Hi William,

I can concede that for those examples. 

Honestly I'm not particularly fussed about categorisation of the examples and 
there are plenty of examples which use a question/answer format with a total 
score at the end, so it is not clear if we should call it a questionnaire or a 
scale. 

The principles that I've laid out remain the same. 

Regards

Heather

-----Original Message-----
From: openEHR-technical [mailto:[email protected]] On 
Behalf Of William Goossen
Sent: Monday, 5 June 2017 4:45 PM
To: [email protected]
Subject: Re: openEHR-technical Digest, Vol 64, Issue 4

The examples given as Glasgow Coma Scale and Barthel index are definitely NOT 
questionnaires. These are assessment scales and require quite a different 
approach than the also extremely useful questions and answers.

Vriendelijke groet,

Dr. William Goossen

Directeur Results 4 Care BV
+31654614458

> Op 5 jun. 2017 om 08:25 heeft [email protected] het 
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> Today's Topics:
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>   1. Re: Questionnaires (Grahame Grieve)
>   2. RE: Questionnaires (Heather Leslie)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Mon, 5 Jun 2017 15:59:26 +1000
> From: Grahame Grieve <[email protected]>
> To: For openEHR technical discussions
>    <[email protected]>
> Cc: For openEHR clinical discussions
>    <[email protected]>
> Subject: Re: Questionnaires
> Message-ID:
>    
> <cag47hgypmsi1u1znhheoh_ymz841m7mlvwd6hgccufsy-vq...@mail.gmail.com>
> Content-Type: text/plain; charset="utf-8"
> 
> hi Heather
> 
>> A generic question/answer pattern is next to useless - 
>> interoperability
> is really not helped
> 
> I think you should rather say "A generic question/answer pattern is 
> only useful for exchanging the questions and answers, and does not 
> allow re-use of data". This is not 'next to useless for 
> interoperability', just not fit for any wider purpose
> 
> Grahame
> 
> 
> On Mon, Jun 5, 2017 at 3:51 PM, Heather Leslie < 
> [email protected]> wrote:
> 
>> Following Thomas? suggestion re a separate thread:
>> 
>> 
>> 
>> I wrote a blog post in 2014 which still reflects our current thinking 
>> re
>> questionnaires: https://omowizard.wordpress.com/2014/02/21/the-
>> questionnaire-challenge/
>> 
>> 
>> 
>> Our experience is that the data is the priority and so we want to 
>> focus on questionnaires to support capture of good quality data.
>> 
>> 
>> 
>> If you want to try to capture data from the majority of existing 
>> questionnaires then good luck ? questionnaires notoriously ask 
>> questions badly, conflating multiple concepts into one question, 
>> Boolean True/False when there are other ?shades of gray? etc. They 
>> work variably as far as human interpretation but usually very badly wrt 
>> computer interpretation.
>> 
>> 
>> 
>> We do have experience in taking previous paper questionnaires, 
>> analysing the data requirements sought in terms of what we want to 
>> persist and then we design the UI/questions to match the data desired 
>> and/or suggesting the UI might show a questionnaire but each question 
>> the clinical data is actually recorded using core archetypes ? for 
>> example ?Do you have diabetes?? ? ?Yes?, is recorded using the value 
>> ?Diabetes? in the EVAL.problem_diagnosis and ?No? is recorded in the 
>> matching exclusion archetype. This creates real clinical data that 
>> can be used as part of a health record rather than create an 
>> electronic checkbox version of the original paper questionnaire which 
>> will never be used again, but capture dust in our EHR?s virtual archives.
>> 
>> 
>> 
>> In summary:
>> 
>>   - A generic question/answer pattern is next to useless -
>>   interoperability is really not helped, especially if both the question and
>>   answer has to be managed in the template. We have tried many variations of
>>   this in the past, some of which were uploaded into CKM and subsequently
>>   rejected.
>>   - Lock in those questionnaires that are ubiquitous, evidence based,
>>   validated as OBSERVATION archetypes and share them in the international CKM
>>   ? eg AUDIT, Glasgow coma scale, Barthel index, Edinburgh post natal
