

Charlie Harp (28:31):

In my pocket protector. Hold on. I

Sarah C DeSilvey, DNP, FNP-C (28:35):

Talk about psychometrics just Okay.

Speaker 3 (28:37):

Alright. Alright.

Sarah C DeSilvey, DNP, FNP-C (28:40):

Because we fundamentally don't just name a thing. Food insecurity, we always are thinking about all of the measurable dimensions within it. So the components that make up food insecurity, just like there's dimensions in depression that roll up to a major depression diagnosis.

Speaker 4 (29:03):

There's

Sarah C DeSilvey, DNP, FNP-C (29:03):

Measurable dimensions in social risks like worry about not having enough food, the food running out affecting quality of food, missing meals, going hungry. These are all dimensions of food insecurity. So what I am thinking about doing with colleagues in the ecosystem kind of supplement and support the mission is really trying to get diagnostic criteria published for these things so that we don't have to use an instrument. If I'm thinking about the future, I don't want any patient who is truly food insecure to have to name their twice if they said it once, I want us to find them, right? I don't want every patient whose food insecure to have to go back and do a standardized instrument if they're communicating to their social worker that they are missing meals, but they're really glad their kid is getting school meals, so at least they're covered. That's good. I'm good. So part of what I see as a future for AI as well is not just what's missing, but enabling AI to seek and search for those dimensions of these insecurities that we know matter and help identify and raise that up again to the care team, the community health worker or the social worker or the care manager or the provider, so that we can actually intervene. Those stories are being said, but if they're missing, it's hard to help.

Charlie Harp (30:29):

I saw a presentation, I forget it was probably at HLTH and the guy was talking about a platform around social care and he brought up something really interesting, which is when you're looking into things like food insecurity and housing, there's a certain level of trust that has to be there because people don't want to necessarily talk about the fact that they can't feed their kids. They're afraid people are going to come and take their kids. Correct. And that just makes it even more challenging. And every time you ask somebody to answer the question, I imagine they have to go through that same, do I trust this person enough that I should answer that question honestly?

Sarah C DeSilvey, DNP, FNP-C (31:10):

Yeah. And luckily the core, I'm in family medicine, so American Academy Pediatrics and American Academy of Family Physicians, even though I'm not a physician, are my go-to gold standards in how we do what we do. Huge fan, huge. And they know it. I'm their biggest fan girl. So luckily there is clinical guidance about how to establish trust. And the American Academy of Pediatrics put out a beautiful toolkit a few years ago with the Food Research and Action Coalition on just that setting the grounds for screening safely so people feel like they can trust you. A hundred percent. Especially, I think it's just you always have to tell people why you're doing what you're doing. I think there's actually a very, there's a paucity of doing that. Patients walk into rooms and I'm one of them, and you get a list of instruments and you don't know why you're getting a list of instruments. And it's really, because I know it's to support UDS, FQ quality measures and NCQA, but no, this is why we're collecting this information. FYI. So generally speaking, truly informed consent is really important, Charlie, generally speaking.

Charlie Harp (32:38):

Alright. Alright. Whether or not that baby has four or five pack years of smoking history, these are things we need to know. So talked about what it is. We've talked about the fantastic work. What's top of mind? What are you concerned about with everything right now? What is the future? Let me take concern off the table. I don't

Sarah C DeSilvey, DNP, FNP-C (33:02):

Want, yeah, I know that's a big one, Charlie for a girl because yeah,

Charlie Harp (33:06):

What does the future look like and what can we do to help guide the future?

Sarah C DeSilvey, DNP, FNP-C (33:14):

Okay. I'm also going to give an authentic answer to the first thing that you said, and I'm going to explain why I had a big sigh, right,

Speaker 4 (33:20):

Of course,

Sarah C DeSilvey, DNP, FNP-C (33:23):

Gravity, because we work in such vulnerable with vulnerable people by design, vulnerable populations by design, that's the world of addressing social risks.

(33:35):

We created a set of data principles for ourselves to orient in this work about autonomy and what we're aiming for. And the last one is preventing reducing and remediating harm. And it's a very interesting time right now because I think data is getting the innocent data proliferation, data creation. We're now seeing some of the effects of whether it be reproductive data crossing state lines. We think about what happened with Maryland. We're seeing the effects of data being available and people being at risk, whether it be state to state differences or whether it be state and federal differences. So as someone who's a data creator, that's top of mind to me right now is risk of data being made visible and the differences in safety, it all goes back to that Charlie between states and federal entities and states to state. So I'm thinking about that all the time. I'm also thinking about data missing from some of our normative federal measurement techniques. Getting sunset as the winnowing of federal investments in those things takes its course. We just saw the announcement that the gold standard, I mentioned the USDA food security module,

(35:18):

We just saw the announcement this week that that's getting retired 30 years of data about food insecurity in households. And so there is definitely concern about the state of data in this moment in time that doesn't keep me up at night because I tend to try to take care of myself, but I wake up first thing in the morning thinking about it. But I do feel like the flip side of that is in the standards based community, we certainly have solutions to offer the data missing problems. And when I think about things like food insecurity, measurement, gravity, because we have standardized the USDA instrument and because we work within and intersect with an HL seven communities, there's pretty easy solutions to imagine supporting entities in using fire to leverage the USD module that's encoded to continue measuring. So if a state wanted to continue to measure their population, they could. So that's an opportunity of being in the standard space.

