Talk:Functional Status Assessments (FSA) Integration Profile Supplement

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Getting Started

We need to answer a few questions to get this draft going:

  1. What is the name of this profile?
  2. What is the short name for it?
  3. Give me a one line description of it.
  4. We need about a one paragraph description.

This is information that will be reused in a variety of places in the WIKI and the technical framework.

Kboone 10:21, 18 December 2006 (CST)

Minutes from 1 February 2006 TCON

What part of the work interests you?

How much time and what work can you personally commit?

Peter Kress, Chair of EHR Task Group in Aging Health Services Technologies (?) Has a formal project committed to taking a functional status from a CCD document through IHE

Wants to use at least one of the five functional status assessments from their list.

Use process similar to that which Tom White has used.

Have a list of 30-40 scales which will be voted on next week. Some will be large regulatory scales that might not be appropriate for the IHE process, but they expect to have a few smaller ones that would be appropriate. They will be deciding on them next week.

They are also building a use library, which may provide an additional sourcing of use cases.

We do have members of the group who will take on some of the technical task, but also have funding to supplement the work.

Rita Scichilone, AHIMA Dedicated some time to support this project. Possibly would be able to provide resources.

Sue Bakken, Clinical LOINC committee member One possible contribution is to be a conduit to Clinical LOINC Some experience with Clinical Document Architecture, and Document Ontology work. They have a project eNote project, a Physician documentation project, with operational and research side. They actively use CDA. Sook Yung Hyun has some experience with CDA.

Cindy Lundberg, SNOMED International, Terminology Manager Brings expertise around the SNOMED concept model. Judy Warren is a cochair of the Nursing Working group. Serves on NCVHS. To get this work done is an essential keystone for that.

Jenny Elro Grad Student at Loyola in Health Systems Management She has dedicated hours each week for this.

Becky Dadamio, Clinical Informatics group at Siemens Medical Has definite interest in the EHR, as well as the development of a reference terminology.

Judy Osbold, University of Maryland Has worked on numerous projects related to assessment data.

What is already available?

Tom White: There are some CMS assessments available. This is a moving target. There are opportunies to add more.

What is the priority set of assessments? There is a process to work with SNOMED or LOINC. We'd like to be inclusive.

Dan Russler, Co-chair emeritus, Patient Care Coordination We need to focus on scope.

Suggestions for use cases:

  1. Long Term Care
  2. Inpatient Care
  3. Mental Health

Peter: Work from Generic Use case (already done), to assessments, then use cases. At the HIMSS meeting, we could discuss this.

We need to use scales that end users are using now. Some of these are very large.

One of the most basic things to do is an ADL and IADL assessment.

From a bedside nurses point of view the Functional Independance Measure and Functional Assessment Measure for Brain Injury. This is one that is used in a lot of rehab areas.

What some folks have found is that users take these scales and modify them for their own local area. We should not do that.

We should pick topics that are very widely accessed along with scales that are widely used.

Action Items:

  • Send link on FIM/FAM
  • Peter to supply a use case for review

Kboone 15:03, 1 February 2007 (CST)

FIM/FAM Information

The FIM scale is one possibility for us to look at. It also may be combined with the FAM for more depth. Either way, it captures information in a way that the bedside practitioner of many disciplines would do an assessment and the tool is valid and reliable. I recognize it would be just a start to demonstrate the assessment.

Here are two websites I used to find the FIM/FAM. The GWU site brings one to a site for Center to Improve Care of the Dying. That site gives the option to read a comparison of various tools. While they are looking for scales to be used in the last part of life, the FIM was created for and in use in rehabilitation facilities though out the US and Europe. It does not review the FAM, I had to do other investigating to find information and I did not print any of it out. Click on the functional status to review the tools on the CICD toolkit..

The second site I provided takes one to a page with a pdf of the FIM/FAM and provides links to many articles and research related to the scale. You will note that the FAM items could be taken out 

Marcia Veenstra RN BSN

Project Manager: Ambulatory/ED/Community

CPM Resource Center, a subsidiary of Eclipsys Corporation® 600 - 28th St. SW Grand Rapids, Michigan 49509 616-530-9206 Fax

Forming partnerships across the world to co-create the best places to work and the best places to receive care.

Sample Scales



Thank you to everyone who took the time yesterday to participate in the conference call (t-con) for the Care Assessments IHE Profile. I know all of you are exceptionally busy. Please find attached 2 examples of the scale types we were discussing yesterday. During the Patient Care Coordination (PCC) discussions when the Care Assessments application was accepted, criteria for selecting the scales was discussed, one criteria is that the scale be well described. Please consider what other criteria may be desired for the scales to work well with the coding necessary for the IHE Care Assessments profile.

