Heather Leslie heather.leslie at
Thu Jul 6 00:40:24 EDT 2017

Hi Pablo,

From my POV the critical words in your email are “(defined on templates)”. If we have to define the semantics of each questionnaire in the templates, why not just archetype it and lock it down at that level.

In a generic questionnaire every data element will have to be an ‘Any’, defined in the template; the questions will need to be added, the relevant values defined etc.

AND the biggest problem for me is defining the pattern for the generic questionnaire – every time I’ve tried to design a flexible pattern that allows various levels of nesting under cluster headings for questionnaire groupings etc I get tied up in knots. There is no one single solution that will cover all questionairres – simple tree structures will not provide the solutions we need.

We could use a generic OBSERVATION container and a simple CLUSTER that allows multiple instances of a question with an ‘Any’ data type and a SLOT for nesting further instances. But the modelling overheads are onerous and I’m still struggling to see the value in pushing the work to the template design rather than just archetyping it. I’ve attached an example to show a possible pattern – but it is SO MESSY with renaming of every data point, constraining every aspect of each question (just as you would in a de novo archetype) and the overheads of explaining how to build a template from a generic pattern and define every single part of it in the template seem not worth the benefit.

Maybe I’m missing something…


From: openEHR-technical [mailto:openehr-technical-bounces at] On Behalf Of Pablo Pazos
Sent: Thursday, 6 July 2017 12:05 PM
To: For openEHR technical discussions <openehr-technical at>
Cc: For openEHR clinical discussions <openehr-clinical at>
Subject: Re: Questionnaires

Hi Heather,
I read your post and your answer. Got two clear ideas:
1. generic approach / pattern is not clear or valuable.
2. current questionnaires might need a semantic review / corrections to check if a. questions are correctly asked, b. possible answers correspond to the question, c. the goal of the questions is clinical or has other goal, and that can determine if that question/answer should or not be part of the EHR

In my specific case, the scope might be narrower:
+ consider all questions are correctly modeled and answers correspond to questions
+ need the content to be archetyped and the data to be in the openEHR IM
+ most answer types will be boolean, coded text, text, and their null flavours

Since no generic approach might be possible, it might not be so bad to have a generic archetype for the questionnaire definition, just as a framework, and do the custom work on templates.
I thought about this for some time:
1. questions are elements with value alternatives for boolean, coded text, text
2. those elements have coded text names, that is where the question is specified, and codes can be custom (defined on templates)
3. of course, question occurrence is 1..*
4. on templates, specific occurrences are modeled, with specific codes for the element name, and those should have occurrence 1..1 (this should be possible in terms of the AOM/TOM but I doubt it is currently supported by modeling tools, I think TD doesn't have this)

I know this is more an implementation idea, using standard modeling artifacts. But since there is no generic modeling for this, and the implementation needs to use the standard artifacts, I find this to be a not so bad solution.
Opinions? :)

On Mon, Jun 5, 2017 at 2:51 AM, Heather Leslie <heather.leslie at<mailto:heather.leslie at>> wrote:
Following Thomas’ suggestion re a separate thread:

I wrote a blog post in 2014 which still reflects our current thinking re questionnaires:

Our experience is that the data is the priority and so we want to focus on questionnaires to support capture of good quality data.

If you want to try to capture data from the majority of existing questionnaires then good luck – questionnaires notoriously ask questions badly, conflating multiple concepts into one question, Boolean True/False when there are other ‘shades of gray’ etc. They work variably as far as human interpretation but usually very badly wrt computer interpretation.

We do have experience in taking previous paper questionnaires, analysing the data requirements sought in terms of what we want to persist and then we design the UI/questions to match the data desired and/or suggesting the UI might show a questionnaire but each question the clinical data is actually recorded using core archetypes – for example “Do you have diabetes?” – ‘Yes’, is recorded using the value ‘Diabetes’ in the EVAL.problem_diagnosis and ‘No’ is recorded in the matching exclusion archetype. This creates real clinical data that can be used as part of a health record rather than create an electronic checkbox version of the original paper questionnaire which will never be used again, but capture dust in our EHR’s virtual archives.

In summary:
·  A generic question/answer pattern is next to useless - interoperability is really not helped, especially if both the question and answer has to be managed in the template. We have tried many variations of this in the past, some of which were uploaded into CKM and subsequently rejected.
·  Lock in those questionnaires that are ubiquitous, evidence based, validated as OBSERVATION archetypes and share them in the international CKM – eg AUDIT, Glasgow coma scale, Barthel index, Edinburgh post natal depression scale – there are many examples in CKM.
·  Lock in local questionnaires that are going to be reused in your organisation, region or jurisdiction even though they may not be reusable elsewhere. They will provide some interoperability even if might only be appropriate within one clinical system or national CKM. An example is the Modified Early Warning Score/National Early Warning Score – there are a few different variations used in different locations and whether they should all be in the international CKM is still not clear.

BTW Questionnaires should be modelled as OBSERVATIONs (ie evidence that can be collected over and over again using the same protocol) not EVALUATIONS (as they are not meta-analysis nor summaries).



From: openEHR-technical [mailto:openehr-technical-bounces at<mailto:openehr-technical-bounces at>] On Behalf Of Pablo Pazos
Sent: Thursday, 1 June 2017 12:58 AM
To: For openEHR technical discussions <openehr-technical at<mailto:openehr-technical at>>
Subject: Re: Reports - a new openEHR RM type?

Besides specific ways to model questionnaires, my questions is if our openEHR clinical modelers have a pattern to represent questionnaires using the openEHR information model.

On Wed, May 31, 2017 at 3:37 AM, GF <gfrer at<mailto:gfrer at>> wrote:
There are several kinds of context archetypes/templates and their meta-data are used for:
- de novo data - re-used data
- step in the clinical treatment model (observation, assessment/inference, planning, ordering, execution)
- kind of interface it is designed for (data presentation on a screen, data capture, database store/retrieve, CDSS, …

Each Template needs to capture all this and is a Composition.
All these contexts are characteristics of a Composition in the end.

Questionnaires are in essence a tool that classifies information.
And sometimes it transforms a set of responses into an aggregated value/code
The questionnaire can be treated as any classification, meaning we need to de fine inclusion and exclusion criteria,
and possible results per question can be a quantitative result (number, PQ, code), or a semi-quantitative result (high, low), or a qualitative result (present/ not present).
Semi-Qualitative results need, inclusion/exclusion criteria and a definition of what the norm/population is is about (females, children, etc.)

Gerard Freriks
+31 620347088<tel:+31%206%2020347088>
gfrer at<mailto:gfrer at>

On 31 May 2017, at 06:54, Pablo Pazos <pablo.pazos at<mailto:pablo.pazos at>> wrote:

Hi Thomas,
Thinking about the hierarchy, at which level will be a Report be? Below compo? Below entry? Structure? Representation?
OT: many asked me this and didn't had a good answer. Do we have a pattern to model questionnaires? Some require to define questions, and the answer type in most cases is boolean, or coded text (multiple choice), and answers might be 0..* (more than one answer for the same question is valid).

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