eHealth Infrastructure
3.4.1 - release
eHealth Infrastructure
3.4.1 - release
eHealth Infrastructure, published by Den telemedicinske infrastruktur (eHealth Infrastructure). This guide is not an authorized publication; it is the continuous build for version 3.4.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/fut-infrastructure/implementation-guide/ and changes regularly. See the Directory of published versions
| Official URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire | Version: 3.4.1 | |||
| Active as of 2025-03-14 | Computable Name: ehealth-questionnaire | |||
A Questionnaire is a structured set of questions intended to guide the collection of answers from end-users. Questionnaires provide detailed control over order, presentation, phraseology and grouping to allow coherent, consistent data collection.
In the eHealth Infrastructure the Questionnaire resource is used in line with this. Questionnaires are built and maintained by Practitioners and presented to Patients by client applications in order to gather input and answers from Patients in the form of QuestionnaireResponse resources.
A question where possible answers are given as a list of options (of item.type set to choice) can allow multiple choices by setting item.repeats to true. When no further constraints are set, item.repeats set to true means that any number of the options can be provided as answer to the question in a QuestionnaireResponse. The standard extensions item.questionnaire-minOccurs and item.questionnaire-maxOccurs can be used to set such further constraints.
item.questionnaire-minOccurs sets the minimum number of answers allowed, for instance 2 (of the number of options, say, 5). The element shall be set only when its value is greater than one.item.questionnaire-maxOccurs sets the maximum number of answers allowed, for instance 3 (of the number of options, say 5). The element shall be set only when its value is greater than one.When exactly one answer shall be required, item.requied shall be set to true and item.repeats shall be set to false. When exactly one answer is permitted, item.requied shall be set to false and item.repeats shall be set to false. In these cases, the minOCcurs and maxOccurs shall not be used.
The Questionnaire resource supports the Question Feedback Pattern from DK QFDD questionnaires. This enables immediate feedback to the patient upon answering a question.
The feedback is pre-defined in the Questionnaire resource using the item.feedback element, so that for each item a patient feedback can be prepared. The feedback will be shown to the patient if the patient's answer to an item lies within a given interval. The mechanism only works for questions which can be answered with a numeric value. The interval is defined by the min and a max elements of the feedback extension. If the Patient answers the item with a numeric value in the interval given by min-max then the value of the feedback extension is intended to be shown to the Patient.
In the recommendation element, a questionnaire can optionally hold a "degree of recommendation" intended to aid the Practitioner in deciding whether or not the Questionnaire should be associated with an ActivityDefinition and used in one or more PlanDefinition.
For each item and item.answerOption in a Questionnaire, a small image can be associated through extensions item.ehealth-questionnaire-image and item.answerOption.ehealth-questionnaire-image, respectively. Both extensions are based on Binary containing the image data base64 encoded.
In the service, the Binary.contentType is verified against a ValueSet with uri http://ehealth.sundhed.dk/vs/questionnaire-item-image-format while the size of Binary.data must not exceed a configurable size, currently 266Kb (base64 encoded).
The item.ehealth-questionnaire-answerSignificance element functions as a triaging indicator, describing the importance of answers to respective questions.
Answer significance is a colour. Currently the possible values are red, yellow, green. Answer condition specifies the conditions that must be fulfilled for the answer to result in the given colour.
answerSignificance has two sub elements:
answerSignificance.significance element which states the triaging coloranswerSignificance.answerCondition contains the value or interval limits for comparison against the given answer.
answerCondition.value[x] is the value to compare with an answer and contains various type depending on the need.answerCondition.operator determines the relationship between the answerCondition.value[x] and a given answer. When a single answerSignificance.answerCondition is given, it represents a precise match or possibly open ended interval. Two answerSignificance.answerCondition can specify an interval. To check that a written answer exists, use answerCondition.operator = exists and answerCondition.valueBoolean = true.The item.questionnaire-itemControl element enables indication of what sort of user interface control type, for instance radio buttons, to use when displaying an item.
