COVID-19 Medical Triage Questionnaire
- Andrew Sills
- Raja Cholan
- Tim Williams
- Penni Hernandez
COVID-19 Medical Triage Questionnaire
Data Gathering Task (BPMN) | Question | Answers | ANF Transformation Pattern |
|---|---|---|---|
Case classification | Laboratory confirmed patient positive for severe acute respiratory syndrome coronavirus 2 | Yes/no/unknown | Existential |
| Patient probably positive for severe acute respiratory syndrome coronavirus 2 “The word ‘Probably’ in the Question leads to uncertainty. Are they asking the clinician to assume/guess whether or not a patient is positive at presentation prior to testing being done? Perhaps this question was drafted when testing was not as widely available?” Once testing is done, a patient can either be confirmed positive or negative. For answering “Probably” in the question, one must assume that all the confirmed positive tests are false positives. Suggestion: “Has the patient been tested for SARS-CoV-2? What type of test was it? What is the test result?” PMH: Here in Colorado it looks like “probable positive” actually has a definition: Probable Positive:
OR
OR
OR
| Yes/no/unknown | Existential |
| clinical evaluation / contact tracing / routine surveillence / other / unknown | Value-to-Attribute Transformation | |
| Was the case first identified by Epidemic Infomation Exchange (EpiX) notification of travelers? | Yes/no/unknown | Existential |
If yes | What was the DGMQID? |
| Narrative |
| What was the report date of case to Center for Disease Control (CDC)? | Date, unknown, N/A | Date |
| What was the date of the first positive specimen collection? | Date, unknown, N/A | Date |
Hospitalization, ICU, and Death Information | Was the patient hospitalized? | Yes/no/unknown | Existential |
If yes | What was the date of admission to the hospital? | Date | Date |
If yes | What was the date of discharge from the hospital? | Date | Date |
If yes | Did the hospitalized patient require a translator? | Yes/no/unknown | Existential |
If yes | What language was required for the hospitalized patient? | <<297289008 |World languages (qualifier value)| | Value-to-Attribute Transformation |
| Was the patient admitted to an intensive care unit (ICU)? | Yes/no/unknown 305351004 |Admission to intensive care unit (procedure)| | Existential |
If yes | What was the date of admission to the ICU? | Date | Date |
If yes | What was the date of discharge to the ICU? | Date | Date |
| Did the patient die as a result of the illness? | Yes/no/unknown | Existential |
If yes | What was the date of death? | Date/unknown | Date |
Case Demographics | What is the patient's date of birth? | Date | Date |
| What is the patient's age? | calculate? |
|
| What is the patient’s age unit? | yr/mo/day |
|
| What is the patient’s state of residence? | <<224037005 |Region of United States of America (geographic location)| | Value-to-Attribute Transformation |
| What is the patient’s county of residence? | https://www.census.gov/library/publications/2011/compendia/usa-counties-2011/file-layout.html | Value-to-Attribute Transformation |
| Does the patient have any tribal affiliation? | Yes/no/unknown | Existential |
If yes | What is the name of the tribe? | Value-to-Attribute Transformation | |
| Is the patient an enrolled member of a tribe? | Yes/no/unknown | Existential |
| What is the biological sex of the patient? | Male/Female/other/unknown | Value-to-Attribute Transformation |
If female | Is the patient currently pregnant? | Yes/no/unknown | Existential |
| What is the ethnicity of the patient? | Hispanic/latino / Non-hispanic/latino / Unknown | Value-to-Attribute Transformation |
| What is the race of the patient? | American Indian/Alaska Native / Asian / Black / Native Hawaiian/other Pacific Islander / White / Unknown / Other/specify | Value-to-Attribute Transformation |
| Where was the patient staying at the time of the illness onset? | 1, House/single family home 2, Apartment 3, Hotel/motel 4, Long term care facility 5, Nursing home/assisted living facility 6, Acute care inpatient facility 7, Rehabilitation facility 8, Correctional facility 9, Mobile home 10, Group home 11, Homeless shelter 12, Outside, in a car, or other location not meant for human habitation 13, Other, specify 14, Unknown | Value-to-Attribute Transformation |
Healthcare Worker Information | Is the patient a healthcare worker in the United States? | Yes/no/unknown | Existential |
If yes | What is the patient's occupation? | 1, Physician 2, Nurse 3, Respiratory therapist 4, Environmental services 5, Other, specify 9, Unknow | Value-to-Attribute Transformation |
