RE: openEHR-technical Digest, Vol 64, Issue 6

[Bakke, Silje Ljosland]

I agree and disagree. ☺

An EHR needs to be able to cope with all kinds of data, “questionnaire” or not. 
However I’m not so sure a modelling pattern that works for everything that 
could be labelled a “questionnaire” is achievable, or even useful.

Modelling patterns are sometimes extremely useful, for instance for 
facilitating modelling by non-clinicians or newbies, but sometimes they aren’t 
very practical. One of the problems is that clinical information in itself is 
messy, because healthcare information doesn’t follow nice semantic rules. 
Clinical modelling must above all be faithful to the way clinicians need to 
record and use data, not to a notion of semantically “pure” models.

Finding “sweet spots” by identifying patterns that are sensible, logical, and 
above else *work* for recording actual clinical information is often an 
excruciatingly slow process of trial and error, exemplified by the substance 
use summary EVALUATION and the physical examination CLUSTER patterns of 
modelling, which both had taken years of trial and error long before I got 
involved in them.

If we can find patterns across some kinds of “questionnaires”, like clinical 
scores, great! However, since there isn’t a standardised pattern for paper 
questionnaires, it’s not likely that it’s possible to make one for electronic 
questionnaires. Outside the RM/AOM, a generic pattern archetype for every 
questionnaire with variable levels of nesting, variable data points, etc isn’t 
possible, nor would it in my opinion be useful. It would put all the modelling 
load on the template modellers, which arguably would be more work than 
modelling the same structures as made-for-purpose archetypes.

Some rules of thumb have developed over time though:

1.   Model the score/assessment/questionnaire in the way that best 
represents the data

2.   Use the most commonly used name for identifying it

3.   Model them as OBSERVATION archetypes, unless they’re *clearly* 
attributes of f.ex. diagnoses, in which case they should be CLUSTERs (example: 
AO classification of fractures)

4.   Make sure to get references that support the chosen structure and 
wording into the archetypes

In my opinion this pragmatic approach is likely to capture the data correctly, 
while at the same time minimising overall modelling workload.

Regards,
Silje

From: openEHR-technical [mailto:openehr-technical-boun...@lists.openehr.org] On 
Behalf Of GF
Sent: Tuesday, June 6, 2017 3:58 PM
To: For openEHR clinical discussions 
Cc: Thomas Beale 
Subject: Re: openEHR-technical Digest, Vol 64, Issue 6

I agree.
‘questionnaire’ is many things, but not at the same time.

In any case any EHR needs to be able to cope with all kinds.
From ones with one or more qualitative results: such as the checklist
To the validated Score where individual results are aggregated in one total 
score.

It must be possible to create one pattern that can deal with all kinds.


Gerard   Freriks
+31 620347088
  gf...@luna.nl

Kattensingel  20
2801 CA Gouda
the Netherlands

On 6 Jun 2017, at 14:46, Vebjørn Arntzen 
> wrote:

Hi all

To me a "questionnaire" is a vague notion. There can be a lot of different 
"questionnaires" in health. From the GP's in Thomas's example to a Apgar score, 
to a clinical guideline and even a checklist. Those are all a set of "questions 
and answers", but the scope and use is totally different. In paper 
questionnaires we will find a mix of many, maybe all, of those, crammed into 
what the local practice have found to be useful (= "Frankenforms"). To try to 
put all of them into a generic questionnaire-archetype is of no use.

Examples:
The GP questionnaire referred to by Thomas is in the quoted question about 
"ever had heart trouble" merely a help for the GP, and of little use for 
computation. But if it is supplemented by more specific questions, based on 
answers by the individual, then the final result can be "occasional arrhythmia 
with ventricular ectopics", which is a relevant information for later use and 
should be put into a relevant archetype. So is it a "questionnaire" or a 
guideline for the consultation? Not relevant IMO, it's the content, that's 
relevant.

Patients with haemophilia in Oslo university hospital are offered a 
questionnaire online to register whether they've had incidents of bleeding, 
what caused it, if they needed medications and if so, the batchnumber of the 
medication. This is followed up by the staff both for reporting of used 
medication, and for the patients next follow-up out-patient control or 
admission. Questionnaire or not? Not relevant – it's what the information is 
and what it is for, that is important. Find relevant archetypes for them, 
OBSERVATIONS or ADMIN-ENTRY for this, I guess.

Even checklists are a set of questions and answers. "Have you remembered to 
fill 

Re: openEHR-technical Digest, Vol 64, Issue 6

[GF]

I agree.
‘questionnaire’ is many things, but not at the same time.