The elements item.text, item.answerOption.value, and item.inital.value supports formatted text for valueString using the standard extension: http://hl7.org/fhir/extension-rendering-xhtml.html
Note that the original text without formatting must be added to the elements item.text, item.answerOption.value, and item.inital.value, respectively, for those where the formatted extension has been used.
The extension rendering-styleSensitive indicates if clients must be able to display the formatted text for this Questionnaire, or if not capable to do this, at least indicate to the user that rendering is not appropriate.
A Questionnaire has two sets of titles and desriptions. title and description are intended for the citizens and should be of a natural language. Whereas ehealth-employee-title and ehealth-usage are intended for clinicians and should be of a specific and professional language.
The item.helpText element supports adding additional descriptions and help for a question. The element must contain a helpText.text string value, and can additionally hold a xhtml formatted equivalent in the helpText.xhtml string value.
The helpText.xhtml value should follow the same standards as http://hl7.org/fhir/extension-rendering-xhtml.html.
The item.enableBehavior.conditionId can be used to identify conditions. This property is primarily used when modeling Questionnaires which should be transformed to CDA documents.
The item.externalIdentifier can be used to identify either questionnaire groups or questionnaire questions. This property is primarily used when modeling Questionnaires which should be transformed to CDA documents.
The item.isCopyright can be used to indicate a copyright structure.
item.isCopyright is a boolean value, and if set to true, the item must have either item.type: 'group' or 'display'. Furthermore, for item.type 'group', the isCopyright is only allowed on root items. For items with type 'display', the item.isCopyright is only allowed true if:
Example of one copyright structure with two copyrights
The element useContext.code has binding to the ValueSet http://hl7.org/fhir/ValueSet/use-context (see https://hl7.org/fhir/R4/valueset-use-context.html). It is, however, validated against the eHealth ValueSet http://ehealth.sundhed.dk/vs/ehealth-usage-context-type (see https://ehealth.sundhed.dk/fhir/ValueSet-ehealth-usage-context-type.html). This validation includes that the value in useContext.valueCodeableConcept is acceptable in the ValueSet described for useContext.code.
The useContext element can be updated at any time, regardless of the status of the Questionnaire.
The date when the Questionnaire's status is set to active, whether it is initially created as active or changed to active, will be recorded in the approvalDate field.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Questionnaire |
C | 0..* | Questionnaire | A structured set of questions 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 que-0: Name should be usable as an identifier for the module by machine processing applications such as code generation que-2: The link ids for groups and questions must be unique within the questionnaire |
  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 |
2..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
   extension:recommendation |
0..1 | CodeableConcept | Degree to which this questionnaire is recommended for use. URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-recommendation Binding: QuestionnaireRecommendation (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:intendedOrganization |
0..* | Reference(ehealth-organization) {r} | The organization intended to use this questionnaire. URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-intendedOrganization ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:revision |
0..1 | string | Business revision URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-revision ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:modifierRole |
1..* | (Complex) | Modifier role URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-modifier-role ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:type |
1..* | CodeableConcept | Concept that represents the overall questionnaire URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-type Binding: Questionnaire Types (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:styleSensitive |
0..1 | boolean | Are styles important for processing? URL: http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:employeeTitle |
0..1 | string | Title for clinicians URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-employee-title ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:usage |
0..1 | string | usage URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-usage ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:predecessor |
0..1 | Identifier | Predecessor URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-predecessor ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:base |