If yes | What is the patient’s job setting? | 1, Hospital 2, Long-term care facility 3, Rehabilitation facility 4, Nursing home/assisted living facility 5, Other, specify 9, Unknown | Value-to-Attribute Transformation |
Exposure Information | In the 14 days prior to illness onset, did the patient have any of the following exposures? |
|
|
| Did the patient travel outside of the state of their normal residence? | Yes/no/specify <<224037005 |Region of United States of America (geographic location)| | Value-to-Attribute Transformation |
| Did the patient travel internationally? | Yes/no
| Existential - RR |
If yes | Which countries did the patient visit? | <<223369002 |Country (geographic location)| | Value-to-Attribute Transformation |
| Did the patient travel on a cruise ship or vessel as a passenger or crew member? | Yes/no | Existential |
If yes | What was the name of the ship that they travel on? | Text | Narrative |
| Was the patient exposed at their workplace? | Yes/no | Existential |
If yes | Was the workplace designated as critical infrastructure? | Yes/no | Existential |
If yes | What was the name of the workplace setting? | Text | Narrative |
| Where was the patient at the time of exposure? | Airport / airplane / adult congregate living facility / school, university, childcare center / correctional facility / community, mass gathering | Value-to-Attribute Transformation |
| Was the patient exposed to an animal with confirmed COVID-19? | yes/no/unknown | Existential |
| Was the patient exposed to an animal with suspected COVID-19? | yes/no/unknown | Existential |
If yes | What type of animal were they exposed to? | text or 387961004 |Kingdom Animalia (organism)| | Value-to-Attribute Transformation |
| Was the patient exposed in another way? | text | Narrative |
| Was the patient in contact with a known COVID-19 case? | yes probable/yes confirmed | Existential |
| Was the patient exposed by household contact(s)? | yes/no/unknown | Existential |
| Was the patient exposed by community-associated contact(s)? | yes/no/unknown | Existential |
| Was the patient exposed by a healthcare-associated contact? | yes/no/unknown | Existential |
| If the patient had contact with another COVID-19 case, was this person a U.S. case? | yes/no/unknown | Existential |
If yes | What is the jurisdiction-issued nCoV ID of source case? | text room for 3 IDs | Narrative |
| Is the case part of an outbreak? | yes/no/unknown | Existential |
If yes | What is the name of the outbreak? | text | Narrative |
Clinical course, symptoms, past medical history, and social history | Was the history collected by a patient interview? | yes/no | Existential |
| Was the history collected by a medical record review? | yes/no | Existential |
| If the patient is symptomatic what was the date of onset? | Date/unknown | Date |
| Did the patient's symptoms resolve? | yes/no | Existential |
If yes | What was the date of the symptom resolution? | Date/unknown | Date |
If no | What is the status of the patient’s symptoms? | Still symptomatic/ symptoms resolved unknown date/ unknown if symptoms have resolved. | Existential |
| Did the patient develop pneumonia? “Pneumonia is a clinical diagnosis; how will the patient know he developed Pneumonia? The questionnaire is retrospective and being filled after patient had received treatment?” PMH: Yes these questions were all past tense and I would assume pneumonia would already be documented in the patient record. I am not sure if they are asking: · Does the patient have a history of pneumonia · Does the patient currently have pneumonia · Does the patient have symptoms of pneumonia but it is not diagnosed · Retrospectively did the patient have pneumonia during their stay I would think we just need to document our assumed use case, e.g. is this a triage question? Or a case report to CDC? | yes/no/unknown 233604007 |Pneumonia (disorder)| | Existential |
| Did the patient have acute respiratory distress syndrome? | yes/no/unknown 67782005 |Acute respiratory distress syndrome (disorder)| | Existential |
| Did the patient have an abnormal chest x-ray? Suggestion:
PMH: Agree these are better questions | yes/no/unknown/not done 168734001 |Standard chest X-ray abnormal (finding)| | Existential |
| Did the patient have another diagnosis and/or etiology for their illness? | yes/no/unknown | Existential |
| Did the patient have an abnormal EKG? Suggestion:
PMH: Agree these are better questions
| yes/no/unknown/not done 102594003 |Electrocardiogram abnormal (finding)| | Existential |
| Did the patient receive mechanical ventilation (MV) and/or intubation? | yes/no/unknown 40617009 |Artificial respiration (procedure)| 52765003 |Intubation (procedure)| | Existential |
If yes | What was the total number of days with mechanical ventilation? | number (days) | Frequency Transformation - RR |
