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Omaha System

The Omaha System is a classification system created to assess and document patient problems, define treatments or services, and measure outcomes. It consists of three relational, reliable, and valid components designed to be used together:

  • Problem Classification Scheme: Used for client assessment. There are forty-two client problems or areas of concern are at the second level; by definition, problems are neutral, not negative.
  • Intervention Scheme For care plans and services.
  • Problem Rating Scale for Outcomes (PRSO): To measure client change/evaluation. PRSO consists of three five-point, Likert-type scales to measure the entire range of severity for the concepts of Knowledge, Behavior, and Status. Knowledge is defined as what the client knows, Behavior as what the client does, and Status as the number and severity of the client’s signs and symptoms or predicament. 

Using the Problem Classification Scheme with the Intervention Scheme and Problem Rating Scale for Outcomes creates a comprehensive problem-solving model for practice, education, and research.[1]

The Omaha System is widely used in electronic health records (EHRs) as it provides a simple and standardized taxonomy to capture and track client progress.

 

Applying the Omaha System to the Indicator Registry

There is strong evidence and support for applying the Omaha System to social and behavioral indicators.

Using a common classification scheme and rating scale across indicators provides an evaluation system that is flexible, intuitive, and easy to analyze and report. The Omaha System is a globally-recognized common classification scheme and scoring system that has been translated to other common measures. Using the Omaha System allows researchers to compare outcomes across a variety of indicators.

Therefore, all data elements and their associated value domains in the Indicator registry (www.indicatorregistry.net) have been named and coded to align with the Omaha System, as well as to meet ISO 11179 metadata standards. There is not perfect alignment between the data elements and the Omaha System, but this is a work in progress that will be reviewed by system experts in the future.

Value Domain Translation and Harmonization

Wherever possible, value domains have been translated to the five-point problem rating scale for outcomes and assigned to a concept area (knowledge, behavior, or status). Note that a score of 1 is associated with a poor result, where 5 is the most positive result.

Table 1: Concepts and Ratings of the Problem Rating Scale for Outcomes:

Concepts

1

2

3

4

5

Knowledge:
Ability of the client to remember and interpret information

No knowledge

Minimal knowledge

Basic knowledge

Adequate knowledge

Superior knowledge

Behavior:
Observable responses, actions, or activities of the client fitting the occasion or purpose

Not appropriate behavior

Rarely appropriate behavior

Inconsistently appropriate behavior

Usually appropriate behavior

Consistently appropriate behavior

Status:
Condition of the client in relation to objective and subjective defining characteristics

Extreme signs/ symptoms

Severe signs/ symptoms

Moderate signs/ symptoms

Minimal signs/ symptoms

No signs/ symptoms

 

 

 


 


 

 

 

 

 

 

 

 

 

Procedure

To harmonize the value domains with the Omaha System may require:

Reversing the scoring: For some data elements, a score of 1 is positive, while 5 is negative. These have been reversed to match the Omaha System.

Example:

In general, would you say your mental health is excellent, very good, good, fair or poor? https://www.indicatorregistry.net/item/3413/

The values have been reversed to match the Omaha System (1=poor and 5=excellent). Statistics Canada lists the values as 1=excellent and 5=poor. If comparing with data provided by external sources, ensure the values align with collected data.

Reducing the number of permissible values: The PRSO is always a five-point scale. This means sometimes reducing the number of permissible values so that there are 5 response options. What is lost in detail is made up for in interoperability.

Example:

Using a scale of 0 to 10 where 0 means "Very dissatisfied" and 10 means "Very satisfied", how do you feel about your life as a whole right now?

The values would be collapsed to a five-point scale, where 1 = very dissatisfied and 5 = very satisfied.

Assigning different values to response options: Questions with fewer than five response options can also be harmonized with the Omaha System by assigning a score to align with the five-point PRSO.

Examples:

a) How often did staff treat you with courtesy and respect?

Four-point value domain: Never = 1; Sometimes=2; Usually=4; and Always=5.

b) Do you have any difficulty seeing, even when wearing glasses?

Where “No” is the positive result, no=5, and yes=1. (Yes/No questions: where Yes is a positive result, yes = 5 and no=1)

Inconsistencies in the indicator registry

In the indicator registry, some data elements have been assigned a value domain that is the PRSO (either behavior, knowledge, or status), while others have their original value domain that has been re-scored to harmonize with the Omaha System. This is a known inconsistency within the indicator registry will require review and update by an informatics coder in the future to decide on the best method.

Examples:

Data element assigned to PRSO: Team effectiveness. Note that the survey question should NOT provide the PRSO for the value domain, but rather the original answer options.

Data element with original value domain, re-scored to harmonize with Omaha System: Equity in service delivery. The original value domain has been rescored from 11 to 5 points, but it has not been assigned PRSO value domain.

 

Coding of Data Elements

Each data element has been coded using a combination of the problem classification scheme and the signs and symptoms. Each code begins with “SS” for signs/symptoms, followed by the SS number, and a short alpha description of the element

Example:

Code: SS1200azssm

Data element: An individual’s mental health status, rated on the Arizona Self-Sufficiency Scale.

Name: Person - mental health (Arizona self-sufficiency scale), status rating code (OMS 2005) N

This corresponds with:

  • Omaha Problem: 0012 Mental Health
  • Sign/Symptom: n/a - it is overall mental health
  • PRSO: Status

Reading the indicator registry

Review the “Comments” section on the data element to see what transformations have been made to the original value domain to align with the Omaha System, and other relevant notes.

 


[1] http://omahasystem.org/problemclassificationscheme.html

Last modified: Dec. 1, 2017, 8:04 p.m.