0..1 | Identifier | Base URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-base ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
 extension:baseEnvironment |
0..1 | Identifier | Base environment URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-base-environment 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 |
| version |
Σ | 1..1 | string | Business version of the questionnaire ele-1: All FHIR elements must have a @value or children |
| status |
?!Σ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. ele-1: All FHIR elements must have a @value or children |
 jurisdiction |
Σ | 0..* | CodeableConcept | Intended jurisdiction for questionnaire (if applicable) Binding: Jurisdiction (required) ele-1: All FHIR elements must have a @value or children |
 item |
C | 0..* | BackboneElement | Questions and sections within the Questionnaire ele-1: All FHIR elements must have a @value or children 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 sliderStepValueDecimal-Type: Item must have type='decimal' when using extension 'ehealth-questionnaire-sliderStepValueDecimal' copyright-type: If item extension 'ehealth-questionnaire-item-is-copyright' is set to true, item.type must be either 'group' or 'display'. |
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:questionnaire-minOccurs |
0..1 | integer | Minimum repetitions URL: http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:questionnaire-maxOccurs |
0..1 | integer | Maximum repetitions URL: http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:minValue |
0..1 | date, dateTime, time, decimal, integer, Quantity | Must be >= this value URL: http://hl7.org/fhir/StructureDefinition/minValue ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:maxValue |
0..1 | date, dateTime, time, decimal, integer, Quantity | Must be <= this value URL: http://hl7.org/fhir/StructureDefinition/maxValue ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:questionnaire-sliderStepValue |
0..1 | integer | Increment value for slider URL: http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:questionnaire-sliderStepValueDecimal |
0..1 | decimal | The slider step-value as decimal-number URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-sliderStepValueDecimal ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:feedback |
0..1 | (Complex) | Feedback if reponse is within the defined range. URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-feedback ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:overviewUsageMode |
0..* | CodeableConcept | Identifies whether the specified element and/or results of the element should appear in overview or table presentation. URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-overviewUsageMode Binding: Overview Usage Mode (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
 extension:itemControl |
0..1 | (Complex) | E.g. Fly-over, Table, Checkbox, Combo-box, Lookup, etc. URL: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
  extension |
0..0 | |||
| url |
1..1 | uri | "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl" | |
 value[x] |
1..1 | CodeableConcept | Value of extension Binding: Questionnaire Item Control (required) ele-1: All FHIR elements must have a @value or children | |
| extension:ehealth-question-image |
0..1 | (Complex) | The image for a questionnaire URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:shortText |
0..1 | string | Short text URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-shortText ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:helpText |
0..1 | (Complex) | Help text URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-helpText ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:answerSignificance |
0..* | (Complex) | The Answer significance for an answer URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-answerSignificance ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:externalIdentifier |
0..1 | Identifier | External Identifier URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-external-identifier ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:isCopyright |
0..1 | boolean | Indicates that the item is part of a copyright structure (CDA Document sharing - QFDD/QRD) URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-item-is-copyright 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 |
1..1 | string | Unique id for item in questionnaire ele-1: All FHIR elements must have a @value or children | |
| type |
1..1 | code | group | display | boolean | decimal | integer | date | dateTime + Binding: QuestionnaireItemType (required): Distinguishes groups from questions and display text and indicates data type for questions. ele-1: All FHIR elements must have a @value or children | |
| enableWhen |
?!C | 0..* | BackboneElement | Only allow data when ele-1: All FHIR elements must have a @value or children que-7: If the operator is 'exists', the value must be a boolean |
| 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 |
| question |
