This page is part of the PACIO Cognitive Status Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Representative Assessments

Note to Commenters: The PACIO Cognitive Status workgroup is seeking feedback on the level of guidance needed related to specific assessment instruments. In addition, comments around whether this guidance should be included in the Cognitive Assessment IG or published as a supplemental guide.

Note to Commenters: LOINC is included as an example. We would like to find out how prevalent other code systems (i.e. SNOMED) and should guidance be included here.

Standardized Assessments and Code Systems

A large number and variety of assessment instruments exist for assessing cognitive function in care settings. The following instruments have been analyzed for the purposes of providing implementation guidance and exchange of cognitive status. Standardized instruments that assess cognitive function fall into three broad categories based on use of standardized code systems.

1. Fully Codified – These instruments have standardized terminology associated with them, meaning the entire instrument can be modelled.
2. Partially Codified – These instruments generally have standardized question and answer pairs and a code to describe the instrument and total score. However, critical meta data or other information may only be found on the assessment itself.
3. Not Codified – These instruments do not have standard codes associated with them and may be proprietary. Exchange of this information may require special handling and/or development. In this case it is expected that the assessment instrument and result are expected to be exchanged.

Representative examples of each of these categories are provided in the following sections to guide implementers.

Fully Codified Assessments

The following are considered fully codified assessments:

COGNITIVE TESTS/SCREENS	LOINC
Confusion Assessment Method (CAM)	52495-9 Confusion Assessment Method (CAM)    52738-2 Inattention    52739-0 Disorganized thinking    52740-8 Altered level of consciousness/alertness    52741-6 Psychomotor retardation
Brief Interview for Mental Status (BIMS)	52491-8 Brief Interview for Mental Status    52731-7 Repetition of Three Words. Number of words repeated after first attempt    54510-3 Temporal Orientation (orientation to year, month, and day)      52732-5 Able to report correct year      52733-3 Able to report correct month      54609-3 Able to report correct day of the week    52493-4 Recall      52735-8 Able to recall "sock"      52736-6 Able to recall "blue"      52737-4 Able to recall "bed"    54614-3 BIMS Summary Score
Patient Health Questionnaire (PHQ)	58120-7 Patient Health Questionnaire 2 item (PHQ-2) [PHQ.CMS] 55758-7 Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] 54635-8 Patient Mood Interview (PHQ-2 to 9) 44261-6 Patient Health Questionnaire 9 item (PHQ-9) total score [Reported] 54657-2 Staff assessment of resident mood (PHQ-9-OV) [Observed PHQ-9 CMS] 54677-0 Staff assessment of resident mood total severity score [Observed PHQ-9 CMS] 89206-7 Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen] 89204-2 Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]

Partially Codified Assessments

Assessments that have LOINC codes for representing the instrument should be used for exchanging the instrument and result. Additional ‘meta data’ fields, such as author can be mapped using QuestionnaireResponse.

MoCA is provided as an example:

Montreal Cognitive Assessment (MoCA)

72133-2 Montreal Cognitive Assessment [MoCA] 72172-0 Total score [MoCA]

Not Codified Assessments

Some assessments do not have any codes associated with them. In this case, the individual data elements contained in the assessment instrument can be mapped to QuestionnaireResponse fields.

The Brief Cognitive Assessment Tool (BCAT) is included here as an example:

BCAT Fields	Mapping	Reference Mapping	Values
Name	QuestionnaireResponse.Subject	patient.name
DOB	QuestionnaireResponse.Subject	patient.birthDate
Gender	QuestionnaireResponse.Subject	patient.gender	AdministrativeGender (required)
Education	Observation.component		91694-0, LL836-8
Examiner	QuestionnaireResponse.author	Reference to Practitioner/role
Today's Date	QuestionnaireResponse.authored ('dateTime' type)
Total Score	Observation.value	Not contained in QuestionareResponse
referenceRange	Observation.ReferenceRange	Not part of BCAT form but needed for interpreting total score.

Codes for Education:

• CMS Data Element A1050 Highest education completed
  
• LOINC 91694-0 Highest level of education of Personnel