The IHE ACDC Questionnaire Profile defines the constraints on Questionnaire resources returned by the PCC-71 transaction, and referenced by the QuestionnaireResponse resource used in the PCC-73 transaction. This resource describes the Questionnaire that represents an Assessment that can be performed on a patient.

Constraints

At a minimum, Questionnaire resources that comply with this provide must provide:

extension[@url=”http://ihe.net/fhir/ACDC/StructureDefinition/questionnaire-launchurl”]

The EHR launch URL for the questionnaire. This is the URL to use for the SMART on FHIR EHR Launch flow. At least one of these elements must be present when no items are provided in the questionnaire. It enables limited content to be returned from a questionnaire to enable others to explore assessment instrument content without fully exposing the content of the questionnaire.

url

a canonical URI that is used represent the questionnaire. This is essentially a unique identifier for the questionnaire instrument.

name

The name of the questionnaire (for computer use).

title

The title of the questionnaire (for human use).

date

The date of last update to the questionnaire.

publisher

The name of the inidividual or organization that published the questionnaire.

description

A natural language description of the questionnaire.

item

If the EHR launch is not provided, at least one item must be present in the response. This enables the Assessor actor implement the assessment described by questionnaire.

• Text Summary
• Differential Table
• Snapshot Table
• All

This structure is derived from Questionnaire

Name	Flags	Card.	Type	Description & Constraints
Questionnaire		0..*	Questionnaire	A structured set of questions
extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
questionnaire-launchurl	S	0..*	uri	Extension URL: http://ihe.net/fhir/ACDC/StructureDefinition/questionnaire-launchurl
url		1..1	uri	Canonical identifier for this questionnaire, represented as a URI (globally unique)
name		1..1	string	Name for this questionnaire (computer friendly)
title		1..1	string	Name for this questionnaire (human friendly)
date		1..1	dateTime	Date last changed
publisher		1..1	string	Name of the publisher (organization or individual)
description		1..1	markdown	Natural language description of the questionnaire
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Questionnaire	I	0..*	Questionnaire	A structured set of questions
id	Σ	0..1	string	Logical id of this artifact
meta	ΣI	0..1	Meta	Metadata about the resource
implicitRules	?!ΣI	0..1	uri	A set of rules under which this content was created
language	I	0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages
text	I	0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	I	0..*	Extension	Extension Slice: Unordered, Open by value:url
questionnaire-launchurl	SI	0..*	uri	Optional Extensions Element URL: http://ihe.net/fhir/ACDC/StructureDefinition/questionnaire-launchurl
modifierExtension	?!I	0..*	Extension	Extensions that cannot be ignored
url	ΣI	1..1	uri	Canonical identifier for this questionnaire, represented as a URI (globally unique)
identifier	ΣI	0..*	Identifier	Additional identifier for the questionnaire
version	ΣI	0..1	string	Business version of the questionnaire
name	ΣI	1..1	string	Name for this questionnaire (computer friendly)
title	ΣI	1..1	string	Name for this questionnaire (human friendly)
derivedFrom	I	0..*	canonical(Questionnaire)	Instantiates protocol or definition
status	?!ΣI	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required)
experimental	ΣI	0..1	boolean	For testing purposes, not real usage
subjectType	ΣI	0..*	code	Resource that can be subject of QuestionnaireResponse Binding: ResourceType (required)
date	ΣI	1..1	dateTime	Date last changed
publisher	ΣI	1..1	string	Name of the publisher (organization or individual)
contact	ΣI	0..*	ContactDetail	Contact details for the publisher
description	I	1..1	markdown	Natural language description of the questionnaire
useContext	ΣI	0..*	UsageContext	The context that the content is intended to support
jurisdiction	ΣI	0..*	CodeableConcept	Intended jurisdiction for questionnaire (if applicable) Binding: Jurisdiction ValueSet (extensible)
purpose	I	0..1	markdown	Why this questionnaire is defined
copyright	I	0..1	markdown	Use and/or publishing restrictions
approvalDate	I	0..1	date	When the questionnaire was approved by publisher
lastReviewDate	I	0..1	date	When the questionnaire was last reviewed
effectivePeriod	ΣI	0..1	Period	When the questionnaire is expected to be used
code	ΣI	0..*	Coding	Concept that represents the overall questionnaire Binding: QuestionnaireQuestionCodes (example)
item	I	0..*	BackboneElement	Questions and sections within the Questionnaire que-1: Group items must have nested items, display items cannot have nested items que-3: Display items cannot have a "code" asserted que-4: A question cannot have both answerOption and answerValueSet que-5: Only 'choice' and 'open-choice' items can have answerValueSet que-6: Required and repeat aren't permitted for display items que-8: Initial values can't be specified for groups or display items que-9: Read-only can't be specified for "display" items que-10: Maximum length can only be declared for simple question types que-11: If one or more answerOption is present, initial[x] must be missing que-12: If there are more than one enableWhen, enableBehavior must be specified que-13: Can only have multiple initial values for repeating items
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId	I	1..1	string	Unique id for item in questionnaire
definition	I	0..1	uri	ElementDefinition - details for the item
code	I	0..*	Coding	Corresponding concept for this item in a terminology Binding: QuestionnaireQuestionCodes (example)
prefix	I	0..1	string	E.g. "1(a)", "2.5.3"
text	I	0..1	string	Primary text for the item
type	I	1..1	code	group | display | boolean | decimal | integer | date | dateTime + Binding: QuestionnaireItemType (required)
enableWhen	?!I	0..*	BackboneElement	Only allow data when que-7: If the operator is 'exists', the value must be a boolean
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
question	I	1..1	string	Question that determines whether item is enabled
operator	I	1..1	code	exists | = | != | > | < | >= | <= Binding: QuestionnaireItemOperator (required)
answer[x]	I	1..1		Value for question comparison based on operator Binding: QuestionnaireAnswerCodes (example)
answerBoolean			boolean
answerDecimal			decimal
answerInteger			integer
answerDate			date
answerDateTime			dateTime
answerTime			time
answerString			string
answerCoding			Coding
answerQuantity			Quantity
answerReference			Reference(Resource)
enableBehavior	I	0..1	code	all | any Binding: EnableWhenBehavior (required)
required	I	0..1	boolean	Whether the item must be included in data results
repeats	I	0..1	boolean	Whether the item may repeat
readOnly	I	0..1	boolean	Don't allow human editing
maxLength	I	0..1	integer	No more than this many characters
answerValueSet	I	0..1	canonical(ValueSet)	Valueset containing permitted answers
answerOption	I	0..*	BackboneElement	Permitted answer
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	I	1..1		Answer value Binding: QuestionnaireAnswerCodes (example)
valueInteger			integer
valueDate			date
valueTime			time
valueString			string
valueCoding			Coding
valueReference			Reference(Resource)
initialSelected	I	0..1	boolean	Whether option is selected by default
initial	I	0..*	BackboneElement	Initial value(s) when item is first rendered
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	I	1..1		Actual value for initializing the question Binding: QuestionnaireAnswerCodes (example)
valueBoolean			boolean
valueDecimal			decimal
valueInteger			integer
valueDate			date
valueDateTime			dateTime
valueTime			time
valueString			string
valueUri			uri
valueAttachment			Attachment
valueCoding			Coding
valueQuantity			Quantity
valueReference			Reference(Resource)
item	I	0..*		Unknown reference to #Questionnaire.item Nested questionnaire items
Documentation for this format

