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

[Thomas Beale]

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 difference is that the assessment scales have a scientific 
validation, leading to clinimetric data, often for populations, but 
e.g. Apgar and Barthell are also reliable for individual follow up 
measures.


a simple question, answer, even with some total score, does usually 
not have such evidence base. I agree that in the data / semantic code 
representation in a detailed clinical model it is not different.




--
Thomas Beale
Principal, Ars Semantica 
Consultant, ABD Team, Intermountain Healthcare 

Management Board, Specifications Program Lead, openEHR Foundation 

Chartered IT Professional Fellow, BCS, British Computer Society 

Health IT blog  | Culture blog 

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

[GF]

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

Kattensingel  20
2801 CA Gouda
the Netherlands

> On 5 Jun 2017, at 10:48, William Goossen  wrote:
> 
> Hi Heather,
> 
> the key difference is that the assessment scales have a scientific 
> validation, leading to clinimetric data, often for populations, but e.g. 
> Apgar and Barthell are also reliable for individual follow up measures.

Correct.
But in essence it is a set of questions and answers plus a set of rules to 
aggregate the collected data.




> 
> a simple question, answer, even with some total score, does usually not have 
> such evidence base. I agree that in the data / semantic code representation 
> in a detailed clinical model it is not different.

As you write yourself.

> 
> Hence, also Grahame's nonsense comment on the value of semantic 
> interoperability of such things. It is for user groups of stakeholders to 
> determine the clinical and scientific merits of such instruments not a 
> technical implementer.
> 

Yes. Local players must decide what they need.
But there is an interoperability issue, as well.
It is very likely that for research many years  from now we need to be able to 
interpret the old data.
In other words we need interoperability over longer periods of time, or better 
interpretability over longer periods of time.



> 
> vriendelijke groeten, with kind regards,
> 
> dr. William Goossen

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Re: Questionnaires

[Ian McNicoll]

Hi all,

First of all, I largely agree with Heather re the current approach. At
freshEHR, we generally try to maximise the use of international 'semantic'
archetypes, including scales, scores etc  but accept that this is often not
necessary and that there is place for simply modelling aspects of the
questionnaire as-is.

Commercially, I am interested in how we might make use of , or at worst,
play nicely with the FHIR Questionnaire resources.

Ian

Dr Ian McNicoll
mobile +44 (0)775 209 7859
office +44 (0)1536 414994
skype: ianmcnicoll
email: i...@freshehr.com
twitter: @ianmcnicoll


Co-Chair, openEHR Foundation ian.mcnic...@openehr.org
Director, freshEHR Clinical Informatics Ltd.
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL

On 5 June 2017 at 10:05, GF  wrote:

> Hi,
>
> A few of generic ideas around the question-answer pair.
>
> There are several kinds of question-answer pairs:
> - The general generic pattern is the pair: question - answer;
> - The questionnaire can be one or more question-answer pairs;
> - The questions can be locally defined or regionally, nationally,
> internationally used;
> - Answers can be* free text*, *quantitative* (number, code),
> *semi-quantitative* (derived from a categorised set of possible answers
> using inclusion and exclusion criteria) or *qualitative* (present, not
> present);
> - Answers can be aggregated by means of category, mathematical formula.
>
> This list of kinds of questionnaires ranges from simple to very complex
> patterns.
> Some are simple statements others are very complex scales and
> questionnaires in between.
> They are all variations on a theme.
> Any answer can expressed in the in-line local form and/or with a reference
> to an external source.
>
>
> Gerard   Freriks
> +31 620347088 <+31%206%2020347088>
>   gf...@luna.nl
>
> Kattensingel  20
> 2801 CA Gouda
> the Netherlands
>
> On 5 Jun 2017, at 07:59, Grahame Grieve  com.au> wrote:
>
> 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
>
>
>
> ___
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Re: Questionnaires

[GF]

Hi,

A few of generic ideas around the question-answer pair.

There are several kinds of question-answer pairs:
- The general generic pattern is the pair: question - answer;
- The questionnaire can be one or more question-answer pairs;
- The questions can be locally defined or regionally, nationally, 
internationally used;
- Answers can be free text, quantitative (number, code), semi-quantitative 
(derived from a categorised set of possible answers using inclusion and 
exclusion criteria) or qualitative (present, not present);
- Answers can be aggregated by means of category, mathematical formula.

This list of kinds of questionnaires ranges from simple to very complex 
patterns.
Some are simple statements others are very complex scales and questionnaires in 
between.
They are all variations on a theme.
Any answer can expressed in the in-line local form and/or with a reference to 
an external source.


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

Kattensingel  20
2801 CA Gouda
the Netherlands

> On 5 Jun 2017, at 07:59, Grahame Grieve  
> wrote:
> 
> 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
> 

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

[William Goossen]

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.






