4.7 Questionnaire リソース

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A set of answers to predefined lists of questions. The questions may be ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the underlying questions.

The resource name as it appears in a RESTful URL is [root]/questionnaire/

A Questionnaire is a structured set of questions and their answers. The Questionnaire may be a flat list, or can be hierarchically organized in groups and sub-groups, each containing questions. Questions may contain and single answer, which can take the form of simple text, numbers, dates or a set of coded choices.

Questionnaires cover the need to communicate data originating from forms used in medical history examinations, research questionnaires and sometimes full clinical speciality records. In many systems this data is collected using user-defined screens and forms. Questionnaires record specifics about data capture - exactly what questions were asked, in what order, what choices for answers were, etc. Each of these questions are part of the Questionnaire, and as such the Questionnaire is a separately identifiable Resource, whereas the individual questions are not.

Groups and questions that make up a Questionnaire can be explicitly named to refer to externally defined numbering or identification of questions and sections on formally defined questionnaires. This allows extraction of the data on a form and post-processing of the data contained in a Questionnaire. Such naming is not required however and Questionnaires may be quite loosely defined. The sectionQuestionnaire versus Resources below discusses the issues of collecting data in such loosely defined Questionnaires versus collecting data as well-defined separate Resources.

Questionnaires differ from Lists because Lists regroup or summarize existing information, while Questionnaires contain original, clinician collected data. Questionnaires are similar to Documents. However, the purpose of a Questionnaire is the capture of raw data as opposed to the composition and assertion of information intended for long term persistence and use in a Document.

Examples of Questionnaires are:

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

Support for validation is outside the scope of this Resource, although basic structural features can be defined using the Questionnaire core extensions.

Alternate definitions: Schema/Schematron, Resource Profile

• Inv-1: On Questionnaire.question: Must supply either a simple answer, a choice, data or nothing (xpath on f:Questionnaire/f:question: count(f:data) + count(f:choice) + count(f:value) <= 1)

• The information on questionnaires can be collected during several interactions with the patient, and therefore amended and changed over time. The Questionnaire.status attribute is used to support this lifecycle.
• Questionnaires can be authored by clinicians, the patient his/herself or a patients relatives (or even owner in the case of animals). Clinicians may author questionnaires, where the answers are provided by others on behalf of the patient his/herself. Additionally, information gathered for the purpose of a patient may be about the patient's relatives (e.g. in family anamnesis). Therefore, Questionnaire makes a distinction between the author, the subject and the source of information.
• Questionnaires often correspond to predefined forms, which may be recorded using Questionnaire.name. Questionnaires.identifier identify a specific set of answers to the questions on these forms.
• Questionnaires may directly contain Questions and/or contain Groups and subgroups with Questions. These may or may not correspond to the structure of the original form. If they do correspond, Groups may be named, so answers on a Questionnaire can refer to a corresponding sections of a form. Likewise, answers to Questionnaires can be named to refer to the question on a form. It is also possible to include textual content on the form in Questionnaire (see below).
• Since sections and questions may be answered multiple times, the same Group.name and Question.name may appear multiple times.
• Questionnaire allows for flexible naming and structuring of its contents to reflect the flexible and varying nature of forms and questionnaires. It explicitly does not try to standardize or streamline exchange of its contents outside its context of use, although exchanging partners may further constrain its structure and flexibility using profiles to define standardized, reusable forms.
• Because of the lack of explicit support for Questionnaires in HL7v3, HL7 CDA Documents frequently used named sections with Observations to model Questionnaires. Such use cases should now utilize the Questionnaire Resource instead.
• The Questionnaire's encounter element can be used to link to the encounter during which the Questionnaire was taken. This can be relevant since the encounter gives context to the answers and can be used to relate information in the Questionnaire to orders and observations that were done during the same Encounter.

There is considerable overlap between the information covered by Questionnaires and other Resources (especially FamilyHistory, MedicationStatement, Observation, Procedure, etc.): Questionnaire's flexible structure can easily be misused to capture any data, even data that should be captured as separate Resources. 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.

However, 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. Moreover, 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: encoding data from such Questionnaires using other, more specific, Resources increases the ability and consistency with which it can be understood and queried.

To facilitate better standardization of the information on a form, Questionnaire has the capacity (Using a Question's data element) to allow systems to communicate (part of) the answers in the form of structured FHIR data. This provides an upgrade path to the questionnaire designer and communicating systems, where capable systems may use FHIR data to answer (sets of) questions, whereas other systems can simply continue to supply the direct answers as input by the user.

The Questionnaire has been specifically designed to be able to contain both a form's questions and answers. The Group and Question construct has elements to carry textual data of the form like headings, explanatory text, actual question text and the text of (multiple)choice options. As such, the Questionnaire can be used to:

• only contain answers (in which case the actual layout and questions of the form is defined in some external way, and the nameelements are used to relate the answers to the questions)
• contain a combination of questions and answers (e.g. when it is deemed important to keep the actual question text with the answer) or
• only contain the Questions, which is equivalent to an "empty form".

This third case can be useful to make Questionnaire serve as a kind of form "definition", where FHIR clients receive the empty form, display it to the user, get answers from the users and then return the combined questions and answers to the server. The questionnaire core extensions provide additional means for control over repeating sections and expected answer format.

Search Parameters for RESTful searches. The standard parameters also apply. See Searching for more information.