Speaker 4 (36:34):

And

Sarah C DeSilvey, DNP, FNP-C (36:34):

I think in general, because of the shift in priorities and kind of the no longer assumption of the national infrastructure being there, the existence of those standards really liberates any entity to do many different projects and use cases. So if you are a health system that wants to study homelessness in your health system, we have the data for that. If you are a state that wants to assess how transportation security might be affecting your population, we have value sets to support that too. So I think the concern is risks of data and data missing and this unique moment in time. And then the opportunity is the tools and supports and resources that the standards we've made are well the tools and support and the resources that are the standards we've made. I'm going to back up a little bit. We have made the resources to support folks and still measuring and still intervening and still assessing if they wish. And that gives me comfort. Well,

Charlie Harp (37:56):

You have to believe that there's a lot of value there, whether it's sanctioned from on high or not. Anybody that's caring for a population in a community has got to see that there's value in understanding what's happening that's keeping part of that community away from being healthier. Well,

Sarah C DeSilvey, DNP, FNP-C (38:20):

Yeah. I mean this is why some of our primary, not the data we make, but the data on outcomes doesn't lie.

(38:30):

We cannot control costs pure and simple unless address social needs in clinical settings. We can't improve outcomes unless we address social needs. So that part is evergreen, right? And the standards we've made supporting that mission, again, again, gravity was born in my awkward attempt to try to be a next gen a CO leader in my health service area in Vermont. I was like, oh my Lord, the mission, I don't have the data I need to complete this mission. And that mission is evergreen. That mission remains. We have a responsibility to do right by patients and right by communities to identify the barriers they have to care to address those barriers and help them frankly. So you were talking about community and the work we do, I think fundamentally it's all about patients, Charlie, it's all about the people we care for and we just have to make sure that we're building the right resources and tools to support them.

Charlie Harp (39:43):

I mean, we all know at least one person.

Sarah C DeSilvey, DNP, FNP-C (39:45):

We do know one person.

Speaker 3 (39:48):

And in my practice I get to meet lots of really cute babies too. So man, really,

Sarah C DeSilvey, DNP, FNP-C (39:55):

I go to work every day to take care of babies, both with the data and with my daily clinical work. Go team Charlie.

Charlie Harp (40:05):

There's a creature that keeps walking back and forth behind you.

Speaker 3 (40:09):

Well, I know I my,

Charlie Harp (40:12):

All right. As long as it's not a raccoon. I think so.

Speaker 3 (40:15):

I mean, I would be fine with that kind of snow white. I'm like bring it.

Charlie Harp (40:23):

Anything else you want to talk about? Anything else? Anybody? Any shout outs you want to give for people that want to learn more about the value sets, the instruments, the data? Where do they go to find that?

Sarah C DeSilvey, DNP, FNP-C (40:39):

So I am going to give you the email answer and then the HL7 Confluence answer. The B two is walking around, is now on my desk right now, my very large main Kon cat. So the simple answer is if you want to email us, the email's very simple. It's gravityproject@hlseven.org and if you send it, it comes to me. You just

Charlie Harp (41:13):

Detoxed yourself.

Sarah C DeSilvey, DNP, FNP-C (41:14):

I know I did. It's okay. But that we take our open consensus mission very seriously at Gravity. So the accessibility is really crucial. You can also find us through every accelerator has what's called a Confluence site.

(41:30):

And so if you type in Gravity project into the net, you're going to get a public facing webpage, which is kind of user-friendly. And then it takes you to the confluence where all the nitty gritty details are. Or you can go right to the Confluence. But those are the two places I feel like to get the most information. We've been written into a lot of regulation too. So if you wanted to explore papers on how Gravity is written into ONC/ASTP regulation, you can read that. But I would say the Confluence, just type in HL seven gravity and you'll find our webpage or emailing and you get me and I'll see if I can help you or I'll find someone who can help.

Charlie Harp (42:17):

Alright. Well hey, thank you so much for taking the time today. I really appreciate it and appreciate you educating my listeners on what's going on with the Gravity Project and thanks for being on.

Sarah C DeSilvey, DNP, FNP-C (42:31):

Thanks for having me. It's been my total pleasure.

Charlie Harp (42:35):

And for those of you listening, thank you for tuning in today. Hope you enjoyed it. I'm Charlie Harp. Thank you so much again, and this has been the Informonster Podcast. Take care.