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Asim Muhammad (Philips, Chair E2E Architecture) Martin Rosner (Philips, Chair E2E Security )

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.

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Asim Muhammad (Philips, Chair E2E Architecture) Martin Rosner (Philips, Chair E2E Security )

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  1. 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

  2. Outline • Continua Questionnaire Use Case • Sample Questions • Workshop with Lantana on the Realization of Continua Requirements • Options • Results • Discussion and next steps

  3. Current Architecture and Enhancements Personal Device (PAN/LAN/TAN) HRN Device ApplicationHosting Device WAN Device Thermometer Pulse Oximeter CCD Pulse /Blood Pressure PCD 01 Weight Scale NFC Glucose Meter Cardio / Strength EHR Wide Area Network (WAN) Interface Health Reporting Network (HRN) Interface Peak Flow Low Energy HIE Adherence Monitor PHR Independent Living Activity NHIN Water Gas Temperature Fall 3 Device Connectivity

  4. 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 Application Hosting Device WAN Device (hosts telehealth services) WAN-Interface Future (2013): Enable questionnaires and questionnaire response

  5. Questionnaire use case Questionnaire document (inc. branching logic) ApplicationHosting Device WAN Device Out of scope for Continua Out of scope for Continua Questionnaire Response document Patient fills-in the questionnaire 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.

  6. Question Set 1 • Question Set • It groups questions related to a domain e.g. mental well-being. Confidential Information

  7. Question 1

  8. Question 2

  9. Question 3

  10. 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) Additional elementsto Question 1 (slide 7) Confidential Information

  11. Additional requirements (2/2) • 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. Confidential Information

  12. 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: Confidential Information

  13. 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

  14. 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) Confidential Information

  15. 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. Confidential Information

  16. 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

  17. 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.

  18. From the CDA Hierarchical Descriptor Confidential Information

  19. HL7 RIM (1/3) Confidential Information

  20. HL7 RIM (2/3) Confidential Information

  21. HL7 RIM (3/3) Confidential Information

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