This structure is derived from Questionnaire

Summary

Mandatory: 6 elements
Must-Support: 1 element

Extensions

This structure refers to these extensions:

• http://ihe.net/fhir/ACDC/StructureDefinition/questionnaire-launchurl

Differential View

This structure is derived from Questionnaire

Name	Flags	Card.	Type	Description & Constraints
Questionnaire		0..*	Questionnaire	A structured set of questions
extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
questionnaire-launchurl	S	0..*	uri	Extension URL: http://ihe.net/fhir/ACDC/StructureDefinition/questionnaire-launchurl
url		1..1	uri	Canonical identifier for this questionnaire, represented as a URI (globally unique)
name		1..1	string	Name for this questionnaire (computer friendly)
title		1..1	string	Name for this questionnaire (human friendly)
date		1..1	dateTime	Date last changed
publisher		1..1	string	Name of the publisher (organization or individual)
description		1..1	markdown	Natural language description of the questionnaire
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Questionnaire	I	0..*	Questionnaire	A structured set of questions
id	Σ	0..1	string	Logical id of this artifact
meta	ΣI	0..1	Meta	Metadata about the resource
implicitRules	?!ΣI	0..1	uri	A set of rules under which this content was created
language	I	0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages
text	I	0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	I	0..*	Extension	Extension Slice: Unordered, Open by value:url
questionnaire-launchurl	SI	0..*	uri	Optional Extensions Element URL: http://ihe.net/fhir/ACDC/StructureDefinition/questionnaire-launchurl
modifierExtension	?!I	0..*	Extension	Extensions that cannot be ignored
url	ΣI	1..1	uri	Canonical identifier for this questionnaire, represented as a URI (globally unique)
identifier	ΣI	0..*	Identifier	Additional identifier for the questionnaire
version	ΣI	0..1	string	Business version of the questionnaire
name	ΣI	1..1	string	Name for this questionnaire (computer friendly)
title	ΣI	1..1	string	Name for this questionnaire (human friendly)
derivedFrom	I	0..*	canonical(Questionnaire)	Instantiates protocol or definition
status	?!ΣI	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required)
experimental	ΣI	0..1	boolean	For testing purposes, not real usage
subjectType	ΣI	0..*	code	Resource that can be subject of QuestionnaireResponse Binding: ResourceType (required)
date	ΣI	1..1	dateTime	Date last changed
publisher	ΣI	1..1	string	Name of the publisher (organization or individual)
contact	ΣI	0..*	ContactDetail	Contact details for the publisher
description	I	1..1	markdown	Natural language description of the questionnaire
useContext	ΣI	0..*	UsageContext	The context that the content is intended to support
jurisdiction	ΣI	0..*	CodeableConcept	Intended jurisdiction for questionnaire (if applicable) Binding: Jurisdiction ValueSet (extensible)
purpose	I	0..1	markdown	Why this questionnaire is defined
copyright	I	0..1	markdown	Use and/or publishing restrictions
approvalDate	I	0..1	date	When the questionnaire was approved by publisher
lastReviewDate	I	0..1	date	When the questionnaire was last reviewed
effectivePeriod	ΣI	0..1	Period	When the questionnaire is expected to be used
code	ΣI	0..*	Coding	Concept that represents the overall questionnaire Binding: QuestionnaireQuestionCodes (example)
item	I	0..*	BackboneElement	Questions and sections within the Questionnaire que-1: Group items must have nested items, display items cannot have nested items que-3: Display items cannot have a "code" asserted que-4: A question cannot have both answerOption and answerValueSet que-5: Only 'choice' and 'open-choice' items can have answerValueSet que-6: Required and repeat aren't permitted for display items que-8: Initial values can't be specified for groups or display items que-9: Read-only can't be specified for "display" items que-10: Maximum length can only be declared for simple question types que-11: If one or more answerOption is present, initial[x] must be missing que-12: If there are more than one enableWhen, enableBehavior must be specified que-13: Can only have multiple initial values for repeating items
