IHE ACDC Implementation Guide
0.1.0 - CI Build
IHE ACDC Implementation Guide, published by Integrating the Healthcare Enterprise (IHE). This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of https://github.com/IHE/ACDC/ and changes regularly. See the Directory of published versions
Defines constraints and extensions on the QuestionnaireResponse Resource for responses used with the IHE ACDC Profile
The official URL for this profile is:
http://ihe.net/fhir/ACDC/StructureDefinition/ihe-acdc-questionnaireresponse
The IHE ACDC QuestionnaireResponse Profile defines the constraints on QuestionnaireResponse resources returned by the PCC-73 transaction. This resource describes the QuestionnaireResponse that represents the results of an Assessment that was performed on a patient.
At a minimum, QuestionnaireResponse resources that comply with this provide must provide:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from QuestionnaireResponse
This structure is derived from QuestionnaireResponse
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | I | 0..* | QuestionnaireResponse | A structured set of questions and their answers |
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact |
![]() ![]() ![]() | ΣI | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() | ?!ΣI | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() | I | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages |
![]() ![]() ![]() | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |
![]() ![]() ![]() | I | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
![]() ![]() ![]() | I | 0..1 | Signature | A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature |
![]() ![]() ![]() | ?!I | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() | ΣI | 0..1 | Identifier | Unique id for this set of answers |
![]() ![]() ![]() | ΣI | 0..* | Reference(CarePlan | ServiceRequest) | Request fulfilled by this QuestionnaireResponse |
![]() ![]() ![]() | ΣI | 0..* | Reference(Observation | Procedure) | Part of this action |
![]() ![]() ![]() | ΣI | 1..1 | canonical(Questionnaire) | Form being answered |
![]() ![]() ![]() ![]() | 0..1 | string | xml:id (or equivalent in JSON) | |
![]() ![]() ![]() ![]() | I | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
![]() ![]() ![]() ![]() | I | 0..* | Reference(Questionnaire) | Optional Extensions Element URL: http://ihe.net/fhir/ACDC/StructureDefinition/ihe-acdc-contained-questionnairereference |
![]() ![]() ![]() ![]() | 0..1 | string | Primitive value for canonical | |
![]() ![]() ![]() | ?!ΣI | 1..1 | code | in-progress | completed | amended | entered-in-error | stopped Binding: Status Values allowed in a QuestionnaireResponse resource (required) |
![]() ![]() ![]() | ΣI | 1..1 | Reference(Patient) | The subject of the questions |
![]() ![]() ![]() | SΣI | 0..1 | Reference(Encounter) | Encounter created as part of |
![]() ![]() ![]() | ΣI | 1..1 | dateTime | Date the answers were gathered |
![]() ![]() ![]() | ΣI | 1..1 | Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization) | Person who received and recorded the answers |
![]() ![]() ![]() | SΣI | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | The person who answered the questions |
![]() ![]() ![]() | I | 0..* | BackboneElement | Groups and questions qrs-1: Nested item can't be beneath both item and answer |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | I | 1..1 | string | Pointer to specific item from Questionnaire |
![]() ![]() ![]() ![]() | I | 0..1 | uri | ElementDefinition - details for the item |
![]() ![]() ![]() ![]() | I | 0..1 | string | Name for group or question text |
![]() ![]() ![]() ![]() | I | 0..* | BackboneElement | The response(s) to the question |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | I | 0..1 | Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example) | |
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||
![]() ![]() ![]() ![]() ![]() ![]() | decimal | |||
![]() ![]() ![]() ![]() ![]() ![]() | integer | |||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||
![]() ![]() ![]() ![]() ![]() ![]() | dateTime | |||
![]() ![]() ![]() ![]() ![]() ![]() | time | |||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||
![]() ![]() ![]() ![]() ![]() ![]() | uri | |||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||
![]() ![]() ![]() ![]() ![]() ![]() | Coding | |||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||
![]() ![]() ![]() ![]() ![]() | I | 0..* | Unknown reference to #QuestionnaireResponse.item Nested groups and questions | |
![]() ![]() ![]() ![]() | I | 0..* | Unknown reference to #QuestionnaireResponse.item Nested questionnaire response items | |
![]() |
This structure is derived from QuestionnaireResponse
Differential View
This structure is derived from QuestionnaireResponse
Snapshot View
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() | I | 0..* | QuestionnaireResponse | A structured set of questions and their answers |
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact |
![]() ![]() ![]() | ΣI | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() | ?!ΣI | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() ![]() | I | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages |
![]() ![]() ![]() | I | 0..1 | Narrative | Text summary of the resource, for human interpretation |
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |
![]() ![]() ![]() | I | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
![]() ![]() ![]() | I | 0..1 | Signature | A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature |
![]() ![]() ![]() | ?!I | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() ![]() | ΣI | 0..1 | Identifier | Unique id for this set of answers |
![]() ![]() ![]() | ΣI | 0..* | Reference(CarePlan | ServiceRequest) | Request fulfilled by this QuestionnaireResponse |
