MCC eCare Plan Implementation Guide
1.0.0 - STU1 United States of America flag

This page is part of the MCC eCare Plan Implementation Guide (v1.0.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

MCC Questionnaire Response Value Sets

This draft of the IG recommends the use of the NIH, Lister Hill Center (LHC) FHIR Tools for Structured Data Capture (SDC) Questionnaire/QuestionnaireResponse in implementations of the MCC eCare Plan. The The LHC-Forms widget supports both actual generation of forms for user interfaces and the generation of the conformant FHIR R4 Questionnaire/QuestionnaireResponse resource instances. Other tooling or methods are not precluded. The only difference between the QuestionnaireResponse in the form JSON generator and the MCC QuestionnaireResponse is the addition of the Resource_pertains to Goal extension in the MCC version.

The value sets in the table below contain LOINC Panel codes pertaining to questionnaire panels of importance to chronic disease management. It is assumed that questionnaires will be completed in the original EHR or other health IT system or application, and the QuestionnaireResponses will be imported into this aggregated FHIR Care Plan associated with the relevent observation, condition, goal etc. It is expected that the LOINC panel codes in the value sets can be used to find questionnaires a given patient has completed, or to find patients that have completed questionnaires. The codes may also be used to generate questionnaire forms and conformant FHIR Questionnaire and QuestionnaireResponse Resources using the NIH LHC Forms Widget. FHIR QuestionnaireResponses do not contain the high-level panel LOINC codes, only the contained question codes. However, the QuestionnaireResponse must contain a reference back to the Questionnaire upon which it is based. This IG does not constrain FHIR Questionairre Resource, but expects it will be used as technically required to properly convey and communicate the Questionnaire/QuestionnaireResponse relationship.

Table Key

  • Value Set Name and Link: All of these value sets are housed in the NLM Value Set Authority Center (VSAC). The value set name is a link to the value set. You must have an NLM/UMLS account to access. There is no charge for an account. Note: the first time you click on the value set name link in a given session, there my be a delay in loading and you will need to sign in once loaded.
  • Value Set Clinical Focus: The Value Set Clinical Focus is the same as the clinical focus as written in VSAC which is a free text statement describing the general context of the concepts in the set.
  • OID: The Object Identifier (OID) of the set. OIDs of value sets are unique, whereas the names may not be. If accessing the value set outside of this table link, it is safest to perform that search with the OID
  • Profile Element: The Profile element asserts the location within the profile the value set term SHALL be used. In this table, the appropriate profile element is listed as Questionnaire.code in the FHIR Questionairre Resource
  • LHC LOINC Form examples: Contains links to the LHC forms widget leveraged by LOINC and associated with each LOINC panel code in the value set. This presents a rendering of the Questionnaire form, the panel code and contained questions and all posssible answers. In order to use or view the LHC form widget and the panels FHIR Conformant Questionnaire and QuestionnaireResponse instance example visit LHC Forms and enter the LOINC panel code and the lower left of the screen under, "Search LOINC panels". Select the panel and the form is rendered. Select "Show Form Data As…" and choose to show the FHIR SDC Questionnaire or the FHIR SDC QuestionnaireResponse in JSON instance examples.

The codes in the value sets below should be able to retrieve MCC QuestionnaireResponses associated with its FHIR Questionairre Resource.

Value Set Name and VSAC Link

Value Set Clinical Focus

OID

QuestionnaireResource Element

LHC LOINC Form examples

Alcohol Use Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to Alcohol Use.

2.16.840.1.113762.1.4.1222.1585

Questionnaire.code

Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]

PROMIS short form - alcohol - alcohol use 7a - version 1.0

Balance Assessments

This set of values addresses terms representing Balance Assessments.

2.16.840.1.113762.1.4.1222.828

Questionnaire.code

PhenX - balance protocol 170801

Standing Balance Test [NIH Toolbox]

Caregiver Considerations Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to Caregiver Considerations Related Questionnaire Panel Codes.

2.16.840.1.113762.1.4.1222.1594

Questionnaire.code

Caregiver Patient Activation Measure - 10 [PAM] Caregiver

Caregiver Patient Activation Measure - 13 [PAM] Caregiver

WE CARE Survey [WE CARE] Caregiver

Cognitive Health Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to cognitive health questionnaire panels.

2.16.840.1.113762.1.4.1222.1584

Questionnaire.code

Cognitive Functioning [FACIT]

General Practitioner Assessment of Cognition [GPCOG]

Montreal Cognitive Assessment [MoCA]

Perceived cognitive abilities [FACIT]

Perceived cognitive impairments [FACIT]

PROMIS item bank - cognitive function - abilities subset - version 2.0

PROMIS short form - cognitive function - abilities subset 4a - version 2.0

PROMIS short form - cognitive function - abilities subset 6a - version 2.0

PROMIS short form - cognitive function - abilities subset 8a - version 2.0

PROMIS short form - cognitive function 4a - version 2.0

PROMIS short form - cognitive function 6a - version 2.0

PROMIS short form - cognitive function 8a - version 2.0Short Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE]

Covid 19 Related Health Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to Covid 19 Related Health Questionnaire Panel Codes

2.16.840.1.113762.1.4.1222.1593

Questionnaire.code

COVID-19 participant experience survey

COVID-19 experiences - media use panel [COVEX]

COVID-19 experiences - employment and school changes panel [COVEX]

COVID-19 experiences - coping panel [COVEX]

Post COVID-19 functional status scale [PCFS]

COVID-19 comorbidity and healthcare questionnaire

COVID-19 related household finances

COVID-19 health questions panel

COVID-19 Knowledge, Attitudes, and Avoidant Behaviors panel

Criminal Justice Involvement or Incarceration History

This set of values contain LOINC Panel codes pertaining to criminal justice involvement or incarceration in the past year.

