Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Psychometric Underpinnings Of Various Assessment Instruments And Potential Conflict With Hitech Goal Of Reuse

12/01/2011

In 2006, Tom White and others reviewed the HL7 CCD Ballot and submitted a white paper to the HL7 Structured Document Technical Committee (SDTC) describing a conflict between the CCD Ballot proposal for Functional Status, and psychometric theory and recommendations made by the National Committee for Vital and Health Statistics (NCVHS). The paper describes how the vast number of assessment instruments, particularly those for which psychometric properties were considered in their design, and the dozens of functional status domains across these instruments creates challenges for developing a unique list of functional status values within each of these domains (as was included in the HL7 SDTC CCD Ballot). White states that psychometric and survey theories “dictate that even minor changes to the wording of questions or the allowable response options can significantly change the meaning” of the concept being measured in the assessment form. In his paper, he suggested "supporting the creation of unique codes for all elements of each standard assessment instrument, while at the same time facilitating the creation and use of semantic links -- mappings -- between instrument concepts and external terminology standards-such as SNOMED CT". The paper then describes a process for linking LOINC codes to assessment instruments and the questions and answers embedded in such instruments; and linking these LOINC coded instruments and question/answer pairs to other clinical vocabularies (e.g., SNOMED).

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