Research Data Sharing IG
1.0.0 - CI Build International flag

Research Data Sharing IG, published by IEHR-Workgroup. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/InteropEHRate-project/research-data-sharing/ and changes regularly. See the Directory of published versions

Questionnaire: Questionnaire Example - CRF Intervall

Official URL: http://interopEHRate.eu/fhir-resource/Questionnaire/CRFIntervalQuestionnaire Version: 1.0.0
Active as of 2022-04-25 Computable Name: CRFInterval
Structure
LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. CRFIntervalQuestionnairehttp://interopEHRate.eu/fhir-resource/Questionnaire/CRFIntervalQuestionnaire#1.0.0
... sec1Section 1:. Patient general data0..1group
.... 1.1Surname0..1string
.... 1.2Name0..1string
.... 1.3Allergies0..1string
.... 1.4Gender0..1choiceOptions: 2 options
.... 1.5Date of birth (DD/MM/YYYY)0..1date
... sec2Section 2:. Disease related data0..1group
.... 2.1Year of hypertension diagnosis0..1string
.... 2.2blood pressure measurement SYS/DIA (mmHg/mmHg)0..1string
.... 2.3Latest creatinine (mg/dL)0..1string
.... 2.4Current Medications0..1string
.... 2.5EKG report signal0..1string
.... 2.6Echocardiogram report and video0..1attachment
.... 2.7Latest left ventricular ejection fraction (%)0..1decimal
.... 2.8Latest interventricular septum thickness (mm)0..1decimal
... sec3Section 3:. Questionnaire on side effects0..*group
.... 3.11.. Name of the Drug0..*string
.... 3.22.. Type of symptom(s)0..*open-choiceOptions: 11 options
.... 3.33.. How long the adverse event last?0..1choiceOptions: 4 options
.... 3.44.. Did you withdraw the drug?0..1boolean
.... 3.55.. Did the adverse reaction require specific treatment?0..1boolean
... sec4Section 4:. Feasibility assessment0..1group
.... 4.1Preliminary Questions0..1group
..... 4.1.1Age0..1integer
..... 4.1.2Sex0..1string
..... 4.1.3Educational Level0..1choiceOptions: 4 options
..... 4.1.4Urban Zone (rural/ urban)0..1string
..... 4.1.5Profession (if retired, previously exercised0..1string
..... 4.1.6Do you routinely use apps of your smartphone/table in your daily life (excluded messages and phone calls)?0..1boolean
..... 4.1.7Do you have wifi/xDSL/3g/4g connection in you home0..1boolean
.... 4.2What satisfaction level do you have about the clinical staff explanation or instruction manual for use and maintenance of the system?0..1choiceOptions: 4 options
.... 4.3How would you rate the ease of use of the platform?0..1choiceOptions: 4 options
.... 4.4What satisfaction level do you have about the received clinical care provided by the use of the platform?0..1choiceOptions: 4 options
.... 4.5If you had any technical problem, were you satisfied with the solution of it?0..1choiceOptions: 4 options
.... 4.6How would you rate the mobile device operation?0..1choiceOptions: 4 options
.... 4.7Has the INTEROPEHRATE System helped you understand better your disease?0..1choiceOptions: 4 options
.... 4.8Has the INTEROPEHRATE System allowed you to have more autonomy to access to hospitals or care Centres?0..1choiceOptions: 4 options
.... 4.9Do you consider that INTEROPEHRATE system has a major role i communicating with foreign healthcare provider?0..1choiceOptions: 4 options
.... 4.10The INTEROPEHRATE System has had a positive impact in the way that you live your disease?0..1choiceOptions: 4 options
.... 4.11Do you consider that your family/caregivers have been benefited from your use of the INTEROPEHRATE system by a lower possibility of psychological or physical burden that can cause the disease?0..1choiceOptions: 4 options
.... 4.12Please mark from 1 to 4 your satisfaction level about the INTEROPEHRATE system (1 ist considered as Very dissatisfied and 4 as Very satisfied)?0..1decimal
.... 4.13Please mark from 1 to 4, if you would recommend other people to use the INTEROPEHRATE System0..1decimal

doco Documentation for this format

Option Sets

Answer options for 1.4

  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#female ("Female")

Answer options for 3.2

  • Cutaneous symptoms
  • Nausea
  • Constipation
  • Palpitation
  • Cough
  • Swollen feet or legs
  • Cold hands or feet
  • Cramps
  • Persistent dry cough
  • Frequent urination
  • Decreased sexual desire

Answer options for 3.3

  • < 1 day
  • 1 day to 1 week
  • 1 week to 1 month
  • > 1 month

Answer options for 4.1.3

  • No studies
  • Some School
  • Graduate
  • Postgraduate

Answer options for 4.2

  • Very dissatisfied
  • Dissatisfied
  • Satisfied
  • Very Satisfied

Answer options for 4.3

  • Very difficult
  • Difficult
  • Easy
  • Very Easy

Answer options for 4.4

  • Very dissatisfied
  • Dissatisfied
  • Satisfied
  • Very Satisfied

Answer options for 4.5

  • Very dissatisfied
  • Dissatisfied
  • Satisfied
  • Very Satisfied

Answer options for 4.6

  • Very unsafe
  • Bit unsafe
  • Fairly safe
  • Very safe

Answer options for 4.7

  • Strongly disagree
  • Disagree
  • Agree
  • Strongly Agree

Answer options for 4.8

  • Strongly disagree
  • Disagree
  • Agree
  • Strongly Agree

Answer options for 4.9

  • Strongly disagree
  • Disagree
  • Agree
  • Strongly Agree

Answer options for 4.10

  • Strongly disagree
  • Disagree
  • Agree
  • Strongly Agree

Answer options for 4.11

  • Strongly disagree
  • Disagree
  • Agree
  • Strongly Agree