Happy News! Next week, as my family gathers to welcome our first grandchild, Joyce Sensmeier, VP for Informatics at HIMSS has agreed to join the t-con for Care Assessments. Next t-con meeting is Thursday, February 8, 2007 1:30-2:30pm CENTRAL / 2:30-3:30pm EASTERN

Regards, Audrey

Subsequent Information

Jennie Harvell (HHS/ASPE) notes that we should see Consolidated Health Informatics report on Disability, presented to NCVHS last fall, which was subsequently endorsed by NCVHS.

Link to the CHI Recommendation Report that was endorsed by NCVHS and which they recommended that the Secretary of HHS endorse and adopt for use:

Also the link to the NCVHS letter to the Secretary:

Kboone 11:19, 2 February 2007 (CST)

Note from Peter Kress

I had promised to provide you access to some of CAST's early work on Use Cases. Let me preface the link by saying that it is indeed early work. We have brainstormed out a set of use case/scenario names, and populated some rudimentary story lines within many of them. We have a generic structure but it has not yet been consistently applied. We have not yet reviewed that we have exactly the right or highest priority uses cases identified. Nor have we begun editing the use cases in order to ensure applicability to our primary interest, sharing of information.

As you look at our list, you may want to drill in particularly to "Nursing Home to Emergency Room" (under transfers) or Acute Care informs Family Physician (under Health Management). Not that these are any more complete then the others.


Over the next couple of weeks, our group will be trying to develop a set of style and content guidelines to help our members perfect improved scenarios. We will also be prioritizing use cases to improve based on the assessments we are prioritizing. Later this week we are looking to prioritize five assessments from our current short list of 8.

  • MDS
  • Katz ADL
  • FIM
  • Geriatric Depression Scale
  • interRAI HC
  • interRAI AC
  • CAM

Site Link:

Kboone 08:56, 8 February 2007 (CST)

Telcon on February 8


My apologies for not having the agenda out sooner, I had a computer melt-down preventing me from using it for most of the day.


  1. . Additions to the minutes?
  2. . Finish introductions, interest in the work and commitment.
  3. . Discussion of scales; work to date.
  4. . Discussion of workgroups/ division of work.
  5. . Agreement of what will be accomplished by Feb 26 meeting.



The orginal use case in the proposal includes a pediatric use case.

We want to be able to include the use of information from a PHR within the use case. That's already part of the PCC Technical Framework. We can work this into one or more use cases.

We need to narrow down on what the scales are.

AHIMA's interest in this is towards standardization of terminologies.

Marshia: We need something that can be used in acute care.

Certain elements of the the FIM are nearly in the MDS, they would need to be mapped.

IP issues with the FIM are already being addressed.

Cindy from SNOMED and Sue Bakken, and Sook Yung Hyun joined the call. Joyce Sensmeyer joined the call.

The key issue is getting agreement on the scales.

Is is the scales or the use case that is going to drive this? This is intertwined.

We probably don't want to limit ourselves to one provider type for who can complete the scales. If there is a way to be more inclusive, that would be good.

This is nursing focused.

What is the decision criteria for picking scales?

  • Functional Status
  • Nursing Focused
  • Size
  • Intelectual Property (Availability for use)

CAST Criteria

  • Prevalence of use -- international and widely used.
  • Use case fit and priorities.
  • Evidence based.
  • Generalizable across setting.

Pain scales seem to belong in Functional Status.

Minutes from Call on Feb 15

Audry Dickerson, Jenny Elrod, Judy Ozbolt, Davera Gabriel, Dan Russler, Keith Boone, Peter Kress, Becky Dadamio, Cindy

Discussion of scales

CAST Recommends Section G of MDS

There are many aspects of an assessment that may not be of interest to all stakeholders, but portions of an assessment are of value. This is a very widely used set of questions, not necessarily the best ones, but still something.

AD: Would there be copyright issues with that?

PK: Not in the US.

AD: What about outside the US?

PK: I don't know.

KB: I've heard that others claim rights to the MDS outside the US.

PK: Yes, InterRAI has claims to something called the MDS, but we need to research. All care settings are free to use assessments without royalty, but software companies would have to pay royalties.

When we are dealing with the MDS, we are talking about a derivative work done prior to InterRAI licensing.

AD: If we put something into a profile, we want to be sure that it can be used in Europe and Asia.

TW: He can talk with Clem McDonald about this to see what we can find out.

KB: Software could be configured to support implementation of a testing instrument and a care provider could then configure the application to support recording of testing instrument data.

PK: If it was percieved as an InterRAI assesment, they assert rights when it involves the creation of an assessment tool.

