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Continua Health Alliance and HL-7 Result of the workshop with Lantana on investigating the options for Questionnaire Standardization. Asim Muhammad (Philips, Chair E2E Architecture) Martin Rosner (Philips, Chair E2E Security ). Confidential Information. Outline. - PowerPoint PPT Presentation
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Copyright© 2010 Continua Health Alliance ® All Rights Reserved
Continua Health Alliance and HL-7Result of the workshop with Lantana on investigating the options for Questionnaire Standardization
Asim Muhammad (Philips, Chair E2E Architecture)Martin Rosner (Philips, Chair E2E Security )
Confidential Information
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Outline
• Continua Questionnaire Use Case• Sample Questions• Workshop with Lantana on the
Realization of Continua Requirements– Options– Results
• Discussion and next steps
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NFC
HealthReportingNetwork
(HRN)Interface
Personal Device(PAN/LAN/TAN)
Weight Scale
Pulse Oximeter
Independent Living
Activity
Cardio / Strength
Adherence Monitor
Glucose Meter
Pulse /Blood
Pressure
Thermometer
Peak Flow
ApplicationHostingDevice
DeviceConnectivity
WideArea
Network(WAN)
Interface
WANDevice
HRN Device
EHR
PHR
HIE
NHIN
CCD
PCD 01
3
WaterGas
TemperatureFall
Current Architecture and Enhancements
Low Energy
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WAN-Interface
Application Hosting Device
WAN Device (hosts
telehealth services)
Future (2013):Enable questionnaires and questionnaire response
Continua E2E Reference Topology(with real-world example devices overlayed)
Current state:•Observations upload based on IHE PCD 01-HL7 v2.6 and WS-I basic profile•IHE XDR + HL7 CDA R2 Consent Directive IG
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Questionnaire use case
WAN Device
ApplicationHosting Device
Questionnaire document
(inc. branching logic)
Questionnaire Responsedocument
The objective is to enable the interoperable representation and exchange of the questionnaire and questionnaire response across the WAN-IF.Defining the rendering / layout (XHTML, XForm etc.) of the questionnaire on the AHD is an implementer responsibility and out of scope for Continua.
Patient fills-in the questionnaire
Out of scope for Continua
Out of scope for Continua
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Question Set 1
• Question Set– It groups questions related to a domain
e.g. mental well-being.
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Element(or Attribute)
Definition Multiplicity
Question Set ID This uniquely identifies a question set within a Questionnaire document.
[1..1]
Question Set Title
This is the title of the question set. For example, “Questions related to mental well-being”.
[1..1]
Questions These are the actual questions which may be asked and are organized within the Question Set 1
[1..*]
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Question 1
Element(or Attribute)
Definition Multiplicity
Question ID This uniquely identifies a question within the Questionnaire document.
[1..1]
Question text “Compared to last week, how would you rate your health status in general?”
[1..1]
Answer options A1 The same as last week [2..n] A2 Better than last week A3 Worse than last week
Question type Indicates the type of question.In this example the type of question is “Multiple Choice”.
[1..1]
Skip Indicates whether it is allowed to skip this question (Skip=TRUE) or not (Skip=FALSE). By default the value of Skip could be “FALSE”.
[0..1]
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Question 2
Element(or Attribute)
Definition Multiplicity
Question ID This uniquely identifies a question within a Questionnaire document.
[1..1]
Question text “Compared to last week, please rate your breathlessness.” [1..1]Answer options B1 The same as last week [2..n]
B2 Better than last weekB3 Worse than last week
Question type Indicates the type of question.In this example the type of question is “Multiple Choice”.
[1..1]
Skip Indicates whether it is allowed to skip this question (Skip=TRUE) or not (Skip=FALSE). By default the value of Skip could be “FALSE”.
[0..1]
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Question 3
Element(or Attribute)
Definition Multiplicity
Question ID This uniquely identifies a question within a Questionnaire document.
[1..1]
Pre condition This element holds the logical expression. For example, Ask this question ONLY if answer to “Question 1” is “A3” AND answer to “Question 2” is “B3”.
[0..1]
Question text “Why do you feel worse?” [1..1]Answer Answer could be “I didn’t drink coffee ”. [1..n]Question type Indicates the type of question.
In this example, the type of question is “Free Text”.[1..1]
Skip Indicates whether it is allowed to skip this question (Skip=TRUE) or not (Skip=FALSE). By default the value of Skip could be “FALSE”.
[0..1]
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Additional requirements (1/2)• A question may also hold link to a multimedia item (e.g. image, video)• A question may also consists of attributes that are used to signal the
minimum and maximum number of answer option a patient must select (similar to ObservationRange construct)
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Element(or
Attribute)
Definition Multiplicity
Question ID This uniquely identifies a question within the Questionnaire document.
[1..1]
Question text “Compared to last week, how would you rate your health status in general?”