>>   depression scale ? there are many examples in CKM.
>>   - Lock in local questionnaires that are going to be reused in your
>>   organisation, region or jurisdiction even though they may not be reusable
>>   elsewhere. They will provide some interoperability even if might only be
>>   appropriate within one clinical system or national CKM. An example is the
>>   Modified Early Warning Score/National Early Warning Score ? there are a few
>>   different variations used in different locations and whether they should
>>   all be in the international CKM is still not clear.
>> 
>> 
>> 
>> BTW Questionnaires should be modelled as OBSERVATIONs (ie evidence 
>> that can be collected over and over again using the same protocol) 
>> not EVALUATIONS (as they are not meta-analysis nor summaries).
>> 
>> 
>> 
>> Regards
>> 
>> 
>> 
>> Heather
>> 
>> 
>> 
>> *From:* openEHR-technical [mailto:openehr-technical- 
>> [email protected]] *On Behalf Of *Pablo Pazos
>> *Sent:* Thursday, 1 June 2017 12:58 AM
>> *To:* For openEHR technical discussions <openehr-technical@lists.
>> openehr.org>
>> *Subject:* Re: Reports - a new openEHR RM type?
>> 
>> 
>> 
>> Besides specific ways to model questionnaires, my questions is if our 
>> openEHR clinical modelers have a pattern to represent questionnaires 
>> using the openEHR information model.
>> 
>> 
>> 
>> On Wed, May 31, 2017 at 3:37 AM, GF <[email protected]> wrote:
>> 
>> There are several kinds of context archetypes/templates and their 
>> meta-data are used for:
>> 
>> - de novo data - re-used data
>> 
>> - step in the clinical treatment model (observation, 
>> assessment/inference, planning, ordering, execution)
>> 
>> - kind of interface it is designed for (data presentation on a 
>> screen, data capture, database store/retrieve, CDSS, ?
>> 
>> 
>> 
>> Each Template needs to capture all this and is a Composition.
>> 
>> All these contexts are characteristics of a Composition in the end.
>> 
>> 
>> 
>> Questionnaires are in essence a tool that classifies information.
>> 
>> And sometimes it transforms a set of responses into an aggregated 
>> value/code
>> 
>> The questionnaire can be treated as any classification, meaning we 
>> need to de fine inclusion and exclusion criteria,
>> 
>> and possible results per question can be a quantitative result 
>> (number, PQ, code), or a semi-quantitative result (high, low), or a 
>> qualitative result (present/ not present).
>> 
>> Semi-Qualitative results need, inclusion/exclusion criteria and a 
>> definition of what the norm/population is is about (females, 
>> children, etc.)
>> 
>> 
>> 
>> 
>> Gerard Freriks
>> +31 620347088 <+31%206%2020347088>
>> [email protected]
>> 
>> 
>> 
>> On 31 May 2017, at 06:54, Pablo Pazos <[email protected]> wrote:
>> 
>> 
>> 
>> Hi Thomas,
>> 
>> Thinking about the hierarchy, at which level will be a Report be? 
>> Below compo? Below entry? Structure? Representation?
>> 
>> OT: many asked me this and didn't had a good answer. Do we have a 
>> pattern to model questionnaires? Some require to define questions, 
>> and the answer type in most cases is boolean, or coded text (multiple 
>> choice), and answers might be 0..* (more than one answer for the same 
>> question is valid).
>> 
>> Cheers,
>> 
>> Pablo.
>> 
>> 
>> 
>> 
>> 
>> 
>> _______________________________________________
>> openEHR-technical mailing list
>> [email protected]
>> http://lists.openehr.org/mailman/listinfo/openehr-
>> technical_lists.openehr.org
>> 
>> 
>> 
>> 
>> --
>> 
>> Ing. Pablo Pazos Guti?rrez
>> Cel:(00598) 99 043 145
>> Skype: cabolabs
>> 
>> <http://cabolabs.com/>
>> http://www.cabolabs.com
>> [email protected]
>> Subscribe to our newsletter <http://eepurl.com/b_w_tj>
>> 
>> 
>> 
>> _______________________________________________
>> openEHR-technical mailing list
>> [email protected]
>> http://lists.openehr.org/mailman/listinfo/openehr-
>> technical_lists.openehr.org
>> 
> 
> 
> 
> --
> -----
> http://www.healthintersections.com.au / 
> [email protected]
> / +61 411 867 065
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> ------------------------------
> 
> Message: 2
> Date: Mon, 5 Jun 2017 06:24:50 +0000