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--

Ing. Pablo Pazos Guti?rrez
Cel:(00598) 99 043 145
Skype: cabolabs

<http://cabolabs.com/>
http://www.cabolabs.com
pablo.pa...@cabolabs.com
Subscribe to our newsletter <http://eepurl.com/b_w_tj>



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grah...@healthintersections.com.au
/ +61 411 867 065
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Message: 2
Date: Mon, 5 Jun 2017 06:24:50 +
From: Heather Leslie <heather.les...@oceanhealthsystems.com>
To: For openEHR clinical discussions
<openehr-clini...@lists.openehr.org>,"For openEHR technical
discussions" <openehr-technical@lists.openehr.org>
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:openehr-clinical-boun...@lists.openehr.org] On Behalf Of
Grahame Grieve
Sent: Monday, 5 June 2017 3:59 PM
To: For openEHR technical discussions
<openehr-technical@lists.openehr.org>
Cc: For openEHR clinical discussions
<openehr-clini...@lists.openehr.org>
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 
<heather.les...@oceanhealthsystems.com<mailto:heather.les...@oceanhealthsystems.com>>
 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 - interoperabilit

RE: openEHR-technical Digest, Vol 64, Issue 4

[Pablo Pazos]

e 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>
> >> gf...@luna.nl
> >>
> >>
> >>
> >> On 31 May 2017, at 06:54, Pablo Pazos <pablo.pa...@cabolabs.com> 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
> >> openEHR-technical@lists.openehr.org
> >> 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
> >> pablo.pa...@cabolabs.com
> >> Subscribe to our newsletter <http://eepurl.com/b_w_tj>
> >>
> >>
> >>
> >> ___
> >> openEHR-technical mailing list
> >> openEHR-technical@lists.openehr.org
> >> http://lists.openehr.org/mailman/listinfo/openehr-
> >> technical_lists.openehr.org
> >>
> >
> >
> >
> > --
> > -
> > http://www.healthintersections.com.au /
> > grah...@healthintersections.com.au
> > / +61 411 867 065
> > -- next part -- An HTML attachment was
> > scrubbed...
> > URL:
> > <http://lists.openehr.org/pipermail/openehr-technical_lists.openehr.or
> > g/attachments/20170605/1cd4c49e/attachment-0001.html>
> >
> > --
> >
> > Message: 2
> > Date: Mon, 5 Jun 2017 06:24:50 +
> > From: Heather Leslie <heather.les...@oceanhealthsystems.com>
> > To: For openEHR clinical discussions
> ><openehr-clini...@lists.openehr.org>,"For openEHR technical
> >discussions" <openehr-technical@lists.openehr.org>
> > 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:openehr-clinical-boun...@lists.openehr.org] On Behalf Of
> > Grahame Grieve
> > Sent: Monday, 5 June 2017 3:59 PM
> > 

RE: openEHR-technical Digest, Vol 64, Issue 4

[Heather Leslie]

specially 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- 
>> boun...@lists.openehr.org] *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 <gf...@luna.nl> 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>
>> gf...@luna.nl
>> 
>> 
>> 
>> On 31 May 2017, at 06:54, Pablo Pazos <pablo.pa...@cabolabs.com> 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
>> openEHR-technical@lists.openehr.org
>> 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
>> pablo.pa...@cabolabs.com
>> Subscribe to

Re: openEHR-technical Digest, Vol 64, Issue 4

[GF]

  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-
>>> boun...@lists.openehr.org] *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 <gf...@luna.nl> 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>
>>> gf...@luna.nl
>>> 
>>> 
>>> 
>>> On 31 May 2017, at 06:54, Pablo Pazos <pablo.pa...@cabolabs.com> 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
>>> openEHR-technical@lists.openehr.org
>>> http

Re: openEHR-technical Digest, Vol 64, Issue 4

[William Goossen]

eusable
>>   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-
>> boun...@lists.openehr.org] *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 <gf...@luna.nl> 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>
>> gf...@luna.nl
>> 
>> 
>> 
>> On 31 May 2017, at 06:54, Pablo Pazos <pablo.pa...@cabolabs.com> 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.
>> 
>> 
>> 
>> 
>> 
>> 
>> ___
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>> 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
>> pablo.pa...@cabolabs.com
>> Subscribe to our newsletter <http://eepurl.com/b_w_tj>
>> 
>> 
>> 
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> 
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RE: Questionnaires

[Heather Leslie]

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:openehr-clinical-boun...@lists.openehr.org] On 
Behalf Of Grahame Grieve
Sent: Monday, 5 June 2017 3:59 PM
To: For openEHR technical discussions 
Cc: For openEHR clinical discussions 
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 
>
 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-boun...@lists.openehr.org]
 On Behalf Of Pablo Pazos
Sent: Thursday, 1 June 2017 12:58 AM
To: For openEHR technical discussions 
>
Subject: Re: Reports - a new openEHR RM type?

Besides specific ways to model questionnaires, my questions is if our 

Re: Questionnaires

[Grahame Grieve]

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 <
heather.les...@oceanhealthsystems.com> 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-
> boun...@lists.openehr.org] *On Behalf Of *Pablo Pazos
> *Sent:* Thursday, 1 June 2017 12:58 AM
> *To:* For openEHR technical discussions  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  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