2.16.840.1.113762.1.4.1222.1598

Questionnaire.code

PhenX - crime and delinquency - adult protocol 181202

PhenX - crime and delinquency - adolescent protocol 181201

Framingham Risk Assessments

This set of values addresses terms representing Panel code(S) for Framingham Risk Assessments.

2.16.840.1.113762.1.4.1222.582

Questionnaire.code

Framingham Risk Assessments Framingham

Functional Status Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to functional status questionnaire panels.

2.16.840.1.113762.1.4.1222.1586

Questionnaire.code

PROMIS item bank - physical function - version 1.0

PROMIS short form - physical function 10a - version 1.0

PROMIS short form - physical function 4a - version 1.0

PROMIS short form - physical function 20a - version 1.0

PROMIS short form - physical function 6b - version 1.2

PROMIS short form - physical function 8b - version 1.2

PROMIS item bank - physical function w mobility aids - version 1.0

PROMIS short form - physical function w mobility aids - version 1.0

Kidney Disease Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to kidney disease questionnaire panels.

2.16.840.1.113762.1.4.1222.1587

Questionnaire.code

Renal replacement therapy goals panel NKDEP

Kidney failure 2-year and 5-year risk panel by KFRE

Long Covid Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to Long Covid questionnaire panels

2.16.840.1.113762.1.4.1222.1588

Questionnaire.code

Generalized anxiety disorder 7 item (GAD-7)

Post traumatic stress disorder (PTSD) checklist - civilian version [PCL-C]

Polysomnography panel

Post COVID-19 functional status scale [PCFS]

Nutrition Status Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to nutrition status questionnaire panels.

2.16.840.1.113762.1.4.1222.1589

Questionnaire.code

PhenX - dietary supplements protocol 050501

Nutrition assessment panel

Nutrition status observation panel

Pain Perception Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to pain perception questionnaire panels.

2.16.840.1.113762.1.4.1222.1590

Questionnaire.code

Pain assessment panel

PROMIS item bank - pain interference - version 1.0

PROMIS short form - pain interference 6b - version 1.0

PROMIS short form - pain behavior 7a - version 1.0

PROMIS item bank - pain behavior - version 1.0

PROMIS short form - pain intensity 3a - version 1.0

PROMIS short form - pain interference 8a - version 1.0

Patient Goal Related Questionnaire Panel Codes

This set of values contain LOINC Panel codes pertaining to patient goal questionnaire panels.

2.16.840.1.113762.1.4.1222.1591

Questionnaire.code

Therapeutic goals panel

Chronic kidney disease management personal goals panel

Physical therapy goals panel

Renal replacement therapy goals panel NKDEP

Chronic kidney disease management personal goals panel

Sleep Disorder Assessment

This set of values addresses terms representing patient-reported Sleep Disorder Assessment.

2.16.840.1.113762.1.4.1222.1572

Questionnaire.code

PROMIS item bank - sleep disturbance - version 1.0

PROMIS item bank - sleep related impairment - version 1.0

PROMIS short form - sleep disturbance 8b - version 1.0

PROMIS short form - sleep impairment 8a - version 1.0

PhenX - sleep disorders screener protocol 121001

Neuro-Qol item bank - sleep disturbance - version 1.0

PROMIS short form - sleep disturbance 4a - version 1.0

PROMIS short form - sleep disturbance 6a - version 1.0

Sleep panel [R-Outcomes]

Social Determinants of Health Screening Assessments

This set of values represents screening assessments for all SDOH domains as selected by the Gravity Project.

2.16.840.1.113762.1.4.1247.126

Questionnaire.code

PROMIS item bank - 29 profile

PhenX - substance - 30D frequency protocol 031301

PhenX - physical activity - neighborhood environment protocol 151201

PhenX - current quality of life protocol 180301

PhenX - perceived social support - conflict protocol 180701

PhenX - social isolation protocol 181001

PhenX - chronic stress protocol 181301

PhenX - discrimination protocol 210301

PhenX - neighborhood safety protocol 210901

PhenX - neighborhood concentrated disadvantage protocol 211301

PhenX - annual family income protocol 011101

Social - family well-being [FACIT]

Relationships [FACIT]

Social - family well-being - FAMS [FACIT]

Social connection and isolation panel

PROMIS item bank - emotional support - version 2.0

PROMIS item bank - instrumental support - version 2.0

PROMIS item bank - social isolation - version 2.0

PROMIS short form - global - version 1.2