Structured Data Capture
4.0.0-ballot - STU 4 ballot
Structured Data Capture
4.0.0-ballot - STU 4 ballot
This page is part of the Structured Data Capture FHIR IG (v4.0.0-ballot: STU 4 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions
| Page standards status: Trial-use |
Contents:
Adaptive Forms follow an architecture where a questionnaire is not pre-defined, rather the questionnaire is dynamically developed based on previous answers to questions chosen from an item bank of questions. This type of administration is also known as Computerized Adaptive Testing (CAT), or administration of Adaptive Questionnaires. In these cases, a set of questions (typically 4 to 12) are administered from a question bank containing numerous questions. The selected questions are based on Item Response Theory (IRT) algorithms which look at the answers provided and select the next question based on IRT algorithms. The questions are selected to quickly obtain the necessary outcomes (e.g. assessing a person's physical function) using fewer questions rather than administering a large question bank. These small sets of questions still provide the necessary confidence and scores required to interpret the data appropriately as if the whole questionnaire was administered. The Adaptive Questionnaire Profile describes the structure, extensions, and metadata required to define an adaptive questionnaire, while the Adaptive QuestionnaireResponse Profile defines how the responses are captured during administration. The adaptive process relies on the $next-question operation to dynamically determine and retrieve subsequent questions based on previous answers.
The section explains the process of administering an Adaptive Questionnaire and the actors (systems) involved. Figure 1 below shows the abstract model of the administration process.
Figure 1: Adaptive Questionnaire Administration Abstract Model
External Assessment Center: The External IRT based Assessment Center is a system that can administer a questionnaire based on IRT algorithms. The data that is necessary for the administration is only the initial item bank. The External Assessment Center does not need to know about the specific patient identity or any other clinical information. The Assessment Center will use algorithms recommended by the Questionnaire designer to determine how to administer the questionnaire.
Patient Facing Administration App: The Patient Facing Administration App is the actual app that is being used to present the questions to the patient. It can be an EHR, a SMART on FHIR App, an Independent PRO Administration App.
As shown in Figure 1 above, the Patient Facing Administration App (EHR, Care Delivery System, Independent App or SMART on FHIR App) acts as the client
and initiates the administration process.
The following section describes the steps that take place when completing an adaptive Questionnaire and also provides examples of the content sent to and received back from the next question operation. With regard to the server's response, it is possible that more than one new question is returned in the questionnaire, and previously sent questions that were unanswered might not be sent back by the server.
Before initiating the administration process for an adaptive questionnaire, the app must first locate the appropriate questionnaire. This can be done through various mechanisms such as performing a search operation, referencing a Task resource, or other mechanism. The questionnaire being located SHALL conform to the Adaptive Questionnaire Search Profile, which ensures that it is discoverable and compliant with adaptive questionnaire requirements.
Additionally, the located questionnaire SHALL include the questionnaireAdaptive extension. This extension explicitly indicates that the questionnaire supports adaptiveness and may provide details about the endpoints where the $next-question operation can be invoked. If the questionnaireAdaptive extension doesn't specify a URL, the location must be independently negotiated, though as a fallback, try the server on which the Questionnaire is hosted. This step ensures that the app knows whether the questionnaire is adaptive and where to send subsequent requests for the adaptive process.
POST [base]/Questionnaire/$next-question
{ // start body
"resourceType": "QuestionnaireResponse",
// contained Questionnaire
"contained": [
{
"resourceType": "Questionnaire",
"id": "q",
"derivedFrom": "http://example.org/fhir/Questionnaire/12345"
//no items since initiating the adaptive questionnaire
...
}
], // end of contained Questionnaire
// reference to contained Questionnaire
"questionnaire": "#q",
"status": "in-progress",
...
//no items since it is just getting started
} // end body
{ // start response body
"resourceType": "QuestionnaireResponse",
// contained Questionnaire
"contained": [
{
"resourceType": "Questionnaire",
"id": "q",
"derivedFrom": "http://example.org/fhir/Questionnaire/12345",
// First Item being sent back
"item": [
{
"linkId": "1.1", // unique id of the question within the questionnaire
"code" : [
{
"system": "http://loinc.org",
"code": "12345-6"
}
],
"text": "Are you able to walk for 30 minutes ?",
"type": "choice",
"required": true,
"answerValueSet": "http://loinc.org/LA1234"
} // end of item
]
}
] // end of contained Questionnaire
} // end response body
POST [base]/Questionnaire/$next-question
{ // start body
"resourceType": "QuestionnaireResponse",
// contained Questionnaire
"contained": [
{
"resourceType": "Questionnaire",
"id": "q",
"derivedFrom": "http://example.org/fhir/Questionnaire/12345",
// List items here that have been already administered.
"item": [
{
"linkId": "1.1", // unique id of the question within the questionnaire
"code" : [
{
"system": "http://loinc.org",
"code": "12345-6",
}
],
"text": "Are you able to walk for 30 minutes ?",
"type": "choice",
"required": true,
"answerValueSet": "http://loinc.org/LA1234"
} // end of item
]
}
], // end of Contained Questionnaire
// references the contained Questionnaire
"questionnaire": "#q",
"status": "in-progress",
...