| Did the patient receive extracorporeal membrane oxygenation (ECMO)? | yes/no/unknown 233573008 |Extracorporeal membrane oxygenation (procedure)| | Existential |
If symptomatic | Did the patient experience a measured fever >100.4F (38C)? Suggestion:
PMH: Agree this is a better question
| yes/no/unknown 426000000 |Fever greater than 100.4 Fahrenheit (finding)| | Existential |
| Did the patient report a subjective fever? | yes/no/unknown 103001002 |Feeling feverish (finding)| | Existential |
| Did the patient experience chills? | yes/no/unknown 43724002 |Chill (finding)| -not a great concept, might need a new one | Existential |
| Did the patient experience rigors? | yes/no/unknown 38880002 |Rigor (finding)| | Existential |
| Did the patient experience muscle aches (myalgia)? | yes/no/unknown 68962001 |Muscle pain (finding)| | Existential |
| Did the patient experience a runny nose (rhinorrhea)? | yes/no/unknown 64531003 |Nasal discharge (finding)| -no active synonym of “runny nose”, was inactivated as a concept | Existential |
| Did the patient experience a sore throat? | yes/no/unknown 162397003 |Pain in throat (finding)| | Existential |
| Did the patient experience a new loss of sense of smell? | yes/no/unknown 44169009 |Loss of sense of smell (finding)| -not sure | Existential |
| Did the patient experience a new loss of taste? | yes/no/unknown 36955009 |Loss of taste (finding)| | Existential |
| Did the patient experience a headache? | yes/no/unknown 25064002 |Headache (finding)| | Existential |
| Did the patient experience fatigue? | yes/no/unknown 84229001 |Fatigue (finding)| | Existential |
| Did the patient experience a new onset of a cough? Suggestion:
PMH: again questions around present/past tense | yes/no/unknown 49727002 |Cough (finding)| 288524001 |Courses (qualifier value)| - maybe | Existential |
| Did the patient experience the worsening of a chronic cough? | yes/no/unknown 68154008 |Chronic cough (finding)| 385634002 |Change patterns (qualifier value)| | Existential |
| Did the patient experience shortness of breath? | yes/no/unknown 267036007 |Dyspnea (finding)| | Existential |
| Did the patient experience difficulty breathing? | yes/no/unknown 230145002 |Difficulty breathing (finding)| | Existential |
| Did the patient experience chest pain? Suggestion:
Aspirational:
PMH: again this seems to depend on the use case, current vs. retrospective | yes/no/unknown 29857009 |Chest pain (finding)| | Existential |
| Did the patient experience nausea or vomiting? | yes/no/unknown 422587007 |Nausea (finding)| 422400008 |Vomiting (disorder)| | Existential |
| Did the patient experience abdominal pain? | yes/no/unknown 21522001 |Abdominal pain (finding)| | Existential |
| Did the patient experience diarrhea (≥3 loose/looser than normal stools/24hr period)? Suggestion:
PMH: Assuming that the slash means “and/or”, this would need to be two questions one coded to 405729008 |Hematochezia (finding)| and one coded to 271864008 |Mucus in stool (finding)| | yes/no/unknown 62315008 |Diarrhea (finding)| -no definition | Existential |
| Did the patient experience other symptoms? | yes/no/unknown | Existential |
If yes | What other symptoms did the patient experience? | Text | Narrative |
Did the patient have any underlying medical conditions and/or risk behaviors? | Yes/no/unknown 73211009 |Diabetes mellitus (disorder)| | Existential | |
| Suggestion:
PMH: Would probably need both questions right? Current tx
| Yes/no/unknown | Existential |
| Yes/no/unknown | Existential | |
| Current pulse oximetry measurement (SPO2)? |
| IF-to-ANF Transformation |
| Yes/no/unknown 38341003 |Hypertensive disorder, systemic arterial (disorder)| | Existential | |
| Does the patient have severe obesity (BMI >=40) Suggestion:
PMH: Better “learning” questions here would be to ask:
Calculate the BMI and record the number and then flag those values over 40. e.g. in the future, you might learn that the risk is also >=30. BMI = body weight (kg) / height (meteres) squared | Yes/no/unknown 83911000119104 |Severe obesity (disorder)| -no definition | Existential |
| Yes/no/unknown 49601007 |Disorder of cardiovascular system (disorder)| | Existential | |
| Does the patient have chronic renal disease? Suggestion:
PMH: The coding for this should be <<709044004 |Chronic kidney disease (disorder)| representing this concept and any of the subtypes where the more specific stages reside. Since this isn’t a Yes/No/Unk I would think the questionnaire would implement this concept and everything below as choices. | Yes/no/unknown 709044004 |Chronic kidney disease (disorder)| | Existential |
| Does the patient have chronic liver disease? Suggestion:
