This page is part of the MII Implementation Guide PRO (v2027.0.0-ballot.1: 2027 Ballot 5) based on FHIR (HL7® FHIR® Standard) 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

ISR-Z

Clinical Context

The ISR (ICD-10 Symptom Rating) is a German-language self-report instrument that captures psychological symptoms along the ICD-10 taxonomy. The full instrument comprises 29 items and six syndrome scales (depression, anxiety, obsessive-compulsive, somatoform, eating disorders and a supplementary scale) plus a total score.

The MII PRO module deliberately covers only the obsessive-compulsive subscale (ISR-Z) with three items — the excerpt collected in PCOR-MII. Items are answered on a five-point agreement scale (0 = does not apply, to 4 = applies extremely).

⚠️ Scoring: mean, not sum

The ISR departs from the summation used elsewhere in this module: scale values are means of their constituent items, and the total score of the full ISR is the sum of the scale means divided by the number of scales.

For the Z subscale this means the scale value is the mean of the three items, range 0–4 — not 0–12. Summing here by mistake produces values comparable neither to published norms nor to other ISR evaluations.

FHIR Implementation

Language strategy: German as the primary language — the ISR was developed in German. No English translation is claimed or invented.

Questionnaire

Canonical URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-pro/Questionnaire/mii-qst-pro-isr-z

Capabilities: Displayable, Collectable, Calculatable, Extractable, Domain-aligned

Implementation notes:

• linkIds isr-z-q01…isr-z-q03, score item isr-z-score-mean.
• A dedicated, instrument-specific answer scale: MII CodeSystem mii-cs-pro-isr-z-answers with an itemWeight property 0–4, bound via answerValueSet. The display values are German, matching the language of the questionnaire.
• Score calculation via FHIRPath using .avg() rather than .sum(): %resource.item.where(linkId.matches('^isr-z-q0[1-3]$')).answer.value.weight().avg().
• Neither LOINC nor SNOMED CT carries a code for the ISR (checked); coding is via the MII questionnaire catalogue.

The complete resource: Questionnaire definition.

Score Representation

1. Calculated item in the QuestionnaireResponse (linkId: isr-z-score-mean)
2. Observation carrying the MII score code isr-z-mean
3. ObservationDefinition: mii-obsdef-pro-score-isr-z — value range 0–4 {score} as a decimal (a mean, hence not an integer), higher = more pronounced obsessive-compulsive symptoms

License

Freely available per the PCOR-MII DIZ implementation list. Developed in German; no translation required.

Sources

• Tritt K, von Heymann F, Zaudig M, Zacharias I, Söllner W, Loew T. Entwicklung des Fragebogens „ICD-10-Symptom-Rating" (ISR). Zeitschrift für Psychosomatische Medizin und Psychotherapie 2008;54(4):409–418. doi:10.13109/zptm.2008.54.4.409