Path | Short | Definition | Comments |
---|---|---|---|
A structured set of questions and their answers | A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to. | The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse. | |
identifier | Unique id for this set of answers | A business identifier assigned to a particular completed (or partially completed) questionnaire. | |
basedOn | Request fulfilled by this QuestionnaireResponse | The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression. | |
partOf | Part of this action | A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of. | Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn. |
questionnaire | Form being answered | The Questionnaire that defines and organizes the questions for which answers are being provided. | If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.). |
status | in-progress | completed | amended | entered-in-error | stopped | The position of the questionnaire response within its overall lifecycle. | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
subject | The subject of the questions | The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information. | If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types. |
encounter | Encounter created as part of | The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated. | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter. |
authored | Date the answers were gathered | The date and/or time that this set of answers were last changed. | May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured. This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible. |
author | Person who received and recorded the answers | Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system. | Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated. |
source | The person who answered the questions | The person who answered the questions about the subject. | If not specified, no inference can be made about who provided the data. |
item | Groups and questions | A group or question item from the original questionnaire for which answers are provided. | Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer). |
item.id | Unique id for inter-element referencing | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | |
item.extension | Additional content defined by implementations | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
item.modifierExtension | Extensions that cannot be ignored even if unrecognized | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
item.linkId | Pointer to specific item from Questionnaire | The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource. | |
item.definition | ElementDefinition - details for the item | A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item. | The ElementDefinition must be in a [StructureDefinition](structuredefinition.html#), and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. There is no need for this element if the item pointed to by the linkId has a definition listed. |
item.text | Name for group or question text | Text that is displayed above the contents of the group or as the text of the question being answered. | |
item.answer | The response(s) to the question | The respondent's answer(s) to the question. | The value is nested because we cannot have a repeating structure that has variable type. |
item.answer.id | Unique id for inter-element referencing | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | |
item.answer.extension | Additional content defined by implementations | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
item.answer.modifierExtension | Extensions that cannot be ignored even if unrecognized | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
item.answer.value[x] | Single-valued answer to the question | The answer (or one of the answers) provided by the respondent to the question. | More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire. |
item.answer.item | Nested groups and questions | Nested groups and/or questions found within this particular answer. | |
item.item | Nested questionnaire response items | Questions or sub-groups nested beneath a question or group. |
QuestionnaireResponse provides a complete or partial list of answers to a set of questions filled when responding to a questionnaire. The questions may be included directly or by reference to a Questionnaire resource that defines the questions as well as the constraints on the allowed answers. In some cases, both formal rules for editing the questionnaire (via link to Questionnaire) as well as sufficient local information to allow rendering of the questionnaire may be provided.
Each time a questionnaire is completed for a different subject or at a different time, a distinct QuestionnaireResponse is generated, though it may be possible for a previously entered set of answers to be edited or updated.
Questionnaire responses cover the need to communicate data originating from forms used in medical history examinations, research questionnaires and sometimes full clinical specialty records. In many systems this data is collected using user-defined screens and forms. Questionnaire responses record specifics about data capture - exactly what questions were asked, in what order, what answers were given, etc. Each of these questions is part of the Questionnaire, and as such the Questionnaire is a separately identifiable Resource, whereas the individual questions are not.
Examples of Questionnaires include:
QuestionnaireResponse resources can be validated against their corresponding Questionnaire to verify that required groups and questions are answered and that answers fit constraints in terms of cardinality, data type, etc.
The QuestionnaireResponse resource captures the responses to a questionnaire, while Questionnaire represents the definition of the questionnaire form, including what questions are asked, how they're organized and the constraints on the allowed answers.
While Observation, with its nested relatedObservation
structure, can create complex hierarchies of
questions and answers, the focus is different. First, Observation is used primarily for capturing data elements that
are "true" observations - lab measurements, vital signs, social assessments, etc., while QuestionnaireResponse can be used to capture
any types of data, including data that would typically map to other resources (Procedure, Patient,
MedicationStatement, etc.). Second, the focus of QuestionnaireResponse includes the specific phrasing
and organization of the questions. All data must be explicitly captured as a question. With Observation, the focus is
only on the meaning of the answer, not what question was asked (assuming a question was even asked at all). Additional information such as normal
ranges, interpretation, date, etc., may also be captured.
Refer to additional guidance provided in the Questionnaire resource dealing with the design of questionnaires.
A QuestionnaireResponse
may be stand-alone or may point to the definition of the questions in Questionnaire.
If the QuestionnaireResponse refers to a Questionnaire:
linkId
elementdisplay
. This might also include items
that were >not enabled when the Questionnaire was answered, though of course these will not have answersQuestionnaireResponse resources can have answers with values of type Attachment. These attachments will typically be selected by the user answering the questionnaire and this selection may be done in an uncontrolled environment. Systems should ensure that the attachment is of the desired type and should take precautions before rendering or executing any attached content.
For most resources, the type of information that can be conveyed in the resource is determined by the resource, and the key attributes that determine the sensitivity level of the information are also known; e.g., drug, observation type, clinical trial randomization status, etc. However, for QuestionnaireResponse, the sensitivity of an instance is dependent on what type of Questionnaire it is associated with. And the data elements that determine that sensitivity could be the answers to any of the questions. This makes automatically enforcing access control rules more challenging. Designers should take these challenges into account and may need to place stricter access controls around QuestionnaireResponse to ensure that access to information is not granted improperly.
author | The author of the questionnaire response | QuestionnaireResponse.author |
authored | When the questionnaire response was last changed | QuestionnaireResponse.authored |
based-on | Plan/proposal/order fulfilled by this questionnaire response | QuestionnaireResponse.basedOn |
encounter | Encounter associated with the questionnaire response | QuestionnaireResponse.encounter |
identifier | The unique identifier for the questionnaire response | QuestionnaireResponse.identifier |
part-of | Procedure or observation this questionnaire response was performed as a part of | QuestionnaireResponse.partOf |
patient | The patient that is the subject of the questionnaire response | QuestionnaireResponse.subject.where(resolve() is Patient) |
questionnaire | The questionnaire the answers are provided for | QuestionnaireResponse.questionnaire |
source | The individual providing the information reflected in the questionnaire respose | QuestionnaireResponse.source |
status | The status of the questionnaire response | QuestionnaireResponse.status |
subject | The subject of the questionnaire response | QuestionnaireResponse.subject |