eHealth Infrastructure
2.3.0 - release

eHealth Infrastructure - Local Development build (v2.3.0). See the Directory of published versions

Resource Profile: ehealth-questionnaire

Official URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire Version: 2.3.0
Active as of 2022-09-27 Computable Name: ehealth-questionnaire

Introduction

A Questionnaire is a structured set of questions intended to guide the collection of answers from end-users. Questionnaires provide detailed control over order, presentation, phraseology and grouping to allow coherent, consistent data collection.

Scope and Usage

In the eHealth Infrastructure the Questionnaire resource is used in line with this. Questionnaires are built and maintained by Practitioners and presented to Patients by client applications in order to gather input and answers from Patients in the form of QuestionnaireResponse resources.

Setting minimal and maximal number of permitted choices

A question where possible answers are given as a list of options (of item.type set to choice) can allow multiple choices by setting item.repeats to true. When no further constraints are set, item.repeats set to true means that any number of the options can be provided as answer to the question in a QuestionnaireResponse. The standard extensions item.questionnaire-minOccurs and item.questionnaire-maxOccurs can be used to set such further constraints.

  • item.questionnaire-minOccurs sets the minimum number of answers allowed, for instance 2 (of the number of options, say, 5). The element shall be set only when its value is greater than one.
  • item.questionnaire-maxOccurs sets the maximum number of answers allowed, for instance 3 (of the number of options, say 5). The element shall be set only when its value is greater than one.

When exactly one answer shall be required, item.requied shall be set to true and item.repeats shall be set to false. When exactly one answer is permitted, item.requied shall be set to false and item.repeats shall be set to false. In these cases, the minOCcurs and maxOccurs shall not be used.

Feedback to the Patient

The Questionnaire resource supports the Question Feedback Pattern from DK QFDD questionnaires. This enables immediate feedback to the patient upon answering a question.

The feedback is pre-defined in the Questionnaire resource using the item.feedback element, so that for each item a patient feedback can be prepared. The feedback will be shown to the patient if the patient’s answer to an item lies within a given interval. The mechanism only works for questions which can be answered with a numeric value. The interval is defined by the min and a max elements of the feedback extension. If the Patient answers the item with a numeric value in the interval given by min-max then the value of the feedback extension is intended to be shown to the Patient.

Recommendation

In the recommendation element, a questionnaire can optionally hold a “degree of recommendation” intended to aid the Practitioner in deciding whether or not the Questionnaire should be associated with an ActivityDefinition and used in one or more PlanDefinition.

Images for items and answerOptions

For each item and item.answerOption in a Questionnaire, a small image can be associated through extensions item.ehealth-questionnaire-image and item.answerOption.ehealth-questionnaire-image, respectively. Both extensions are based on Binary containing the image data base64 encoded.

In the service, the Binary.contentType is verified against a ValueSet with uri http://ehealth.sundhed.dk/vs/questionnaire-item-image-format while the size of Binary.data must not exceed a configurable size, currently 266Kb (base64 encoded).

Answer significance

The item.ehealth-questionnaire-answerSignificance element functions as a triaging indicator, describing the importance of answers to respective questions.

Answer significance is a colour. Currently the possible values are red, yellow, green. Answer condition specifies the conditions that must be fulfilled for the answer to result in the given colour.

answerSignificance has two sub elements:

  • The answerSignificance.significance element which states the triaging color
  • The answerSignificance.answerCondition contains the value or interval limits for comparison against the given answer.
    • answerCondition.value[x] is the value to compare with an answer and contains various type depending on the need.
    • answerCondition.operator determines the relationship between the answerCondition.value[x] and a given answer. When a single answerSignificance.answerCondition is given, it represents a precise match or possibly open ended interval. Two answerSignificance.answerCondition can specify an interval. To check that a written answer exists, use answerCondition.operator = exists and answerCondition.valueBoolean = true.

Item control

The item.questionnaire-itemControl element enables indication of what sort of user interface control type, for instance radio buttons, to use when displaying an item.

Formatted text

The elements item.text, item.answerOption.value, and item.inital.value supports formatted text for valueString using the standard extension: http://hl7.org/fhir/extension-rendering-xhtml.html Note that the original text without formatting must be added to the elements item.text, item.answerOption.value, and item.inital.value, respectively, for those where the formatted extension has been used.

The extension rendering-styleSensitive indicates if clients must be able to display the formatted text for this Questionnaire, or if not capable to do this, at least indicate to the user that rendering is not appropriate.

Title and description

A Questionnaire has two sets of titles and desriptions. title and description are intended for the citizens and should be of a natural language. Whereas ehealth-employee-title and ehealth-usage are intended for clinicians and should be of a specific and professional language.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Questionnaire

Summary

Mandatory: 3 elements (1 nested mandatory element)

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Questionnaire.languagepreferredCommonLanguages
Max Binding: AllLanguages
Questionnaire.statusrequiredPublicationStatus
Questionnaire.subjectTyperequiredResourceType
Questionnaire.jurisdictionrequiredJurisdiction
Questionnaire.codeexampleQuestionnaireQuestionCodes
Questionnaire.item.extension:itemControl.value[x]extensibleQuestionnaireItemUIControlCodes
Questionnaire.item.extension:itemControl.value[x]:valueCodeableConceptrequiredQuestionnaireItemControl
Questionnaire.item.codeexampleQuestionnaireQuestionCodes
Questionnaire.item.typerequiredQuestionnaireItemType
Questionnaire.item.enableWhen.operatorrequiredQuestionnaireItemOperator
Questionnaire.item.enableWhen.answer[x]exampleQuestionnaireAnswerCodes
Questionnaire.item.enableBehaviorrequiredEnableWhenBehavior
Questionnaire.item.answerOption.value[x]exampleQuestionnaireAnswerCodes
Questionnaire.item.initial.value[x]exampleQuestionnaireAnswerCodes