Relationship between FHIR Questionnaire/QuestionnaireResponse and External Representations

In the eHealth Infrastructure, questionnaires and responses to them are represented as:

• FHIR Questionnaire profile https://docs.ehealth.sundhed.dk/latest-released/ig/StructureDefinition-ehealth-questionnaire.html and https://docs.ehealth.sundhed.dk/latest-released/ig/StructureDefinition-ehealth-questionnaire-advanced.html

• FHIR QuestionnaireResponse profile https://docs.ehealth.sundhed.dk/latest-released/ig/StructureDefinition-ehealth-questionnaireresponse.html

There are external representations in the form of documents with a somewhat similar division between questionnaire and response:

• HL7 Questionnaire Form Definition Document (QFDD), Danish profile DK QFDD

• HL7 Questionnaire Response Document (QRD), Danish profile DK QRD - See https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2242281473/Performing+Document+Query+and+Retrieve+and+Using+Transformations#Provided-Transformations-between-FHIR-resources-and-Danish-CDA-Profiles for version details and reference to specification.

Questionnaires can exist independently in the eHealth Infrastructure as FHIR Questionnaire and independently as QFDD in the Clinical Document Architecture domain. An external QFDD document can exist without having a corresponding definition as FHIR Questionnaire in the eHealth Infrastructure and vice versa.

There is, however, the possibility that a questionnaire definition exists or is made to exist both in the eHealth Infrastructure (as FHIR Questionnaire) and in the CDA domain (as QFDD). This situation can be accomplished in a number of ways:

1. The QFDD exists already:

   1. The FHIR Questionnaire can be manually designed in the eHealth Infrastructure

   2. The QFDD could be imported by transforming it to FHIR Questionnaire and persisting it in the eHealth Infrastructure

2. The FHIR Questionnaire exists already:

   1. The FHIR Questionnaire could be exported by transforming it to QFDD and persisting it as a QFDD XML file

For all of the above cases, there will be certain differences in how the questionnaire definition is manifested as FHIR Questionnaire and QFDD, even for the same questionnaire definition. This is a consequence of inherent differences in the the representations and the principle of enabling document sharing of responses described below.

The prime requirements behind the principle in enabling document sharing for questionnaire responses is that:

• The FHIR Questionnaire and QFDD shall be so similar that:

  • a FHIR QuestionnaireResponse can be transformed to a Questionnaire Response Document (QRD) to a degree that:

    • the QRD will be a valid response to the QFDD.

When this is the case, the FHIR Questionnaire is said to be a near approximation of the QFDD.

For a FHIR Questionnaire to be a near approximation of a QFDD, certain constraints and requirements on structure and content must be followed.

In order for the FHIR QuestionnaireResponse to QRD transformation to produce a QRD valid for the QFDD, the FHIR Questionnaire must be a near approximation and the QFDD XML representation must be available in the eHealth Infrastructure. This is achieved by uploading the QFDD to the eHealth Infrastructure, which creates a FHIR DocumentReference containing the QFDD XML.

When this is the case, the near approximation is reflected by:

• the FHIR Questionnaire having an identifier (Questionnaire.identifier) which is identical to the QFDD document id

• a FHIR DocumentReference:

  • having a master identifier (DocumentReference.masterIdentifier) identical to the QFDD document id

  • a type set to Coding for QFDD

  • the QFDD XML document contained (in DocumentReference.content.attachment)