![]() ![]() ![]() | ΣI | 0..* | Reference(Observation | Procedure) | Part of this action |
![]() ![]() ![]() | ΣI | 1..1 | canonical(Questionnaire) | Form being answered |
![]() ![]() ![]() ![]() | 0..1 | string | xml:id (or equivalent in JSON) | |
![]() ![]() ![]() ![]() | I | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
![]() ![]() ![]() ![]() | I | 0..* | Reference(Questionnaire) | Optional Extensions Element URL: http://ihe.net/fhir/ACDC/StructureDefinition/ihe-acdc-contained-questionnairereference |
![]() ![]() ![]() ![]() | 0..1 | string | Primitive value for canonical | |
![]() ![]() ![]() | ?!ΣI | 1..1 | code | in-progress | completed | amended | entered-in-error | stopped Binding: Status Values allowed in a QuestionnaireResponse resource (required) |
![]() ![]() ![]() | ΣI | 1..1 | Reference(Patient) | The subject of the questions |
![]() ![]() ![]() | SΣI | 0..1 | Reference(Encounter) | Encounter created as part of |
![]() ![]() ![]() | ΣI | 1..1 | dateTime | Date the answers were gathered |
![]() ![]() ![]() | ΣI | 1..1 | Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization) | Person who received and recorded the answers |
![]() ![]() ![]() | SΣI | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | The person who answered the questions |
![]() ![]() ![]() | I | 0..* | BackboneElement | Groups and questions qrs-1: Nested item can't be beneath both item and answer |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() | I | 1..1 | string | Pointer to specific item from Questionnaire |
![]() ![]() ![]() ![]() | I | 0..1 | uri | ElementDefinition - details for the item |
![]() ![]() ![]() ![]() | I | 0..1 | string | Name for group or question text |
![]() ![]() ![]() ![]() | I | 0..* | BackboneElement | The response(s) to the question |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |
![]() ![]() ![]() ![]() ![]() | I | 0..* | Extension | Additional content defined by implementations |
![]() ![]() ![]() ![]() ![]() | ?!ΣI | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
![]() ![]() ![]() ![]() ![]() | I | 0..1 | Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example) | |
![]() ![]() ![]() ![]() ![]() ![]() | boolean | |||
![]() ![]() ![]() ![]() ![]() ![]() | decimal | |||
![]() ![]() ![]() ![]() ![]() ![]() | integer | |||
![]() ![]() ![]() ![]() ![]() ![]() | date | |||
![]() ![]() ![]() ![]() ![]() ![]() | dateTime | |||
![]() ![]() ![]() ![]() ![]() ![]() | time | |||
![]() ![]() ![]() ![]() ![]() ![]() | string | |||
![]() ![]() ![]() ![]() ![]() ![]() | uri | |||
![]() ![]() ![]() ![]() ![]() ![]() | Attachment | |||
![]() ![]() ![]() ![]() ![]() ![]() | Coding | |||
![]() ![]() ![]() ![]() ![]() ![]() | Quantity | |||
![]() ![]() ![]() ![]() ![]() ![]() | Reference(Resource) | |||
![]() ![]() ![]() ![]() ![]() | I | 0..* | Unknown reference to #QuestionnaireResponse.item Nested groups and questions | |
![]() ![]() ![]() ![]() | I | 0..* | Unknown reference to #QuestionnaireResponse.item Nested questionnaire response items | |
![]() |
Other representations of profile: Schematron
Path | Conformance | ValueSet |
QuestionnaireResponse.language | preferred | CommonLanguages Max Binding: AllLanguages |
QuestionnaireResponse.status | required | ACDCQuestionnaireResponseStatus |
QuestionnaireResponse.item.answer.value[x] | example | QuestionnaireAnswerCodes |
Id | Path | Details | Requirements |
qrs-1 | QuestionnaireResponse.item | Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not() |
The Assessor actor may with to return a copy of the Questionnaire with the response as a contained resource. This enables the Assessment Requestor actor to operate with complete knowledge of the assessment being performed, which can aid in operations, and prevent the need to retrieve a copy of the assessment instrument. It also insures that the assessor has a copy of the exact instrument used, given that assessment instruments may be updated over time.
Because the reference to the Questionnaire at QuestionnaireResponse.questionnaire
must be the canonical URL of the resource, the
ACDC Contained Questionnaire Reference
extension has been provided which allows the contained reference to be pointed to in the
QuestionnaireResponse resource.
In JSON, this is represented using a special syntax to support the extension because Reference is a primitive type. An example is given below.
"questionnaire": "http://example.com/PHQ-2",
"_questionnaire": {
"extension": [
{
"url": "http://ihe.net/fhir/ACDC/StructureDefinition/ihe-acdc-contained-questionnairereference",
"valueReference": {
"reference": "#contained-questionnaire"
}
}
]
}
In XML, this would be represented as shown below:
<questionnaire value="http://example.com/PHQ-2">
<extension url="http://ihe.net/fhir/ACDC/StructureDefinition/ihe-acdc-contained-questionnairereference">
<valueReference value="#contained-questionnaire"/>
</extension>
</questionnaire>
This extension is provided because some FHIR implementations do not send contained resources which are not directly referenced by the resource in which they are contained (e.g., HAPI on FHIR). This does not represent an error on behalf of those implementations, but rather an interpretation of the FHIR requirements that state that contained resources must be referenced by the resource that contains them.
Assessment results contained in a QuestionnaireResponse often have very sensitive data, not just health data, but also sensitive data regarding information such as social determinants of health, which could include education level, income level, access to housing or food, et cetera. Such data should be encrypted in transit (e.g., using TLS as per the requirements of the ATNA Secure Node actor), and may also need to be encrypted or marked sensitive when stored.