Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. 2. HL7 CDA Representation Of Questionnaire Assessments

12/01/2011

HL7 created a preliminary DSTU update, the MDS CDA Implementation Guide, based on the CMS MDS3.0 data specifications v1.00.0, October 2009. The MDS CDA IG specifies a standard for electronic submission of CDA questionnaire assessments that allows healthcare facilities to communicate assessment documents in an interoperable, industry-standard format. The questionnaire assessments contain multiple questions with specific answers.

The MDS CDA IG defines both a required Model of Use (MoU) representation and an optional Model of Meaning (MoM) representation for each entry in the CDA Body. These models (described below) support both a faithful representation of the exact questions and answers on an assessment questionnaire and a semantically interoperable and reusable representation that encodes their meaning. In addition, the EHR system may have data to determine the answer to a particular form’s question. In such a case, the relevant EHR data can be optionally included in the questionnaire instance as a Supporting Observation(s).

Re-Use of MDS & OASIS Data Through Interoperable, Industry Standard Formats

Model of Use (MoU): MDS and OASIS concepts are represented using LOINC codes that have been developed to convey each question and answer precisely as it was captured on the assessment instrument.

Model of Meaning (MoM): MDS and OASIS concepts are represented using standard vocabulary (e.g., SNOMED CT) and formal CDA clinical statement modeling.

Supporting EHR Observations: MDS and OASIS concepts are represented as standard vocabulary value sets that support re-use of EHR content relevant to assessment questions.

  • Model of Use (MoU) is the representation of question/answer data precisely in the form in which it was captured in the application of origin (i.e., the assessment instrument). A set of Logical Object Identifiers Names and Codes (LOINC) codes have been developed to represent each question and coded answer on the assessment questionnaire.

    • This MoU will support queries of the type “Find all patients with a Response of X to Question Y on Form Z.”

    • See 1.13.1 -- Model of Use Base Pattern and 1.13.2 -- Model of Use Question and Answer Patterns for details on MoU representation in the MDS CDA IG.

  • Model of Meaning (MoM) includes the representation of clinical data or concepts using standard vocabulary and formal CDA Refined Message Information Model (RMIM)-compliant clinical statement modeling. Some or all of the questions and responses on a form are amenable to partial or complete formal modeling using constructs provided by the HL7 Reference Information Model (RIM) coupled with standard terminologies. MoM representation is optional in this specification because many questions are not currently amenable to formal representation using standard terminologies.

    • This MoM will support queries of the type “Find all patients with Condition X, regardless of the form used to collect the data.”

    • See 1.13.3 -- Model of Meaning Representation for details on MoM representation in the MDS CDA IG.

  • Supporting EHR Observations -- Existing electronic health record (EHR) data may be relevant to making the decision about how to answer a particular form's question. In such a case, the MDS CDA IG defines how to optionally include “supporting observations” in the questionnaire instance.

    • See 1.13.4 -- Supporting Observations for details on supporting EHR observation representation in the MDS CDA IG.

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