Assessment scales and scores: project proposal

Hello Piper, the UK would support the development of a formal project plan to develop editorial guidance and ideally modelling guidance for this area of SNOMED CT. 

It is a question / problem for the UK on how to model and parent this type of concept within the context of the larger observable entity model. 

We would be willing to actively support such a project with some time from our authors. 

Terrific.

Thank you Stuart! 

I think we need to set up a document sharing space, rather the cluttering Confluence with working documents. 

I will work with Elaine Wooler and Monica Harry to get some guidance around how to proceed.

Piper

We have two people interested, Fatima Haidaree and Emma-jane Macdonald .

Please let them konw once we have a Working Group.

Thank you Stuart Abbott.

I'll send an initial email to find a time for a kick off meeting. 

Best,

Piper

Stuart Abbott , Fatima Haidaree , Emma-jane Macdonald ,

Are you able to access Microsoft Box for shared documents, or is Google Drive better for you?

Thanks,

Piper

Hi Piper Allyn Ranallo in theory we can access both, im not familiar with box though, but im sure it wouldnt be too difficult - may be a test document to start?

Hi Emma-jane Macdonald 

I have created a Box folder here and a folder in the MABH-CRG google drive here.

I believe I set up the Box folder so anyone with a link can access it, but I may need to add email addresses. 

Let me know if you have any trouble access either location.

My direct email address is sven0018@umn.edu.

Best,

Piper

Hi all.

Wow - the categorisation work already done in the two 'SNOMED assessment...' excel files is impressive!

I wonder if the instruments listed on the NHS's NCCR library site will complement those from OMOP and RDoC in identifying priority areas to test the approach? If needed I'm sure we can coerce the page into another spreadsheet.

As noted in the proposal there tends to be a lack of subscales (sometimes related to licensing concerns). The following 'observable'-based refset includes a lot of UK extension sub-score codes which might help highlight those instruments where it is felt this extra precision is needed for meaningful recording:

991471000000104 |Mental health assessment observables simple reference set (foundation metadata concept)|

There are other related refsets but this one seems to be the most useful starting point.

Ed

Ed Cheetham -

Thank you for sharing the refset and the link to the NCCR library. I was not aware that either existed.

This is exceedingly helpful!

May I add your name to the list of folks interested in working on this content? 

Piper

That's brilliant Ed! 

I can't wait to see what you find. Thanks for being one of us

Piper

Hi Piper Allyn Ranallo  unfortunately the link re Hamilton Rating Scale for Depression is no longer workign for me. Please could you put the relevant document on Box or Drive? Thanks

Hi Emma-jane Macdonald -

I copied a folder named 'Library' into the Box Drive.

It needs some organization, but this has contains a) publications about assessment instruments and b) copies of assessment instruments. 

We'll need to figure out a good way to organize links, documents, etc.

Piper

I've posted some historic and background stuff on Box (in 'Background' folder):

• 2005: An unattributed 'Proposal for representing SNOMED CT Assessment Scales in HL7 V3'
• 2007: A text archive of the original 'Using SNOMED CT in HL7 Version 3' implementation guide (very old, none of the links work, not a lot relevant to this work but section 3.3 deals specifically with '3.3 Assessment Scale Results').
• 2009/10: A UK document titled 'Use of SNOMED CT UK Edition for Scored Assessments Implementation Guidance' - a long (and I'm not sure how enlightening now) document. Quite a lot on explicit version identification.
• 2020: UKSNOMEDCT_Editorial_Principles_v26 - largely restates the international position in section 6.2.

It's also worth considering these two external resources:

• HL7 FHIR's Questionnaire and Questionnaire Response resources; I note the former has a version attribute.
• openEHR's CKM provides glimpses of how they handle structured instruments (just, for example, type 'scale' in the search box on the left) but I cannot see a general pattern for assesssment instruments.

Downstream analysis standards such as OMOP CDM may have target patterns that are of importance here too.

The reason I mention these is to keep in mind the opportunity for complementary approaches to representing the various facets of assessment instruments, but history tends to tell us that most things end up (by design and because of heterogeneous user groups) duplicated across terminologies and information models so we're probably on our own however unsatisfactory that may seem.

I've also posted (in the 'EdData' folder) an attempt to associate SNOMED CT 'assessment' codes from the various chapters (trying to line up, programmatically, each scale, procedure and observable 'set'). The 'TripleMatch' tab is where I was able to associate all three, 'OneMatch' includes incomplete match rows and 'NoMatch' is, well, codes with no match. There are, of course, a lot of false positives and negatives, but it might help bootstrap any work that needs to do such an association, and certainly gives some indication of the scale of the problem.

It'll be easier to explain what I've done on a call, but the main build code is in 'instruments.py' and 'instruments2.py' in this repo. I've run it against the latest UK data because I know we have added a lot of extension content in the past to try and complete each scale-procedure-observable 'triple' (but this does mean an international group will be looking at a lot of UK codes!). It's worth noting there are smatterings of relevant 'findings' content (such as scored GCS values) in SNOMED CT but considering them is for another day.