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId	I	1..1	string	Unique id for item in questionnaire
definition	I	0..1	uri	ElementDefinition - details for the item
code	I	0..*	Coding	Corresponding concept for this item in a terminology Binding: QuestionnaireQuestionCodes (example)
prefix	I	0..1	string	E.g. "1(a)", "2.5.3"
text	I	0..1	string	Primary text for the item
type	I	1..1	code	group | display | boolean | decimal | integer | date | dateTime + Binding: QuestionnaireItemType (required)
enableWhen	?!I	0..*	BackboneElement	Only allow data when que-7: If the operator is 'exists', the value must be a boolean
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
question	I	1..1	string	Question that determines whether item is enabled
operator	I	1..1	code	exists | = | != | > | < | >= | <= Binding: QuestionnaireItemOperator (required)
answer[x]	I	1..1		Value for question comparison based on operator Binding: QuestionnaireAnswerCodes (example)
answerBoolean			boolean
answerDecimal			decimal
answerInteger			integer
answerDate			date
answerDateTime			dateTime
answerTime			time
answerString			string
answerCoding			Coding
answerQuantity			Quantity
answerReference			Reference(Resource)
enableBehavior	I	0..1	code	all | any Binding: EnableWhenBehavior (required)
required	I	0..1	boolean	Whether the item must be included in data results
repeats	I	0..1	boolean	Whether the item may repeat
readOnly	I	0..1	boolean	Don't allow human editing
maxLength	I	0..1	integer	No more than this many characters
answerValueSet	I	0..1	canonical(ValueSet)	Valueset containing permitted answers
answerOption	I	0..*	BackboneElement	Permitted answer
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	I	1..1		Answer value Binding: QuestionnaireAnswerCodes (example)
valueInteger			integer
valueDate			date
valueTime			time
valueString			string
valueCoding			Coding
valueReference			Reference(Resource)
initialSelected	I	0..1	boolean	Whether option is selected by default
initial	I	0..*	BackboneElement	Initial value(s) when item is first rendered
id		0..1	string	Unique id for inter-element referencing
extension	I	0..*	Extension	Additional content defined by implementations
modifierExtension	?!ΣI	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	I	1..1		Actual value for initializing the question Binding: QuestionnaireAnswerCodes (example)
valueBoolean			boolean
valueDecimal			decimal
valueInteger			integer
valueDate			date
valueDateTime			dateTime
valueTime			time
valueString			string
valueUri			uri
valueAttachment			Attachment
valueCoding			Coding
valueQuantity			Quantity
valueReference			Reference(Resource)
item	I	0..*		Unknown reference to #Questionnaire.item Nested questionnaire items
Documentation for this format

User Interface

The content and presentation of items returned by the questionnaire are not defined by this profile. The content of these questionnaires can be further constrained by the HL7 Structured Data Capture or Patient Reported Outcomes FHIR Implementation Guides in order to support different presentation and assessment capabilities. An Assessor that also implements Form Filler capabilities of these profiles can be used to implement the user interface and collect data from the patient or provider to perform the assessment.

EHR Launch URL

When an Clinical Knowledge Resource Repository that supports the EHR Launch option returns the questionnaire, it must return at least one extension[@url=”http://ihe.net/fhir/ACDC/StructureDefinition/questionnaire-launchurl”] field populated with a URL that will execute the questionnaire via the SMART on FHIR EHR Launch workflow.

More than one EHR Launch URL may be returned in the Questionnaire resource. The Assessment Requester actor can choose any of these URLs to enable access.

Security Concerns

The EHR Launch URL represents an endpoint that will be used to pass launch credentials and possibly other sensitive information, including individually identifiable information. The URL must be an absolute URL. The content of this URL must be secured via Transport Layer Security, and so the URL must begin with https://.