"item": [
// First Item being sent back with answer to be used to determine completeness or next question.
{
"linkId": "1.1", // unique id of the question within the questionnaire
"text": "Are you able to walk for 30 minutes ?",
"answer": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA1234"
}
}
]
} // end of item
]
} // end body
{ // start body
"resourceType": "QuestionnaireResponse",
// contained Questionnaire
"contained": [
{
"resourceType": "Questionnaire",
"id": "Id of the Questionnaire Instance on which operation is being invoked",
"derivedFrom": "http://example.org/fhir/Questionnaire/12345",
"item": [
// Item already administered
{
"linkId": "1.1", // unique id of the question within the questionnaire
"code" : [
{
"system": "http://loinc.org",
"code": "12345-6",
}
],
"text": "Are you able to walk for 30 minutes ?",
"type": "choice",
"required": true,
"answerValueSet": "http://loinc.org/LA1234"
}, // end of Item already administered
// New Item
{
"linkId": "1.2", // unique id of the question within the questionnaire
"code" : [
{
"system": "http://loinc.org",
"code": "23456-7",
}
],
"text": "Are you able to lift a chair to move it from one room to another ?",
"type": "choice",
"required": true,
"answerValueSet": "http://loinc.org/LA1234"
} // end of New Item
] // end of items
}
], // end of contained Questionnaire
// References the contained Questionnaire
"questionnaire": "#q",
"status": "in-progress",
...
"item": [
// First Item that was sent back with answer when requesting next question.
{
"linkId": "1.1", // unique id of the question within the questionnaire
"text": "Are you able to walk for 30 minutes ?",
"answer": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA1234"
}
}
]
}
] // end of item
} // end body
POST [base]/Questionnaire/$next-question
{ // start body
"resourceType": "QuestionnaireResponse",
// contained Questionnaire
"contained": [
{
"resourceType": "Questionnaire",
"id": "Id of the Questionnaire Instance on which operation is being invoked",
"derivedFrom": "http://example.org/fhir/Questionnaire/12345",
"item": [
// Items already administered
{
"linkId": "1.1", // unique id of the question within the questionnaire
"code" : [
{
"system": "http://loinc.org",
"code": "12345-6",
}
],
"text": "Are you able to walk for 30 minutes ?",
"type": "choice",
"required": true,
"answerValueSet": "http://loinc.org/LA1234"
}, // end of item
{
"linkId": "1.2", // unique id of the question within the questionnaire
"code" : [
{
"system": "http://loinc.org",
"code": "23456-7",
},
],
"text": "Are you able to lift a chair to move it from one room to another ?",
"type": "choice",
"required": true,
"answerValueSet": "http://loinc.org/LA1234"
}, // end of item
...
// Since the questionnaire is completed, there will be 2 new items with the overall score and confidence.
{
// Mark the item as hidden (if the score should be hidden from the user)
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "1.9", // unique id of the question within the questionnaire
"text": "Overall Score",
"type": "decimal",
"required": true,
"readOnly": true
}, // end of item
{
// Mark the item as hidden (if the confidence should be hidden from the user)
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "1.10", // unique id of the question within the questionnaire
"text": "Score Confidence",
"type": "decimal",
"required": true,
"readOnly": true
} // end of item
]
}
], // end of contained Questionnaire
// references the contained Questionnaire
"questionnaire": "#q",
// completed Status
"status": "completed",
...
"item": [
// First Item that was previously sent back
{
"linkId": "1.1", // unique id of the question within the questionnaire
"text": "Are you able to walk for 30 minutes ?",
"answer": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA1234"
}
}
]
}, // end of item
{
"linkId": "1.2", // unique id of the question within the questionnaire
"text": "Are you able to lift a chair to move it from one room to another ?",
"type": "choice",
"answer": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA3534"
}
}
]
}, // end of item
...
// Since the questionnaire is completed, there will be 2 new items with the overall score and confidence.
{
"linkId": "1.9", // unique id of the question within the questionnaire
"text": "Overall Score",
"answer": [
{
"valueDecimal": "123.45"
}
]
},
{
"linkId": "1.10", // unique id of the question within the questionnaire
"text": "Score Confidence",
"answer": [
{
"valueDecimal": "0.95"
}
]
}
] // end of items
} // end body
Because the adaptive process involves sending answers to a separate endpoint in order to determine the "next question", the connection should be appropriately protected based on the type of information that might be exchanged. (And given that there is no way to be completely certain what questions will be asked, it is best to err on the side of safety and presume that sensitive information might be shared.) As well, there should be trust between the Form Filler and the nextQuestion endpoint as the server performing the operation will obviously have access to that information. In general, servers performing the nextQuestion operation SHOULD NOT take any action with the data other than to return the response and potentially log the information. "Submission" of a completed form should always be a distinct action taken by the client.
IG © 2022+ HL7 International / FHIR Infrastructure. Package hl7.fhir.uv.sdc#4.0.0-ballot based on FHIR 4.0.1. Generated 2024-12-17
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