> From: Heather Leslie <[email protected]>
> To: For openEHR clinical discussions
>    <[email protected]>,    "For openEHR technical
>    discussions" <[email protected]>
> Subject: RE: Questionnaires
> Message-ID:
>    
> <sy3pr01mb19131a7c8e2e230285779c6eea...@sy3pr01mb1913.ausprd01.prod.ou
> tlook.com>
>    
> Content-Type: text/plain; charset="utf-8"
> 
> Thanks Grahame, but I disagree.
> 
> ??          A generic question/answer pattern is next to useless - 
> interoperability is really not helped, especially if both the question and 
> answer has to be managed in the template.?
> 
> The complete sentence qualifies that the dependence on template modelling is 
> the issue wrt interoperability. This is where a generic pattern is made 
> specific for a given questionnaire or data set. Also that we have found there 
> are multiple generic patterns, none of which is universally applicable and so 
> to create multiple generic patterns becomes nonsensical.
> 
> In the templating scenario it is only if the exact same template is shared 
> (where every question has been renamed and associated value sets inserted) 
> that can we get any value. In our experience it is of higher value to create 
> an archetype that can at least be shared locally and explicitly models the 
> precise question/answer combo in order to achieve better reuse.
> 
> Heather
> 
> From: openEHR-clinical 
> [mailto:[email protected]] On Behalf Of 
> Grahame Grieve
> Sent: Monday, 5 June 2017 3:59 PM
> To: For openEHR technical discussions 
> <[email protected]>
> Cc: For openEHR clinical discussions 
> <[email protected]>
> Subject: Re: Questionnaires
> 
> hi Heather
> 
>> A generic question/answer pattern is next to useless - 
>> interoperability is really not helped
> 
> I think you should rather say "A generic question/answer pattern is 
> only useful for exchanging the questions and answers, and does not 
> allow re-use of data". This is not 'next to useless for 
> interoperability', just not fit for any wider purpose
> 
> Grahame
> 
> 
> On Mon, Jun 5, 2017 at 3:51 PM, Heather Leslie 
> <[email protected]<mailto:[email protected]>>
>  wrote:
> Following Thomas? suggestion re a separate thread:
> 
> I wrote a blog post in 2014 which still reflects our current thinking 
> re questionnaires: 
> https://omowizard.wordpress.com/2014/02/21/the-questionnaire-challenge
> /
> 
> Our experience is that the data is the priority and so we want to focus on 
> questionnaires to support capture of good quality data.
> 
> If you want to try to capture data from the majority of existing 
> questionnaires then good luck ? questionnaires notoriously ask questions 
> badly, conflating multiple concepts into one question, Boolean True/False 
> when there are other ?shades of gray? etc. They work variably as far as human 
> interpretation but usually very badly wrt computer interpretation.
> 
> We do have experience in taking previous paper questionnaires, analysing the 
> data requirements sought in terms of what we want to persist and then we 
> design the UI/questions to match the data desired and/or suggesting the UI 
> might show a questionnaire but each question the clinical data is actually 
> recorded using core archetypes ? for example ?Do you have diabetes?? ? ?Yes?, 
> is recorded using the value ?Diabetes? in the EVAL.problem_diagnosis and ?No? 
> is recorded in the matching exclusion archetype. This creates real clinical 
> data that can be used as part of a health record rather than create an 
> electronic checkbox version of the original paper questionnaire which will 
> never be used again, but capture dust in our EHR?s virtual archives.
> 
> In summary:
> 
>  *   A generic question/answer pattern is next to useless - interoperability 
> is really not helped, especially if both the question and answer has to be 
> managed in the template. We have tried many variations of this in the past, 
> some of which were uploaded into CKM and subsequently rejected.
>  *   Lock in those questionnaires that are ubiquitous, evidence based, 
> validated as OBSERVATION archetypes and share them in the international CKM ? 
> eg AUDIT, Glasgow coma scale, Barthel index, Edinburgh post natal depression 