I note the GCS content was discussed a few years ago in the Anaesthesia group (you need to be logged in to see the discussion) which is a reminder of how many groups have requirements in this area and how little agreement there still is.

Ed

FYI - came in an email from our rep. sorry for posting in full - link not working

Jim Case Thank you, this helps.

Just so we're clear on how we can be most helpful in getting this project prioritized and moving the work forward - Do you need us to respond to the 3 bullet pointed items in the letter, and send this information to you and Jane Millar? Or do you need someone to prepare and submit a formal project proposal using the SI project template?

Thanks,

Piper

Wonderful discussion!

I'd like to share an innovative approach we've been taking that uses self-reported data based on a scale of the degree of affective pleasantness or unpleasantness related to meaningful life situations experienced within a biopsychosocial context. These emotional valence data are analyzed to produce measures of psychological well-being (the subjective state of overall life satisfaction from good physical, mental, and emotional health) that can be tracked over time. Etiological factors can be determined via an in-depth mindset assessment we're developing that defines a person's adaptive and maladaptive thought patterns and mindset-shifting recommendations.  

I realize this is a significant departure from conventional psychological assessment approaches. Still, it can provide valuable diagnostic information that offers practical support for mental health therapeutic practitioners' clinical insights and decisions. 

I welcome questions and comments.

Piper Allyn Ranallo Jim Case Jane Millar Emma-jane Macdonald Ed Cheetham Stuart Abbott 

All -

Since we first met the following have occurred:

1) SI made some decisions and announced some guidance around assessment scales (no concept model will be created, guidance provided around how to represent assessments and the associated observable and procedure concepts)

2) Ed Cheetham has developed some methods and tooling for automated extraction of candidate constructs measured by specific assessment instruments

This is critically important b/c we still have a lot of work to do to clean up the hierarchical representation of both the scores (observable entities) and the assessment scales 

3) I created and have been testing a very preliminary concept model for the scales (to propose to SI in the event they are willing to consider one day implementing a concept model for assessments);  We will need to demonstrate the value for patients, clinicians, and researchers to justify the resources required to implement some final, production version of this model SNOMED 

I would like to share the model onour next call -  I will send an email with a doodle poll to get folks' availability

Finally, wondering if anyone knows how (and when) existing LOINC Survey content and SNOMED assessments scales and scores will be integrated in the LOINC-SNOMED ontology?  Jim Case not sure if any decision has been made yet? 

Best,

Piper

Hello Piper Allyn Ranallo

It was good meeting you in Seoul! NRC Germany posted this in the MF discussion page this year:

Hello everybody,

In light of ongoing discussions in the Member Forum on integrating assessment scales into SNOMED CT, we wanted to reach out to inquire if other member countries share our need to incorporate concepts from the Barthel Index as coded entries, preferably into SNOMED CT.
The Barthel Index is used as a central tool for capturing data on activities of daily living in our health care system implementations. Currently, SNOMED CT includes entries for the Barthel index and its associated score:

273302005 |Barthel index (assessment scale)|

725594005 |Barthel Index of Activities of Daily Living score (observable entity)|

However, we are exploring options to enhance our data capture by also including all subscores of the Barthel Index. In order to do so we are looking at a combination of the following options:

- find a sustainable solution on IP issues,
- create a common reference set,
- incorporate the subscores in our national extension,
- model the subscores by providing FHIR questionnaires/observables,
- use a LOINC survey and find a way to put the linguistic variant locally.

Before proceeding, we would like to understand if any other member countries have similar requirements or have already ideas for resolving this matter. We would be happy to join forces and initiate an exchange, also regarding a number of other assessment scales in SNOMED CT.
Your input on this topic would be greatly appreciated.

Looking forward to hearing your thoughts.
NRC Germany 

We are looking into options to pursue this topic further. Please include me in any further discussions.

There is also a thread from NRC Austria regarding ACR RADS: Assessment Scales: ACR RADS (Reporting and Data Systems) Annatina Foppa 

Kind regards,

Frank

NRC Germany

HI Frank,

Thanks for posting this (and for sharing the link the Anesthesia group's discussion).  Jan Ivar Ernø is working to reach out to other European NRCs to get a sense of their needs. 

Yes, we've had a lot of discussions about IP (ccJan Ivar Ernøfor input here) and explored two paths we think we may be able to take in parallel. Needs more discussion for sure. 

The question about linguistic variants is one we've intentionally put off in efforts to date, but looks like we need to address it sooner rather than later.... 

We're working to put a second meeting each month on the calendar dedicated to discussing assessment scales, procedures, and scores. I'll post a link to a doodle poll to get input from folks on a good week/day/time that will work for everyone.

Does that sound like a reasonable next step?

Best,

Piper

Piper Allyn Ranallo Can you add my email rmcclure AT mdpartners.com to the box folder if that is where you are sharing things? Also add me to meeting invites?

Here is a link to a Doodle Poll for finding a time to meet.

Feel free to share with others who may be interested.

Best,

Piper

Here is the link to the call scheduled for today (Mon Nov 22  at 1500 UTC): https://snomed.zoom.us/my/mentalhealthcrg

Attaching slides from today's call along with draft of a paper describing development of a concept model for assessment scales.

Best,

Piper