1. C-HOBIC FINDINGS VALIDATION - REPORT AND CONSENSUS ACTIVITY Kathryn Hannah, Anne Casey, Zac Whitewood-Moores C-HOBIC

2. Acknowledgements  ICNP team  Participants in observables validation workshop, Montreal, 2012  Contributors to findings validation to date  C-HOBIC team  Canada Health Infoway  IHTSDO nursing SIG members C-HOBIC

3. Overview 1. Recap 2. Findings validation approach 3. Outcomes 4. Consensus activity 5. Next steps C-HOBIC

4. Background Journal of the American Medical Informatics Association Volume 16 Number 4 July / August 2009 C-HOBIC

5. C-HOBIC - Canadian Health Outcomes for Better Information and Care project  Collaboration between Canadian Nurses Association, Canada Health Infoway and participating provincial partners Standardised, nurse-sensitive outcomes data based on admitting and discharge assessment of functional status, symptoms, safety, readiness for discharge (therapeutic self care etc in acute care, complex continuing care, long-term care and home care patients  Implemented in 3 provinces – in discussions with 2 more.  Phase 2 in progress – focus is on using synoptic records for transition of data with patients as they move between sectors C-HOBIC

6. Terminology support  Assessment and outcomes concepts were mapped to the International Classification for Nursing Practice (ICNP®)  ICNP Nursing Outcome Indicators Catalogue, published August 2011.  C-HOBIC to SNOMED CT ‘map’ – exploratory exercise that may also provide a resource for system designers implementing C- HOBIC in SNOMED-enabled systems  These mapping exercises provide opportunities for enhancement of both terminologies (and C-HOBIC source materials). C-HOBIC

7. Introduction to the findings validation  C-HOBIC content example  SNOMED CT content for maps  First validation exercise (SCT observables)  This validation (SCT findings) C-HOBIC

8. Bathing0Independent Bathing1Set-up help only Bathing2Supervision Bathing3Limited assistance Bathing4Extensive assistance Bathing5Maximal assistance Bathing6Total dependence ITEM NAMESCORESCORE LABEL C-HOBIC CONTENT EXAMPLE C-HOBIC

9. Two tables for SCT mapping 1. ‘observables’ map – SCT match for the C-HOBIC item name only  This would be used if the clinical requirement is to record a numeric score for the assessment result e.g. bathing = 5 2. ‘findings’ map – SCT match for the expression made up of the C-HOBIC item name and the score label  This would be used if the clinical requirement is to record a clinical term for the assessment result e.g. unable to bath self. C-HOBIC

10. Observables map validation  16 experts met in Toronto in June 2012: 4 from the IHTSDO Nursing SIG, 5 from the ICNP Programme and 7 from Canada.  Working with tables prepared by Zac (with duplicates removed), we reached consensus on all items, including:  One missing concept was added for which there was an exact SCT match (‘number of pressure ulcers’).  3 suggested SCT matches were replaced with better SCT concept matches.  12 C-HOBIC concepts did not have an adequate SCT match – proposed new terms were agreed. C-HOBIC

11. Findings validation  Tables prepared by Zac were updated with lessons from observables validation.  Invitation to review sent to Toronto group and Nursing SIG – 6 experts responded.  Responses collated by Kathryn and Anne - items requiring consensus discussion identified for review at SIG meeting October 2013. C-HOBIC

12. Summary of outcomes of Findings validation  Proposals from the Observables validation were confirmed  e.g. C-HOBIC ‘transfer toilet’ is not limited to ‘transfer between wheelchair and toilet’ but requires new SCT concept ‘ability to get on and off toilet’, with related findings.  Agreement on 12 new SCT concepts to be requested  Main issue as in Zac’s proposal: Functional status and activities of daily living concepts: Content Improvement Project  Recommendation 1: C-HOBIC mapping project technical report to be an input for Zac’s project  Recommendation 2: defer requests for new content for fully elaborated C-HOBIC scale findings pending outcome of same. C-HOBIC

13. Consensus Q 1- Re C-HOBIC ‘continence’  ‘Control with any catheter over 24 hours’ is matched with SCT ‘Urinary catheter in situ’  ‘Control with an ostomy over 24 hours’ is matched with SCT ‘Urostomy present’  1 reviewer challenged, the rest agree that match is acceptable.  Q: is the clinical meaning conveyed by the SCT matches? If not, what is alternative? C-HOBIC

14. Consensus Q 2- Re C-HOBIC ‘fatigue’  For finding of ‘Fatigue = 0’ there was no SCT match identified.  Reviewers made several suggestions e.g. ‘no energy deficit’, ‘no fatigue’.  Recommendation: ‘No fatigue’.  If agreed, needs to be added to the new term request list. C-HOBIC

15. Consensus Q 3- Re C-HOBIC ‘dyspnoea’  C-HOBIC Dyspnoea findings are matched to both SCT dyspnoea classification (class I, II etc) and relevant SCT terms (‘breathless - mild exertion’, ‘dyspnoea at rest’ etc).  Recommendation: the match should be to the terms not the classes for C-HOBIC purposes. C-HOBIC

16. Consensus Q 4 - Re C-HOBIC ‘falls’  C-HOBIC ‘No fall in last 90 days’ is matched to SCT ‘does not fall’.  2 challenges, rest of reviewers agree that match is acceptable.  Q: is the clinical meaning conveyed by the SCT match? If not, what alternative? C-HOBIC

17. Next steps  Revise validation report with outcomes from consensus discussion  Finalise Technical Report  Complete draft (Anne)  Seek comments on draft (Kathryn to circulate to Toronto group and post on SIG discussion space)  Finalise report (Anne and Kathryn)  Approve report and submit to ?? (Nursing SIG / Susan)  Plan how map tables can be disseminated / maintained (Kathryn?)  Include lessons in Functional status and activities of daily living concepts: Content Improvement Project (Zac) C-HOBIC