1..1 | string | Question that determines whether item is enabled ele-1: All FHIR elements must have a @value or children | |
| operator |
1..1 | code | exists | = | != | > | < | >= | <= Binding: QuestionnaireItemOperator (required): The criteria by which a question is enabled. ele-1: All FHIR elements must have a @value or children | |
 answer[x] |
C | 1..1 | Value for question comparison based on operator Binding: QuestionnaireAnswerCodes (example): Allowed values to answer questions. ele-1: All FHIR elements must have a @value or children | |
| answerBoolean |
boolean | |||
| answerDecimal |
decimal | |||
| answerInteger |
integer | |||
| answerDate |
date | |||
| answerDateTime |
dateTime | |||
| answerTime |
time | |||
| answerString |
string | |||
| answerCoding |
Coding | |||
| answerQuantity |
Quantity | |||
  answerReference |
Reference(Resource) | |||
| answerValueSet |
C | 0..1 | canonical(ValueSet) | Valueset containing permitted answers ele-1: All FHIR elements must have a @value or children |
| answerOption |
C | 0..* | BackboneElement | Permitted answer ele-1: All FHIR elements must have a @value or children |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| extension:ehealth-answeroption-image |
0..1 | (Complex) | The image for a questionnaire URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-image 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] |
1..1 | Answer value Binding: QuestionnaireAnswerCodes (example): Allowed values to answer questions. ele-1: All FHIR elements must have a @value or children | ||
 value[x]All Types |
Content/Rules for all Types | |||
  Slices for extension |
Content/Rules for all slices | |||
| extension:xhtml |
0..1 | string | String equivalent with html markup URL: http://hl7.org/fhir/StructureDefinition/rendering-xhtml ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| valueInteger |
integer | |||
| valueDate |
date | |||
| valueTime |
time | |||
| valueString |
string | |||
| valueCoding |
Coding | |||
| valueReference |
Reference(Resource) | |||
| initial |
C | 0..* | BackboneElement | Initial value(s) when item is first rendered ele-1: All FHIR elements must have a @value or children |
| 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] |
1..1 | Actual value for initializing the question Binding: QuestionnaireAnswerCodes (example): Allowed values to answer questions. ele-1: All FHIR elements must have a @value or children | ||
| value[x]All Types |
Content/Rules for all Types | |||
| Slices for extension |
Content/Rules for all slices | |||
| extension:xhtml |
0..1 | string | String equivalent with html markup URL: http://hl7.org/fhir/StructureDefinition/rendering-xhtml ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |
| 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) | |||
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Questionnaire.status | required | PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1from the FHIR Standard | |
| Questionnaire.jurisdiction | required | Jurisdictionhttp://ehealth.sundhed.dk/vs/jurisdictionfrom this IG | |
| Questionnaire.item.extension:itemControl.value[x] | required | QuestionnaireItemControlhttp://ehealth.sundhed.dk/vs/questionnaire-item-controlfrom this IG | |
| Questionnaire.item.type | required | QuestionnaireItemTypehttp://hl7.org/fhir/ValueSet/item-type|4.0.1from the FHIR Standard | |
| Questionnaire.item.enableWhen.operator | required | QuestionnaireItemOperatorhttp://hl7.org/fhir/ValueSet/questionnaire-enable-operator|4.0.1from the FHIR Standard | |
| Questionnaire.item.enableWhen.answer[x] | example | QuestionnaireAnswerCodes (a valid code from SNOMED CT)http://hl7.org/fhir/ValueSet/questionnaire-answersfrom the FHIR Standard | |
| Questionnaire.item.answerOption.value[x] | example | QuestionnaireAnswerCodes (a valid code from SNOMED CT)http://hl7.org/fhir/ValueSet/questionnaire-answersfrom the FHIR Standard | |
| Questionnaire.item.initial.value[x] | example | QuestionnaireAnswerCodes (a valid code from SNOMED CT)http://hl7.org/fhir/ValueSet/questionnaire-answersfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| copyright-type | error | Questionnaire.item | If item extension 'ehealth-questionnaire-item-is-copyright' is set to true, item.type must be either 'group' or 'display'. : extension('http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-item-is-copyright').exists() and extension('http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-item-is-copyright').value = true implies type = 'group' or type = 'display' | |
| sliderStepValueDecimal-Type | error | Questionnaire.item | Item must have type='decimal' when using extension 'ehealth-questionnaire-sliderStepValueDecimal' : extension('http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-questionnaire-sliderStepValueDecimal').exists() implies type = 'decimal' |
Other representations of profile: CSV, Excel, Schematron
IG © 2021+ Den telemedicinske infrastruktur (eHealth Infrastructure). Package dk.ehealth.sundhed.fhir.ig.core#3.4.1 based on FHIR 4.0.1. Generated 2025-03-14