There was some discussion from Peter about interoperabilty between scales. The communication would allow reusability, but not necessarily one to one coorespondence.

TW: There is often (he estimated about 50% - 75% of the time) one to one coorespondence, between codes.

PK: The biggest reason for selecting the ADL section MDS, was that its prevalence of use would be the most interesting for us.

KB: My largest concern is the IP issues.

PK: We should look at this on the next call. Internationally, the use of MDS is supported in parts of Europe and Canada, and elsewhere.

KB: Does anyone have recommendations for anything else.

DR: MDS is clearly from the Aged Care Use case.

PK: We would be pleased if someone recommended a pain assessment, and a geriatric depression scale.

TW: The geriatric depression scale is in the public domain.

DR: That sounds like a number 2.

AD: Has that been verified globally.

TW: I don't know, but we can look into it.

DG: Three pain scales in prevalent use, mostly similar, as well as one in use for pediatrics.

TW: Section J of MDS is all about pain. It would be nice if we could do the semantic map between a pain scale and the MDS.

PK: The MDS is not widely seen in the industry as beeing a good scale for recording pain.

TW: Take a good pain scale and feed it into the MDS would be a good example.

AD: If we resolve the IP issues, we could use both G and J.

PK: But I think you are hearing both of us say that Section J is not the best example to use, but the mapping would be useful.

KB: So that could work into the use case.

TW: Section E of MDS could also be mapped to the geriatric depression scale.

AD: Does it matter if the scales all come from one place or not.

KB: We should be evaluating based on the criteria that we mentioned last week.

PK: The geriatric scale, even though it has 30 items, the results are recorded using the same structure.

KB: What I've heard thus far:

  • MDS Section G
  • Geriatric Depression Scale
  • A pain scale, e.g, Analog scale 1-10.

AD: Could we take a different approach, to not use scales or instruments per se, and show how to do mapping.

KB: It's interesting, because it strikes me that we could do two things: A content profile that would describe how to interchange assessments, and an integration profile which would enable an assessment form to be configured within a system.

DR: I'm not sure we need to worry about IP issues. There will evenutally be a large number of IHE profiles, some of which might have IP issues. I think the biggest issues are with developing the process. Our job is to figure out the pattern. If it works in two countries, we have fewer issues.

DG: That's one reason why the pain scale is such a good idea.

KB: I think we need to discuss further the possibility of developing a profile that supports enabling the configuration of systems to support different assessment scales. In that way, we can have the content profiles publish the configuration data, and people who implement the integration profile can make use of that work. Is there anything in Patient Care that might support this?

DR: It is within the scope, but I don't think we have the definition.

DG: Right, we have the instance of a scale, but not the definition.

KB: I'll have a look, and maybe put together a proposal for patient care to address this topic.

Follow up From Davera


Pursuant to our call yesterday, I've done a little digging in the evidence and cannot really find anyone claiming to be the author of the Numeric Rating Sale (NRS). I have included scans from a reference that compiles much information on many pain scales as background information for the group. I have also included some manuscripts - the earliest I can find full text on that refers to the NRS is from 1974. How long do copyrights persist?

I think it is a safe bet to pursue the NRS. It is my experience that this is universally used, except with children (see Baker Wong Faces scale).

Last comment: the link below is to a (IMHO) comprehensive article about geriatric pain management / assessment, mostly to share with the CAST folks. I like that it contrasts the usefulness of various pain scales for use with folks with a variety of perception and cognitive issues.

Pain management in Elderly
Journal Article
Assessment and measurement of pain in older adults: Clinics in Geriatric Medicine

I hope this helps!

Davera Gabriel, RN Terminology Services Architect Clinical & Translational Science Center University of California, Davis Health System 2921 Stockton Blvd, Suite 1400 Sacramento, CA 95817 Phone (916) 703-9148 FAX: (916) 703-9124 email:

"If we cannot name it, we cannot control it, practice it, research it, teach it, finance it, or put it into public policy." - Norma Lang

Kboone 07:29, 20 February 2007 (CST)

Follow up from Jenny Elrod

Davera, In my previous role with a vendor, we built in the NRS-11 and went through legal to make sure there would not be any IP issues. We did a number of searches and it was determined that it could be built in to the clinical documentation.

In addition, in my research I found another possible scale for consideration-- the Clinical Mobility Scale (see ). Not sure how many of you are familiar with this, but thought I would attach it for those to read and provide input on.

media:mobility clinical scale.xls

Jenny Kboone 14:12, 20 February 2007 (CST)

Request for Information

I have been intermittently following the work of this group and would like to become more involved.

Do you have regularly scheduled discussions?

