Gap analysis for OASIS-B1 functional status information and the HL7 Continuity of Care document (CCD)
The functional status information from the OASIS B1 is: (M0220, M0250 - M0825)
Sensory status
integumentary status
respiratory status
elimination status
neuro/emotional status
ADL/IADL
patient management of medications and equipment
The overall process: The standardization process proposed by Tom White et al. 1 is the framework for this discussion. The encoding steps for sending an OASIS assessment would be:
Step 1: Encode to a standard coding system: Encode all OASIS-B1 items into LOINC (LOINCification)
Step 2: Concept Matching to a standard medical terminology: Where possible match LOINC codes of the OASIS items with one or more equivalent terms from a standard medical terminology. The suggested medical terminology is SNOMED. Use semantic matching to do the matching. Initially this is done using a panel of experts on OASIS and SNOMED.
Step 3: Insert the LOINC codes of the OASIS (and their SNOMED equivalents) into the functional status section of the CCD
Step 4 (Messaging): The CCD is an HL7 document (CDA) that is sent as a sequence of HL7 messages.
Work done on OASIS:
Step 1 (LOINCification): The goal here to capture the entire content of the assessment. To do this, as with other assessment instruments, OASIS requires that certain information be stored with the responses.
the entire assessment be encoded
each question, its text, special instructions, and order within the assessment
each response, its text, special instructions, and order within the question
Versions: the ability to encode versions of any of the above.
LOINC has already done this for MDS by adding supplementary axes to LOINC:2
The supplementary axes are:
- SurveyQuestionText
- AnswerList
- Formula
- SurveyQuestionSource
- Comments
Work has been done encoding OAISIS items into LOINC.3
Step 2: (Semantic Matching)
Does SNOMED have all the terms to cover the concepts covered by OASIS?
Work has been to done to map OASIS to the medical vocabulary (MED) used at Columbia.3
Step 3: Insert the LOINC codes of the OASIS (and their SNOMED equivalents) into the functional status section of the CCD
The information will be placed into the Functional Status section of the ASTM/HL7 CCD.
Is the syntax for the functional status section complete so that multiple semantic equivalents of a LOINC coded assessment response can be represented?
Step 4 (Messaging): The CCD is an HL7 document (CDA) that is sent as a sequence of HL7 messages.
Is the work done for representing LOINC encoded MDS2 into an HL7 document (The CCD) sufficient for LOINC encoded OASIS?
1 White, T, Harvell J, et al. Modifying the HL7 Continuity of Care document (CCD) to Improve eporting of Results form Functional Status Instruments.
2 Carter J, White T., Harvell J, Making the "Minimum Data Set" Compliant with Health Information Technology Standards.
3 Choi J., et al. Towards Semantic Interoperability in Home Health Care: Formally representing OASIS items for integration into a Concept-oriented Terminology.