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# Datatypes R2 Issue 51

## Introduction

Supporting Likert Scales:

Many clinical findings are derived from arithmetic calculations from Likert Scales, e.g. Apgar scores, Barthel Index.

To make the link to HL7 Vocabulary Tooling...

Likert scales are often published as value sets for a particular question or test:

Value Set for Agreement Scale:

a) Strongly Agree : 1

b) Agree : 2

c) Neither Agree nor Disagree : 3

d) Disagree : 4

e) Strongly Disagree : 5

Often, multiple individual Likert scores are added together to produce a composite score, e.g. Agree X 3 = score of 6.

If we refer to the formating in the value set above as "Original Text" : "Corresponding Value," we can imagine that we would like to communicate observation results that support both the Original Text and the Corresponding Value in the same communication. These would both be communicated as the result for a single question, i.e. one is not more important than the other.

One could also imagine that "Original Text" might be coded by a coding system like SNOMED. Unlikely, but also possible, is that the Corresponding Value coding could be changed from arabic base10 to some other arithmetically equivalent expression.

Although many people have tried to model the communication solution using multiple observations or by sticking the Corresponding Value in a numeric data type (in observation.value) and the coded Original Text in a coded datatype (in observation.interpretationCode), these solutions are awkward.

The proposal is that a datatype solution be considered rather than the specific "CO extension" noted below.

Thanks

DanR 10:46, 17 May 2006 (CDT)

Dan Russler asks for an extension of CO where you could actually have a numeric value as in

<value xsi:type="CO" value="2" code="xyz" codeSystem="..." displayName="eye opening to pain"/>

and then also he wants translations, so CO would have to extend CE rather than CV.

We'd also have to add an operation

```INT plus(CO)
```

to the abstract definition of CO.

Backwards compatibility: this would be backwards compatible

## Discussion

Grahame: This is counter to the whole point of designing CO the way it has been designed. It was deliberately designed this way to avoid the trap of explicitly representing the order in a non-manageable fashion, and delgating the order to the CTS -> invite Dan to contribute.