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  1. FHIR Specification Feedback
  2. FHIR-39495

Disagree with removing QuestionnaireResponse

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Core (FHIR)
    • 5.0.1
    • Cross-Group Projects
    • STU
    • Screening and Assessments
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      Will update support as follows

      Profile 5.0.1 6.0.0
      The US Core Observation Screening Assessment Profile SHALL(US Core Observation SDOH Assessment Profile) SHALL
      SDC Base Questionnaire undefined SHOULD
      US Core QuestionnaireResponse Profile MAY SHOULD

      Update Screening and Assessments page:

       

      Choosing Between QuestionnaireResponse and Observation

      For API developers using US Core, it's important to understand when to use the QuestionnaireResponse versus Observation to represent structured assessments and surveys. Here are some guidelines to help choose the appropriate profile:

      • Observations represent specific point-in-time facts that need to be searched, trended, be the subject of statistical analysis, and/or directly referenced in support of other actions. Not all answers in a form will necessarily be appropriate to surface as an Observation. However, anything that meets the preceding criteria SHOULD be surfaced as an Observation.
      • QuestionnaireResponses represent the source-of-truth of a completed form. They show how the question was phrased, what answer text they saw/typed, the order in which they filled out the form, etc. For FHIR implementers, it is important to note that QuestionnaireResponse references specific versions of a form filled out whether the form was represented as a FHIR Questionnaire or not. (however, it may be challenging to determine canonical URLs and linkIds that are consistent across systems without using a FHIR Questionnaire.) This reference provides the context of exactly what options were available to choose from, what logic was used to calculate answers or to determine what questions were act can also be determined. It is important to note that QuestionnaireResponse cannot be used for searching based on individual responses but can be used to capture higher-level information such as what form was filled out, by whom, and when.

      In many cases, data might be represented using both mechanisms - the initial raw assessment retained for audit or detailed review stored as a QuestionnaireResponse, and the detailed key answers surfaced as Observations for easy search and analysis.

      </div><!-- new-content -->

      Show
      Will update support as follows Profile 5.0.1 6.0.0 The US Core Observation Screening Assessment Profile SHALL(US Core Observation SDOH Assessment Profile) SHALL SDC Base Questionnaire undefined SHOULD US Core QuestionnaireResponse Profile MAY SHOULD Update Screening and Assessments page:   Choosing Between QuestionnaireResponse and Observation For API developers using US Core, it's important to understand when to use the QuestionnaireResponse versus Observation to represent structured assessments and surveys. Here are some guidelines to help choose the appropriate profile: Observations represent specific point-in-time facts that need to be searched, trended, be the subject of statistical analysis, and/or directly referenced in support of other actions. Not all answers in a form will necessarily be appropriate to surface as an Observation. However, anything that meets the preceding criteria SHOULD be surfaced as an Observation. QuestionnaireResponses represent the source-of-truth of a completed form. They show how the question was phrased, what answer text they saw/typed, the order in which they filled out the form, etc. For FHIR implementers, it is important to note that QuestionnaireResponse references specific versions of a form filled out whether the form was represented as a FHIR Questionnaire or not. (however, it may be challenging to determine canonical URLs and linkIds that are consistent across systems without using a FHIR Questionnaire.) This reference provides the context of exactly what options were available to choose from, what logic was used to calculate answers or to determine what questions were act can also be determined. It is important to note that QuestionnaireResponse cannot be used for searching based on individual responses but can be used to capture higher-level information such as what form was filled out, by whom, and when. In many cases, data might be represented using both mechanisms - the initial raw assessment retained for audit or detailed review stored as a QuestionnaireResponse, and the detailed key answers surfaced as Observations for easy search and analysis. </div><!-- new-content -->
    • Eric Haas/Brett Marquard: 16-0-0
    • Enhancement
    • Compatible, substantive

    Description

      The rationale provided is:

      1. Promoting two different ways to exchange the same data forces Clients to support both structures and complicates future FHIR Write efforts.
      2. Transforming QuestionnaireResponse to Observations is necessary if a system only supports Observations.
      3. Clients can not query individual responses in QuestionnaireResponse.
      4. Potential clinical safety issues with information spread across two resources.

      I believe these are all flawed.

      Questionnaires is the only acceptable way to capture a significant number of assessments.  Only Questionnaires provide strict control over question wording, permitted answers, order of presentation, flow logic, answer weighting and scoring, etc.  It is not possible to achieve these same things using Observations.  Many assessments are very carefully designed and validated instruments.  Failing to adhere to the strict requirements about presentation means that the data collected is suspect and may be invalid.

      Data has long been captured in existing systems as both completed forms as well as a subset of relevant data (typically scores) then represented as computably retrievable observations.  FHIR offers the ability to move from scanned paper to electronic entry, but the utility of retaining both the original "source of truth" completed form as well as the smaller set of extracted Observation data remains.

      There has likely been some degree of patient safety issues in the past with transcribing scores into electronic systems.  However, with electronic QuestionnaireResponse representation and data extraction mechanisms, this downside is significantly reduced.  And, given the risk certainly wasn't enough to drive systems to stop using proper forms before, it certainly doesn't make sense to move away from them now that the risk is lower.

      In the old world, the source-of-truth data was never searchable based on answers, so the inability to do so in the new world isn't problematic either.  There's generally no need to capture every single answer as an Observation.  Only certain key questions or the final determination need to be computably accessible.  

      Numerous IGs that build on U.S. core require support for Questionnaire and QuestionnaireResponse, including Gravity and Da Vinci DTR and CDex.  Much broader consultation is needed before making such a major shift.

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            Unassigned Unassigned
            lloyd Lloyd McKenzie
            Corey Smith, Himali Saitwal, Lloyd McKenzie, Robert Dieterle
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              Created:
              Updated:
              Resolved: