US Core Implementation Guide
8.0.0 - STU 8 United States of America flag

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: US Core QuestionnaireResponse Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse Version: 8.0.0
Standards status: Trial-use Computable Name: USCoreQuestionnaireResponseProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.55

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core QuestionaireResponse Profile inherits from the Structured Data Capture (SDC) Questionnaire Response Profile. This profile sets minimum expectations for the QuestionnaireResponse resource to record, search, and fetch retrieve captures the responses to form/survey and assessment tools such as the Protocol for Responding to and Assessing Patients\u2019 Assets, Risks, and Experiences (PRAPARE) Survey. It specifies which core additional elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Before reviewing this profile, implementers are encouraged to read the Screening and Assessments guidance page, which documents the process of recording responses and capturing assertions/determinations resulting from surveys and questionnaires.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

  • Query for survey screening results for a patient.
  • Record or update screening results results belonging to a Patient

Mandatory and Must Support Data Elements

In addition to the Mandatory and Must Support data elements in the SDC QuestionnaireResponse Profile, the following data elements must always be present (Mandatory definition]) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements. Note that the Key Elements Table view aggregates all the Must Support elements between this profile and its parent profiles.

Each QuestionnaireResponse Must Have:

  1. a reference back to the assessment upon which it is based
  2. a status
  3. a patient
  4. the date the answers were gathered

Each QuestionnaireResponse Must Support:

  1. a practitioner who recorded the answers
  2. the questions and decimal, string, and coded answers
    • each question must have an identifier pointing to the question

Profile Specific Implementation Guidance:

  • The SDC profile (from which this profile is derived) focuses on the constraints appropriate to capturing the "answer(s)" to a FHIR Questionnaire and demands that the Questionnaire's canonical URL be specified. If the QuestionnaireResponse is based on a non-FHIR form:
    1. Construct a FHIR Questionnaire representing at least the relevant metadata (in other words, the questions may be omitted).
    2. Communicates the identifier of the non-FHIR form instead of the canonical URI using the US Core Extension Questionnaire URI extension.
  • See the Screening and Assessments guidance page for how this profile or Observations can represent SDOH assessments.
  • QuestionnaireResponse can be searched using the standard FHIR RESTful API search parameters. Example searches are shown in the Quick Start section below. Although search chains through the associated Questionnaire can be used to query QuestionnaireResponse by item, individual responses are not directly searchable in QuestionnaireResponse. To search directly for individual responses, they must be "parsed" into a searchable form - i.e., to a local FHIR or non-FHIR data store such as a database or FHIR Observations.
  • The basic workflow for creating, discovering, retrieving, and data-extracting FHIR Questionnaire and QuestionnaireResponse is thoroughly documented in the Structured Data Capture (SDC) implementation guide.

Usage:

Changes since version 7.0.0:

  • No changes

    • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. QuestionnaireResponse C 0..* SDCQuestionnaireResponse US Core Profile based on SDC QuestionnaireResponse
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    sdcqr-1: Subject SHOULD be present (searching is difficult without subject). Almost all QuestionnaireResponses should be with respect to some sort of subject.
    sdcqr-2: When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers.
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... Slices for extension Content/Rules for all slices
    .... extension:signature 0..* Signature A signature attesting to the content
    URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... extension:completionMode 0..1 CodeableConcept E.g. Verbal, written, electronic
    URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode
    Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.


    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... identifier SΣ 0..1 Identifier Unique id for this set of answers
    ele-1: All FHIR elements must have a @value or children
    ... questionnaire SΣ 1..1 canonical(SDCBaseQuestionnaire) Form being answered
    ele-1: All FHIR elements must have a @value or children
    .... Slices for extension Content/Rules for all slices
    ..... extension:questionnaireDisplay S 0..1 string Display name for canonical reference
    URL: http://hl7.org/fhir/StructureDefinition/display
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... extension:url S 0..1 uri The location where a non-FHIR questionnaire/survey form can be found.
    URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!SΣ 1..1 code in-progress | completed | amended | entered-in-error | stopped
    Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.


    ele-1: All FHIR elements must have a @value or children
    ... subject SΣ 1..1 Reference(US Core Patient Profile) The subject of the questions
    ele-1: All FHIR elements must have a @value or children
    ... authored SΣ 1..1 dateTime Date the answers were gathered
    ele-1: All FHIR elements must have a @value or children
    ... author SΣ 0..1 Reference(US Core Practitioner Profile) Person who received and recorded the answers
    ele-1: All FHIR elements must have a @value or children
    ... item SC 0..* BackboneElement Groups and questions
    ele-1: All FHIR elements must have a @value or children
    qrs-1: Nested item can't be beneath both item and answer
    .... Slices for extension Content/Rules for all slices
    ..... extension:itemMedia 0..1 Attachment Media to display
    URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... extension:ItemSignature 0..* Signature A signature attesting to the content
    URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... linkId S 1..1 string Pointer to specific item from Questionnaire
    ele-1: All FHIR elements must have a @value or children
    .... text S 0..1 string Name for group or question text
    ele-1: All FHIR elements must have a @value or children
    .... answer S 0..* BackboneElement The response(s) to the question
    ele-1: All FHIR elements must have a @value or children
    ..... Slices for extension Content/Rules for all slices
    ...... extension:itemAnswerMedia 0..1 Attachment Answer Media to display
    URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ...... extension:ordinalValue 0..1 decimal Assigned Ordinal Value
    URL: http://hl7.org/fhir/StructureDefinition/ordinalValue
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ..... value[x] S 0..1 Single-valued answer to the question
    Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.


    ele-1: All FHIR elements must have a @value or children
    ...... valueDecimal decimal
    ...... valueString string
    ...... valueCoding Coding
    ..... item S 0..* See item (QuestionnaireResponse) Nested groups and questions
    ele-1: All FHIR elements must have a @value or children
    .... item S 0..* See item (QuestionnaireResponse) Nested questionnaire response items
    ele-1: All FHIR elements must have a @value or children

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    QuestionnaireResponse.statusrequiredQuestionnaireResponseStatus
    http://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1
    from the FHIR Standard
    QuestionnaireResponse.item.answer.value[x]exampleQuestionnaireAnswerCodes (a valid code from SNOMED CT)
    http://hl7.org/fhir/ValueSet/questionnaire-answers
    from the FHIR Standard

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to completed questionnnaire, survey and assessement data SHALL support these US Core SMART Scopes:

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support both read QuestionnaireResponse by id AND QuestionnaireResponse search using the _id search parameter:

      GET [base]/QuestionnaireResponse/[id] or GET [base]/QuestionnaireResponse?_id=[id]

      Example:

      1. GET [base]/!QuestionnaireResponse/AHC-HRSN-screening-example
      2. GET [base]/!QuestionnaireResponse/?_id=AHC-HRSN-screening-example

      Implementation Notes: (how to search by the logical id of the resource)

    2. SHALL support searching for all questionnaireresponses for a patient using the patient search parameter:

      GET [base]/QuestionnaireResponse?patient={Type/}[id]

      Example:

      1. GET [base]/QuestionnaireResponse?patient=1032702

      Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient (how to search by reference)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and status search parameters:
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/QuestionnaireResponse?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/QuestionnaireResponse?patient=1137192&status=completed

      Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient and status (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and authored search parameters:
      • including support for these authored comparators: gt,lt,ge,le
      • including optional support for AND search on authored (e.g.authored=[date]&authored=[date]]&...)

      GET [base]/QuestionnaireResponse?patient={Type/}[id]&authored={gt|lt|ge|le}[date]{&authored={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/QuestionnaireResponse?patient=113192&date=ge2021

      Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient and date (how to search by reference and how to search by date)

    3. SHOULD support searching using the combination of the patient and questionnaire search parameters:

      GET [base]/QuestionnaireResponse?patient={Type/}[id]&questionnaire={Type/}[id]

      Example:

      1. GET [base]/QuestionnaireResponse?patient=113192&questionnaire=http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnaireHungerVitalSign

      Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient that have been completed against a specified form. (how to search by reference)

    Searching QuestionnaireResponse by Context

    Searching a patient's QuestionnaireResponses by specific context such as those defined in US Core Category can be achieved by querying the metadata on the associated Questionnaire. Specifically, Questionnaire.useContext with a code="focus" and value of "sdoh"/"functionalStatus"/etc. could be accomplished using a chained search:

    GET [base]/QuestionnaireResponse?subject=Patient/123&questionnaire.context-type-value=focus$sdoh