> scale ? there are many examples in CKM.
>  *   Lock in local questionnaires that are going to be reused in your 
> organisation, region or jurisdiction even though they may not be reusable 
> elsewhere. They will provide some interoperability even if might only be 
> appropriate within one clinical system or national CKM. An example is the 
> Modified Early Warning Score/National Early Warning Score ? there are a few 
> different variations used in different locations and whether they should all 
> be in the international CKM is still not clear.
> 
> BTW Questionnaires should be modelled as OBSERVATIONs (ie evidence that can 
> be collected over and over again using the same protocol) not EVALUATIONS (as 
> they are not meta-analysis nor summaries).
> 
> Regards
> 
> Heather
> 
> From: openEHR-technical 
> [mailto:[email protected]<mailto:openehr-tec
> [email protected]>] On Behalf Of Pablo Pazos
> Sent: Thursday, 1 June 2017 12:58 AM
> To: For openEHR technical discussions 
> <[email protected]<mailto:[email protected]
> enehr.org>>
> Subject: Re: Reports - a new openEHR RM type?
> 
> Besides specific ways to model questionnaires, my questions is if our openEHR 
> clinical modelers have a pattern to represent questionnaires using the 
> openEHR information model.
> 
> On Wed, May 31, 2017 at 3:37 AM, GF <[email protected]<mailto:[email protected]>> 
> wrote:
> There are several kinds of context archetypes/templates and their meta-data 
> are used for:
> - de novo data - re-used data
> - step in the clinical treatment model (observation, 
> assessment/inference, planning, ordering, execution)
> - kind of interface it is designed for (data presentation on a screen, data 
> capture, database store/retrieve, CDSS, ?
> 
> Each Template needs to capture all this and is a Composition.
> All these contexts are characteristics of a Composition in the end.
> 
> Questionnaires are in essence a tool that classifies information.
> And sometimes it transforms a set of responses into an aggregated 
> value/code The questionnaire can be treated as any classification, 
> meaning we need to de fine inclusion and exclusion criteria, and possible 
> results per question can be a quantitative result (number, PQ, code), or a 
> semi-quantitative result (high, low), or a qualitative result (present/ not 
> present).
> Semi-Qualitative results need, inclusion/exclusion criteria and a 
> definition of what the norm/population is is about (females, children, 
> etc.)
> 
> 
> Gerard Freriks
> +31 620347088<tel:+31%206%2020347088>
> [email protected]<mailto:[email protected]>
> 
> On 31 May 2017, at 06:54, Pablo Pazos 
> <[email protected]<mailto:[email protected]>> wrote:
> 
> Hi Thomas,
> Thinking about the hierarchy, at which level will be a Report be? Below 
> compo? Below entry? Structure? Representation?
> OT: many asked me this and didn't had a good answer. Do we have a pattern to 
> model questionnaires? Some require to define questions, and the answer type 
> in most cases is boolean, or coded text (multiple choice), and answers might 
> be 0..* (more than one answer for the same question is valid).
> Cheers,
> Pablo.
> 
> 
> 
> _______________________________________________
> openEHR-technical mailing list
> [email protected]<mailto:[email protected]
> nehr.org> 
> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.open
> ehr.org
> 
> 
> 
> --
> Ing. Pablo Pazos Guti?rrez
> Cel:(00598) 99 043 145
> Skype: cabolabs
> 
> [https://docs.google.com/uc?export=download&id=0B27lX-sxkymfdEdPLVI5UT
> ZuZlU&revid=0B27lX-sxkymfcUwzT0N2RUs3bGU2UUovakc4VXBxWFZ6OXNnPQ]<http:
> //cabolabs.com/> http://www.cabolabs.com<http://www.cabolabs.com/>
> [email protected]<mailto:[email protected]>
> Subscribe to our newsletter<http://eepurl.com/b_w_tj>
> 
> 
> 
> _______________________________________________
> openEHR-technical mailing list
> [email protected]<mailto:[email protected]
> nehr.org> 
> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.open
> ehr.org
> 
> 
> 
> --
> -----
> http://www.healthintersections.com.au / 
> [email protected]<mailto:grahame@healthintersections.
> com.au> / +61 411 867 065
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