eHealth Infrastructure
3.0.0 - release

eHealth Infrastructure - Local Development build (v3.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: ehealth-questionnaire

Official URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire Version: 3.0.0
Active as of 2024-05-16 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.

Help text

The item.helpText element supports adding additional descriptions and help for a question. The element must contain a helpText.text string value, and can additionally hold a xhtml formatted equivalent in the helpText.xhtml string value. The helpText.xhtml value should follow the same standards as http://hl7.org/fhir/extension-rendering-xhtml.html.

ConditionId

The item.enableBehavior.conditionId can be used to identify conditions. This property is primarily used when modeling Questionnaires which should be transformed to CDA documents.

External identifier

The item.externalIdentifier can be used to identify either questionnaire groups or questionnaire questions. This property is primarily used when modeling Questionnaires which should be transformed to CDA documents.

Usage:

Formal Views of Profile Content

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

This structure is derived from Questionnaire

NameFlagsCard.TypeDescription & Constraintsdoco
.. Questionnaire Questionnaire
... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
... recommendation 0..1CodeableConceptDegree to which this questionnaire is recommended for use.
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-recommendation
Binding: QuestionnaireRecommendation (required)
... intendedOrganization 0..*Reference(ehealth-organization) {r}The organization intended to use this questionnaire.
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-intendedOrganization
... modifierRole 1..*(Complex)Modifier role
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-modifier-role
... type 1..*CodeableConceptConcept that represents the overall questionnaire
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-type
Binding: Questionnaire Types (required)
... styleSensitive 0..1booleanAre styles important for processing?
URL: http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive
... employeeTitle 0..1stringTitle for clinicians
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-employee-title
... usage 0..1stringusage
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-usage
... predecessor 0..1IdentifierPredecessor
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-predecessor
... base 0..1IdentifierBase
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-base
... baseEnvironment 0..1IdentifierBase environment
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-base-environment
... version 1..1stringBusiness version of the questionnaire
... jurisdiction 0..*CodeableConceptIntended jurisdiction for questionnaire (if applicable)
Binding: Jurisdiction (required)
... item C0..*BackboneElementQuestions and sections within the Questionnaire
sliderStepValueDecimal-Type: Item must have type='decimal' when using extension 'ehealth-questionnaire-sliderStepValueDecimal'
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... questionnaire-minOccurs 0..1integerMinimum repetitions
URL: http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs
.... questionnaire-maxOccurs 0..1integerMaximum repetitions
URL: http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs
.... minValue 0..1date, dateTime, time, decimal, integer, QuantityMust be >= this value
URL: http://hl7.org/fhir/StructureDefinition/minValue
.... maxValue 0..1date, dateTime, time, decimal, integer, QuantityMust be <= this value
URL: http://hl7.org/fhir/StructureDefinition/maxValue
.... questionnaire-sliderStepValue 0..1integerIncrement value for slider
URL: http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue
.... questionnaire-sliderStepValueDecimal 0..1decimalThe slider step-value as decimal-number
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-sliderStepValueDecimal
.... feedback 0..1(Complex)Feedback if reponse is within the defined range.
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-feedback
.... overviewUsageMode 0..*CodeableConceptIdentifies whether the specified element and/or results of the element should appear in overview or table presentation.
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-overviewUsageMode
Binding: Overview Usage Mode (required)
.... itemControl 0..1CodeableConceptE.g. Fly-over, Table, Checkbox, Combo-box, Lookup, etc.
URL: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Binding: QuestionnaireItemUIControlCodes (extensible): User interface controls or widgets used for questionnaire items.

..... value[x] 1..1CodeableConceptValue of extension
Binding: Questionnaire Item Control (required)
.... ehealth-question-image 0..1(Complex)The image for a questionnaire
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image
.... shortText 0..1stringShort text
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-shortText
.... helpText 0..1(Complex)Help text
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText
.... answerSignificance 0..*(Complex)The Answer significance for an answer
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-answerSignificance
.... externalIdentifier 0..1IdentifierExternal Identifier
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-external-identifier
.... text
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... xhtml 0..1stringString equivalent with html markup
URL: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
.... enableBehavior
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... conditionId 0..1stringCondition Id
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-enableBehavior-conditionId
.... answerOption
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... ehealth-answeroption-image 0..1(Complex)The image for a questionnaire
URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image
..... value[x]
...... xhtml 0..1stringString equivalent with html markup
URL: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
.... initial
..... value[x]
...... xhtml 0..1stringString equivalent with html markup
URL: http://hl7.org/fhir/StructureDefinition/rendering-xhtml

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Questionnaire.jurisdictionrequiredJurisdiction
http://ehealth.sundhed.dk/vs/jurisdiction
from this IG
Questionnaire.item.extension:itemControl.value[x]requiredQuestionnaireItemControl
http://ehealth.sundhed.dk/vs/questionnaire-item-control
from this IG

Constraints

IdGradePath(s)DetailsRequirements
sliderStepValueDecimal-TypeerrorQuestionnaire.itemItem must have type='decimal' when using extension 'ehealth-questionnaire-sliderStepValueDecimal'
: extension('http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-sliderStepValueDecimal').exists() implies type = 'decimal'

 

Other representations of profile: CSV, Excel, Schematron