[1..1]
Answer options
A1 The same as last week [1..n] A2 Better than last week A3 Worse than last week
Question type Indicates the type of question.In this example the type of question is “Multiple Choice”.
[1..1]
Min. of Answers
Indicates the minimum number of answer options a patient should select.
[0..1]
Max. of Answers
Indicates the maximum number of answer options a patient should select.
[0..1]
Multimedia item
Reference to a multimedia item that needs to be rendered simultaneous with the question text.
[0..1]
Skip Indicates whether it is allowed to skip this question (Skip=TRUE) or not (Skip=FALSE). By default the value of Skip could be “FALSE”.
[0..1]
Additional elements to Question 1 (slide 7)
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Additional requirements (2/2)
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Element(or
Attribute)
Definition Multiplicity
Question ID This uniquely identifies a question within the Questionnaire document.
[1..1]
Question text “How many hour do you sleep on average during the night?” [1..1]Answer [1..1]Question type Indicates the type of question.
In this example the type of question is “numeric”.[1..1]
Low value Used to indicate the low boundary e.g. “0” [0..1]High value Used to indicate the low boundary e.g. “24” [0..1]Skip Indicates whether it is allowed to skip this question (Skip=TRUE) or
not (Skip=FALSE). By default the value of Skip could be “FALSE”. [0..1]
• The answer to a question may be of numeric type.• Allowed range of values (e.g. 0 to 24) for an answer can be indicated
using the ObservationRange construct.
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Workshop with Lantana• Three day workshop with Lantana development team
where we discussed Continua use case and requirements (slide 6-10) and then developed a small prototype.
• After several hours of discussion we agreed to focus on the following system diagram:
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uc Primary Use Cases
System Boundary
Exchange Questionnaire Document
Exchange Response Document
Application Hosting Dev ice Human Monitor
Patient
Sensor Dev ice
Create Questionnaire Document
Rev iew Response Document
Monitoring Serv ice
Populate Response Document
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Options• As a result of the three day workshop we identified the following options
for expressing the Questionnaire Document in a standard format• Options
Confidential Information
CDA with extensions
Could use moodCode=”DEF” for defining questions
derivationExpr for holding the conditional logic
custom extensions to transmit value sets (answer options) in IHE SVS (Sharing Value Sets) XML markup
Update to HQMF
Questions would be expressed as criteria
Could modify the standard to define how a CDA document can be generated in response to criteria. This would benefit QRDA implementation as well as addressing questionnaire logic
Need to address what, if any “populations” would be defined in a Continua questionnaire
Template formalism?
If this type of questionnaires are a collection of templates with conditional logic, then perhaps all we really need is a balloted template formalism (aka a wire format for templates) where templates encompass conditional logic
Mash-up of all the above?
Take bits of CDA, HQMF, template formalisms, etc. and build a new standard.
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Results (Questionnaire Document)
• NOT a clinical document, used to extract the input from patient resulting in a response document
• Extended the Questionnaire Assessment templates• If we go with CDA Extension option, then
– Observation/code holds the question text– Observation/value holds the answer option(s)– Answer may be constrained as free text, an integer or multiple-choice expressed as a
coded value set
• Some questions include logic (pre condition- slide 9) that determines what question is shown next depending on the answer(s) to previous questions.– HL-7 Example
• If observation/value in template A is “X-SOME-CODE” from LOINC, then template B is required
– Continua equivalence• If the user answers question A with “SOME ANSWER”, then show question B next
– We also looked at the HQMF IG • can be used to realize logical expressions (ex. a pre condition on slide 9)
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Results (Questionnaire Response)
• We agreed that Questionnaire Response is a clinical document and can be easily mapped to CDA constructs similar to Questionnaire Assessment IG.
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Discussion and Next Steps• Feedback on the options
– ?
• Project scope statement(s)– Draft PSS(s) for Questionnaire and Questionnaire Response
work items– Send draft statements to SDWG by Monday the 17th of Dec.– Review and address comments up until F2F meeting
Confidential Information
Copyright© 2010 Continua Health Alliance ® All Rights Reserved
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Would require extension to accommodate logical expression i.e. AND, OR (a precondition with multiple criterion or multiple preconditions).
See slid 20-22 for RIM related info.
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From the CDA Hierarchical Descriptor
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357 precondition 0..* Act SET<Precondition> N 358 typeCode 1..1 M R ActRelationship CS D PRCN CNE Default: PRCN359 criterion 1..1 ActRelationship Criterion N 360 classCode 1..1 M R Act CS D OBS CNE Default: OBS361 moodCode 1..1 M R Act CS D EVN.CRT CNE Default: EVN.CRT362 code 0..1 Act CD D ActCode CWE 363 text 0..1 Act ED D 364 value 0..1 Observation ANY D
No Element Name Card Mand Conf Rim Sourceof Message Element Type
Src Domain CS Abst Nt
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HL7 RIM (1/3)
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HL7 RIM (2/3)
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HL7 RIM (3/3)
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