PMH: The coding for this should be <<328383001 |Chronic liver disease (disorder)| representing this concept and any of the subtypes | Yes/no/unknown 328383001 |Chronic liver disease (disorder)| | Existential |
| Does the patient have chronic lung disease? Suggestion:
PMH: The coding for this should be <<413839001 |Chronic lung disease (disorder)| representing this concept and any of the subtypes | Yes/no/unknown 413839001 |Chronic lung disease (disorder)| | Existential |
| Does the patient have an immunosuppressive condition? Suggestion:
PMH: I pointed this to the “finding” of 38013005 |Immunosuppression (finding)| just a general condition or maybe 68605000 |Immunosuppression-related infectious disease (disorder)| would be better? | Yes/no/unknown 38013005 |Immunosuppression (finding)| | Existential |
| Does the patient have an autoimmune condition? Suggestion:
PMH: The coding for this should be <<85828009 |Autoimmune disease (disorder)| representing this concept and any of the subtypes | Yes/no/unknown 85828009 |Autoimmune disease (disorder)| | Existential |
| Is the patient a current smoker? | Yes/no/unknown 77176002 |Smoker (finding)| Trying to use the US Core Smoking Status value set https://www.hl7.org/fhir/us/core/ValueSet-us-core-observation-smokingstatus.html have logged a Jira ticket with HL7 regarding “428041000124106|Current some day smoker” (https://jira.hl7.org/browse/FHIR-28118) | Existential |
| Is the patient a former smoker? | Yes/no/unknown 8517006 |Ex-smoker (finding)| | Existential |
| Does the patient have a substance abuse condition? Suggestion:
PMH: I think we still need the original questions (abuse & misuse) but the specific substance would be very useful. Since this could, in theory, be any substance we would have to use <<105590001 |Substance (substance)| | Yes/no/unknown 66214007 |Substance abuse (disorder)| | Existential |
| Does the patient have a substance misuse condition? | Yes/no/unknown 361055000 |Misuses drugs (finding)| | Existential |
| Does the patient have a disability? | Yes/no/unknown defined: neurologic, neurodevelopmental, intellectual, physical, vision or hearing impairment | Existential |
If yes | What disability does the patient have? | Text | Narrative |
| Does the patient have a psychological and/or psychiatric condition? | Yes/no/unknown 74732009 |Mental disorder (disorder)| | Existential |
If yes | What psychological and/or psychiatric condition does the patient have? | Text | Narrative |
| Does the patient have another chronic disease? Suggestion:
PMH: In this case there is a following question that would come up with an “enableWhen”. | Yes/no/unknown | Existential |
If yes | What other chronic disease does the patient have? The coding for this should be <<27624003 |Chronic disease (disorder)| representing this concept and any of the subtypes, and the actual disorder documented would be more specific. | List from SNOMED of anything under chronic disease?
| Value-to-Attribute Transformation |
| Does the patient have another underlying condition? | Yes/no/unknown | Existential |
If yes | What other underlying condition does the patient have? | Text | Narrative |
| Does the patient have another risk behavior? | Yes/no/unknown | Existential |
If yes | What other risk behavior does the patient have? | Text | Narrative |
SARS-CoV-2 Testing | Was a test ordered? |
|
|
If yes | What was the date ordered? | Date | Date |
If yes | What was the date of the result? | Date | Date |
If yes There were 2 DX accelerator Research questions about this.
*harmonize with LOINC per CDC | What type of test?
|
*There are 81 COVID tests listed by LOINC https://loinc.org/sars-cov-2-and-covid-19/ | Value-to-Attribute Transformation |
If yes | What was the test device identifier? |
| Narrative |
| What was the result of the molecular amplification test (RT PCT)? | 1)Positive 2)Negative 3)Indeterminate/inconclusive 4)Pending 5)Not done | Value-to-Attribute Transformation |
| What was the result of the serologic test? | 1)Positive 2)Negative 3)Indeterminate/inconclusive 4)Pending 5)Not done | Value-to-Attribute Transformation |
| Was the patient administered another type of test? | Yes/no/unknown | Existential |
If yes | What was the name of the test? | Text | Narrative |
| What was the result of the other test? | 1)Positive 2)Negative 3)Indeterminate/inconclusive 4)Pending 5)Not done | Value-to-Attribute Transformation |
Specimens for CoV-19 Testing | What is the first local specimen ID? | Text | Narrative |
| What is the second local specimen ID? | Text | Narrative |
| What is the third local specimen ID? | Text | Narrative |
| What is the fourth local specimen ID? | Text | Narrative |
| Are there any other comments or notes about the patient? | Text | Narrative |