In any case any EHR needs to be able to cope with all kinds.
From ones with one or more qualitative results: such as the checklist
To the validated Score where individual results are aggregated in one total 
score.

It must be possible to create one pattern that can deal with all kinds.


Gerard   Freriks
+31 620347088
  gf...@luna.nl

Kattensingel  20
2801 CA Gouda
the Netherlands

> On 6 Jun 2017, at 14:46, Vebjørn Arntzen  wrote:
> 
> Hi all
>  
> To me a "questionnaire" is a vague notion. There can be a lot of different 
> "questionnaires" in health. From the GP's in Thomas's example to a Apgar 
> score, to a clinical guideline and even a checklist. Those are all a set of 
> "questions and answers", but the scope and use is totally different. In paper 
> questionnaires we will find a mix of many, maybe all, of those, crammed into 
> what the local practice have found to be useful (= "Frankenforms"). To try to 
> put all of them into a generic questionnaire-archetype is of no use.
>  
> Examples:
> The GP questionnaire referred to by Thomas is in the quoted question about 
> "ever had heart trouble" merely a help for the GP, and of little use for 
> computation. But if it is supplemented by more specific questions, based on 
> answers by the individual, then the final result can be "occasional 
> arrhythmia with ventricular ectopics", which is a relevant information for 
> later use and should be put into a relevant archetype. So is it a 
> "questionnaire" or a guideline for the consultation? Not relevant IMO, it's 
> the content, that's relevant.
>  
> Patients with haemophilia in Oslo university hospital are offered a 
> questionnaire online to register whether they've had incidents of bleeding, 
> what caused it, if they needed medications and if so, the batchnumber of the 
> medication. This is followed up by the staff both for reporting of used 
> medication, and for the patients next follow-up out-patient control or 
> admission. Questionnaire or not? Not relevant – it's what the information is 
> and what it is for, that is important. Find relevant archetypes for them, 
> OBSERVATIONS or ADMIN-ENTRY for this, I guess.
>  
> Even checklists are a set of questions and answers. "Have you remembered to 
> fill out the diagnosis?". "Is there a need to offer the patient help to deal 
> with the cancer diagnosis?". Main thing is to analyze what the resulting 
> answer is representing, and the use of it. Decision support? Clinically 
> relevant? Merely a reminder? Put them into a template, using appropriate 
> archetypes.
>  
>  
> Regards, Vebjørn
>  
> Fra: openEHR-clinical [mailto:openehr-clinical-boun...@lists.openehr.org 
> ] På vegne av Thomas Beale
> Sendt: 5. juni 2017 18:55
> Til: For openEHR technical discussions; For openEHR clinical discussions
> Emne: Re: openEHR-technical Digest, Vol 64, Issue 6
>  
>  
> 
> this has to be essentially correct, I think. If you think about it, scores 
> (at least well designed ones) are things whose 'questions' have only known 
> answers (think Apgar, GCS etc), each of which has objective criteria that can 
> be provided as training to any basically competent person. When score / scale 
> is captured at clinical point of care, any trained person should convert the 
> observed reality (baby's heartrate, accident victim's eye movements etc) into 
> the same value as any other such person. In theory, a robot could be built to 
> generate such scores, assuming the appropriate sensors could be created.
> 
> With 'true' questionnaires, the questions can be nearly anything. For 
> example, my local GP clinical has a first time patient questionnaire 
> containing the question 'have you ever had heart trouble?'. It's pretty clear 
> that many different answers are possible for the same physical facts (in my 
> case, occasional arrhythmia with ventricular ectopics whose onset is caused 
> by stress, caffeine etc; do I answer 'yes'? - maybe, since I had this 
> diagnosed by the NHS, or maybe 'no', if I think they are only talking about 
> heart attacks etc).
> 
> My understanding of questionnaires functionally is that they act as a rough 
> (self-)classification / triage instrument to save time and resources of 
> expensive professionals and/or tests.
> 
> There is some structural commonality among questionnaires, which is clearly 
> different from scores and scales. One of them is the simple need to represent 
> the text of the question within the model (i.e. archetype or template), 
> whereas this is not usually necessary in models of scores, since the coded 
> name of the item (e.g. Apgar 'heart rate') is understood by every clinician.
> 
> Whether there are different types of questionnaires semantically or 
> otherwise, I don't know.
> 
> - thomas
> 
>  
> On 05/06/2017 09:48, William Goossen wrote:
> Hi Heather, 
> 
> the key