I understand from Keith that there will be discussions during the upcoming HIMSS meeting and that a conference call in line will be available. Is there a date, time, and telephone number for this discussion?

Thanks very much, Jennie

Follow-ups to 2/15 call from Tom White

I agreed to follow-up on three issues before today's call:

  • IP issues related to other sections of the MDS - specifically Section J (pain), and E (mood)
  • IP issues and feasibility of standardizing the Geriatric Depepression scales
  • Feasibility of adding the NIH PROMIS (Patient Reported Outcomes Measurement Information System) pain scale to LOINC/UMLS this Spring

Due to illness in the family, I haven't been able to access the sources for the IP issues (The Mental Health Measurements Yearbook, and the Health and Psychosocial Instruments database), so I don't have answers on IP issues yet.

However, I did speak with Clem McDonald on Tuesday about adding the Geriatric Depression scale to LOINC, and about the PROMIS pain scales. Clem said he'd have his staff start working on the long and short version of the Geriatric Depression scales next week. He also said that NLM is planning to add all of the PROMIS scales and items to the UMLS as they are completed. Clem also said that UMLS is aware of the IP issues and challenges in general, and is exploring ways to address them.

Per Salene Wu of U. Washington, the PROMIS pain scale won't be fully ready for about six months. However, the pre-final items (text of questions and answers) are already being evaluated. I have an email out to Dr. Nan Rothrock to see whether we can get those pre-final items for inclusion in LOINC and UMLS.

Lastly, there may be some technical delay in getting the semantic mappings from the MDS to SNOMED uploaded to the UMLS (e.g. might not truly be included in UMLS until this summer). However, those mappings have already been identified so we have access to them for this project, and could provide vendors with access to them (on the understanding that they will be included within UMLS, which has the authority to re-distributed SNOMED codes).



Provides the link to the US Department of Health and Human Services (ASPE) paper "Making the Minimum Data Set Compliant with Health Information Technology Standards"

Thomas White, NY State Office of Mental Health Jennie Harvell and Samuel Shipley, US Department of Health and Human Services John Carter, Jonathan Evans, Mark Tuttle, Tony Weida, Apelon, Inc.



media:Geriatric Depression Scale.pdf

T-Con 03-22-2007

PCC Workflow Diagram can be found here

See BPMN on Wikipedia as well.

T-Con 04-05-2007 - DSM IV Resources

Search for DSMIV Diagnostic Criteria for Depression - From Bandolier (UK)Evidence Based Thinking About Health Care


From PsychNet-UK


AHIMA has ordered the DSM IV-TR book and will compare these sources with the diagnostic criteria available for depression(official source).

Use Case Diagram


Action Items from the IHE PCC/NSG-SIG T-CON May 3,2007 1)Rita and Marcia will work on Definitions of the scales for the definition section of the Profile. 2) Peter and Tom will submit the loinc encoded MDS-Section G and the GDS to the wiki in the profile. 3) Judy and Cyndie will submit to the wiki and profile the SNOMED encoded scales. 4) Tom will contact Sue Baaken on a LOINC encoded Braden scale. 5) All will add references into the wiki and profile on all 4 chosen scales. References, at least ten (10) and five (5) will be links. 6) Audrey and Jenny will work on putting all 3 diagrams into the wiki with each use case.

May 22-23

Work has begun on Volume II and some restructuring of Volume I content.

To date, I have worked up Volume II content for the Pain, Braden and Geriatric Depression Scales. I will work on the MDS later this week.

I need some editing support for coding up the Braden Scale interpretations. I've built the general framework in for the Braden scale component observations, but need some help plugging in SNOMED CT codes.

Reference Content

Some of the reference content was moved here, rather than becoming part of the profile.

Media:LOINC-PainAssessmentPanel.pdf: A 13 Item Pain Scale

Media:LOINC-PainVisualAnalogScale.pdf: The Visual Analog Pain Scale. Responses can be an integer, ratio, real number, or range and may optionally include relational operators from the set <=, <, >, and >=.

Outcomes and Assessment Information Set (OASIS): A standard core assessment data tool developed to measure the outcomes of adult patients receiving home health services under the Medicare and Medicaid programs in the United States. More information is available from [3].

LOINC Codes for Selected Instruments

Media:LOINCified Braden Scale.pdf

Media:LOINCified Geriatric Depression Scale - 30 Item.pdf

Media:LOINCified MDS.pdf Details about the Nursing Home Minimum Data Set (MDS), which must be completed by Nursing Homes, can be found here

Media:LOINCified OASIS.pdf

Details about the Outcome and Assessment Information Set (OASIS), which must be completed by Home Health Agencies, can be found here