MII IG PRO
2027.0.0-ballot.1 - Germany

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

SCOFF

Clinical Context

The SCOFF is a screening instrument for eating disorders consisting of five yes/no questions. It was deliberately kept short and memorable so that it can be used at first contact without specialist training — the name is an acronym of the English key words: Sick, Control, One stone, Fat, Food.

Scoring and interpretation (sum score 0–5, Morgan et al. 1999): each "yes" answer counts one point. A score of two or more marks the screening as positive; in the original study this cut-off reached 100 % sensitivity and 87.5 % specificity against the clinical diagnosis of anorexia or bulimia nervosa.

A positive screening is explicitly not a substitute for a diagnosis: the instrument is designed to raise a suspicion that warrants careful clinical assessment.

FHIR Implementation

Language strategy: English as the primary language (the original per Morgan et al. 1999, verbatim from the published question box), German texts as translations from the PCOR-MII Item Level Dictionary.

Questionnaire

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

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

Implementation notes:

  • linkIds scoff-q01…scoff-q05, score item scoff-score-total.
  • Answers as inline answerOption with SNOMED CT 373067005 (No, weight 0) and 373066001 (Yes, weight 1) — bundled in the shared RuleSet YesNoAnswerOptions. A dedicated MII CodeSystem would duplicate standardised terminology; since no itemWeight property can be attached to SNOMED concepts, the weights sit inline rather than in an answerValueSet.
  • Score calculation via FHIRPath: %resource.item.where(linkId.matches('^scoff-q0[1-5]$')).answer.value.weight().sum().
  • Divergence between original and translation: item 3 asks about "One stone" (≈ 6.35 kg) in the original, the German version about "mehr als 6 kg". Both wordings are preserved verbatim; the threshold is not harmonised.
  • Neither a LOINC nor a SNOMED CT code exists for the SCOFF instrument itself (checked against LOINC 2.83 and SNOMED International 2026-05-01); coding is therefore via the MII questionnaire catalogue.

The complete resource: Questionnaire definition.

Score Representation

  1. Calculated item in the QuestionnaireResponse (linkId: scoff-score-total)
  2. Observation carrying the MII score code scoff-total
  3. ObservationDefinition: mii-obsdef-pro-score-scoff — value range 0–5 {score}, higher = greater likelihood of an eating disorder

The cut-off ≥ 2 is documented as a qualifiedInterval but deliberately not shipped as executable interpretation logic (see Scoring).

License

SCOFF © Morgan, Reid & Lacey 1999 (BMJ) — freely available; no permission required for reproduction, translation or use.

Sources

  • Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 1999;319(7223):1467–1468. doi:10.1136/bmj.319.7223.1467
  • Hölling H, Schlack R. Essstörungen im Kindes- und Jugendalter. Bundesgesundheitsblatt 2007;50:794–799. doi:10.1007/s00103-007-0242-6