Scope for functioning observables

I am aware this work has been put back a bit and may be up and running again soon? I would be very interested to see some testbed worked examples of modeled functional observables if there are any at this stage.  Perhaps this is planned for a future Observables meeting? The Editorial Guide provides an uncoded example (6.3.3.17) under HAS REALIZATION modeling of:

Ability to walk (observable entity)

PROPERTY TYPE | | ability

INHERES IN | | whole body

HAS REALIZATION | | walking

and identifies << 719982003 |Process as the value set for 'walking' although the current values under 719982003 are pathological processes. I am not clear how this will work.

Going on from this the (to me) very important area of observables from scored assessments seems one that needs a start making on modeling. Just picking the first one to hand: 714474007 Aachen Aphasia Test score.

1. PROPERTY TYPE has no values under 118598001 | Measurement property that would fit.  280433002 Summated scale score (qualifier value) would do but isn't permitted. 
2. Looks like it would INHERE IN 'Brain structure' (body structure)
3.  The only way I can see of fitting in the scale is under USING DEVICE but only Physical object | 260787004 is permitted so the range would need extending to include << 273249006 Assessment scales (assessment scale)?
4. HAS REALIZATION (or CHARACTERIZES?) would need to have values of <<Functional observable (observable entity) to allow for '(Ability to) understand or produce speech' or even all observables but then it's an Observable Entity referencing another Observable entity.  I believe there was a discussion on revising the location of the function observables en masse but I am not clear how far that has got?

Sorry Penni, a lot of questions.  It would be interesting to see the direction of travel.

Just to clarify, this was a proposal for modeling which has not yet been implemented. A number of things would need to be done:

1. | ability | to be added as property type.
2. We've been discussing what abilities inhere in. Is it the person, the body of the patient, the CNS, etc. We would have to decide and move on...
3. We've been considering using | technique | for assessment scales, as the scales typically include assessment protocols in addition to the specific scales
4. Concepts for the actual activities would be a separate hierarchy, or a branch of | qualifier value |, as long as it can be reused for other purposes.

/Daniel

Thanks for the clarification Daniel.  I don't want to occupy time in a thread here when substantive discussion is ongoing so I shall leave you to it and await reports. I'd consider technique to be how the evaluation was conducted: structured interview, self administered questionnaire, physical examination, functional test, etc?  The assessment scale, tool, instrument is (the word associations aren't accidental) more akin to an ophthalmoscope, sphyg or patella hammer etc?  I believe this may align with how international thinking on clinical devices in general is going i.e. that a lot of 'things' are (arguably) tools and devices even though virtual or digital.  Some discussion with pharmacy/devices leads would be useful if it has not already taken place.  It could even be appropriate to move the assessment scales to the devices hierarchy?

Sarah.

Well, this project was ongoing, so your comments are welcome.

/Daniel

Hi Daniel, I'm not sure how you'd model those related observables - but there's obviously something amiss in the organisation of the current hierarchy.
It seems like there's been an assumption (at the time of authoring) those interpret targets would subsume each other... (though it all looks like legacy content)

At Nebraska we are in the process of organizing registry data sets for Alzheimers disease.  One case I would like to discuss as pertains to Function Observales is as follows:

Use case: codify the panel of observables that constitute the Folstein Minimental Status Examination. 

This consists of a validated instrument to assess cognitive function in humans and has been shown to be a useful screen for dementia, ie significant cognitive decline.  Cognition is “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.”(Wikipedia)  It consists of the assembly and use of many processes involving hearing, speech, vision, writing, etc. 

The MMSE consists of an interview including questions and visual interactions that serially assess orientation, registration (short term auditory understanding and memory), attention, calculation, short term recall (memory), understanding and use of language, and the ability to construct and execute complex tasks. Each of these elements of the interview are scored numerically and totaled with possible score of 30.  Research has demonstrated the validity of score <23 in the identification of a population with high probability of cognitive loss, or dementia.  These observation results comprise a panel of observables which assess cognitive function, established to be a process which is managed in the human cerebral cortex.  Based upon the slim discussion of this class of observables in the Inception/Elaboration document copied below, it would appear that the definition of the observable for the MMSE total score would be:

“Folstein Minimental Status Examination total score (observable entity)”

IS_A 363787002|Observable entity (observable entity)|

INHERES_IN 40146001|Cerebral cortex structure|

HAS_REALIZATION “Process\Physiological process\Neuropsychological process\Process of cognition”(NEW)

PROPERTY Measurement property\Process functionality(NEW) or Functional completeness?(NEW) (ie Does the process yield the expected result or proscribed outcome?)

SCALE_TYPE 30766002|Quantitative|

TIME_ASPECT 123029007|Single point in time|

Furthermore, the individual observables of the interview would be defined with attention to orientation, registration, calculation, etc as new subtypes of the cognitive process. 

Given that a function is something that results from or grows out of a process, I find the “Has realization” prescription to be confusing.  I accept the relationship of the two entities, but it would seem that 704321009|Characterizes| is a more intuitive choice of attributes.

>>>Current I&E document

1.1 “Function observables

A function is something that may be realized as a process or activity. The word “function” here is used only in this specific meaning. E.g. the distance walked in a “6 min walking test” is not a function observable but a quality observable even though the distance walked in 6 minutes is a way of quantifying the walking function. Thus, function observables would typically be restricted to observables with ordinal scale results such as “able to”, “unable to” or to Likert[1] style scales.

1.1.1 Attributes with specific use in relation to function observables

1.1.1.1 719722006 | Has realization (attribute) |

The 719722006 | Has realization (attribute) | attribute is used to specify the process or activity that is the consequence of realization of the function. For example, when the walking ability is realized, the realization is the actual walking.”

>>>Ends

[1] https://en.wikipedia.org/wiki/Likert_scale

In followup of the last post, Carol and I have done preliminary work and want to propose definition of the observable panels for the:

1)Folstein Minimental Status Exam,

2)Barthel Geriatric Functional Scale and the

3)Schmid Fall Risk Scale. 

I enclose an excel spreadsheet with additions to the process inventory <<719982003|Process(qualifier)| that would be required and our preliminary modelling of the three scales.  We have followed LOINC conventions and used scale type of Ordinal for all individual metrics and Quantitative for the total score.  We are proposing fully specified name convention of:

“Scale name: element # if ordered Brief description of question (observable entity)”.  Hence two examples from the spreadsheet:

We are treating the three panels as FUNCTION observables assessing MMSE-neuropsychological processes, Barthel – Activities of daily living and Schmid – Balance and maintaining upright posture.  We propose a new 118598001|Measurement property| of ‘Functional assessment’ although it seems a bit of a kludge.

Sprreadsheet appended to this discussion.  Can we discuss Monday?

Jim