Questionnaire Resource Proposal

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Questionnaire

Owning committee name

Orders_&_Observations_WG (temporarily owned by Core team)

Contributing or Reviewing Work Groups

  • Patient Care
  • RCRIM


FHIR Resource Development Project Insight ID

Pending


Scope of coverage

The Questionnaire resource describes artifacts containing sets of answers to predefined lists of questions, a.k.a. questionnaires or "forms". Questionnaires cover the need to record/communicate data originating from medical history examinations, research questionnaires in clinical studies and sometimes full clinical speciality records. Each questionnaire refers to a specific 'instance' of this capture - it hs a single date of capture and can be linked to only a single visit for example.

There is possible overlap between the information covered by Questionnaires and other Resources (FamilyHistory, MedicationStatement, Observation, Procedure, etc.): Questionnaires record specifics about data capture - exactly what questions were asked, in what order, what choices for answers were, etc. The section below ('Exclusions') given guidance to where use of a Questionnaire is not appropriate.

The Questionnaire is a separate identifiable resource, whereas the individual questions within it are not. However, data captured using a Questionnaire frequently can (and should) be used to populate other Resources. For example, questions about allergies can be used to populate AllergyIntolerance instances, questions about medications would be used to populate MedicationStatement, etc.

Even so, the choice between using Questionnaires or separate Resources may be dictated by the procedure of collection and recording. E.g. if the data is captured as a physician-agreed (electronic) form, it might be impossible or undesirable to distill separate resources from it, and the Questionnaire must be stored and communicated as a whole. Interoperability of such Questionnaires is limited as interpretation of its contents is only known to the circle of parties that were involved in its definition.

Data captured only in questionnaires can be difficult to query after-the-fact. Queries against other resources will not return data captured only in questionnaires. And querying against Questionnaires directly may not find all desired data, depending on how the questions may have been phrased or encoded over time or by different clinicians. Encoding data from questionnaires using other, more specific, resources increases the ability and consistency with which it can be queried.

The Questionnaire resource is used to capture answers, but also provides a mechanism to include the definition (i.e. text, choices, repeats) of the questions on the form or questionnaire.

RIM scope

Observation


Resource appropriateness

Questionnaires and forms are part of any patient file and cover a large portion of the (semi-structured) data kept for a patient. In many systems this data is collected using user-defined screens and forms. These forms (especially the physical forms) are normally numbered and kept in the patient file for reference.


Expected implementations

Questionnaires and (digital) forms are supported by most, if not all, hospital and ambulatory care information systems.


Content sources

  • CDISC's CDASH specification, XForms, present experience in the core team and interested early adopters.
  • Any other templated based information capture


Exclusions

This section lists scenarios where a questionnaire would seem appropriate, but there is a more specific resource. It may be appropriate to use a questionnaire linked to the resource to record details of the capture of information that populated the other resource.

  • Questionnaires differ from Lists because Lists regroup or summarize existing information, while Questionnaires contain original, clinician collected data.
  • Questionnaires are similar to Documents in aggregation a range of information. However, the purpose of a Questionnaire is the capture of raw data as opposed to a Document whose purpose is the composition and assertion of information/resources intended for long term persistence.
  • A Family History resource collects information about common conditions afflicting relatives of the concerned patient.

Example Scenarios

Examples of Questionnaires are:

  • Past medical history (PMH)
  • Social history
  • Research questionnaires
  • Quality and evaluation forms


Resource Relationships

The resource references the Encounter, Patient, Practitioner and RelatedPerson. It's Answer.evidence can point to any resource, referring to information the answer is based on.

Questionnaire is most probably only referred to by Document.


Timelines

Expected to be ready for the sept 2013 DSTU ballot


gForge Users

ewoutkramer


Issues

  • RIM scope needs to be defined in a manner that distinguishes Questionaire from the general Observation resource and other resources such as AllergyIntolerance, problem, etc. (Also need to indicate classCode, moodCode, etc.) Not sure that Observation is the correct root. Document, container or grouper might be better. Not sure what the "question" is for the root class.
  • Overlap between other resources (eg family history) should be specified) - ie it should be stated that a questionnaire is NOT to be used for this purpose, though the more specific resoruce may well reference a questionnaire (via an extension) that was used to create/update it)
  • What is the relationship between the list of questions to ask (a template) and a completed form? (class vs instance)