asim muhammad (philips, chair e2e architecture) martin rosner (philips, chair e2e security )

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.


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



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]

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



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 [1..n]

B2 Better than last weekB3 Worse than last week


[1..1]


[0..1]

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Question 3



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]


[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)


Element(or

Attribute)



[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


[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]


[0..1]

Additional elements to Question 1 (slide 7)

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Additional requirements (2/2)


Element(or

Attribute)



[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:


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


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


asim muhammad (philips, chair e2e architecture) martin rosner (philips, chair e2e security )

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