Questionnaires

Questionnaires in ART-DECOR are versionable Objects that define forms with groups and enterable item fields that can subsequently be rendered as forms and populated with data.

In Release 3.8 we added new features to the Questionnaire management

• proper display Questionnaire Responses as child items in the Navigation Card [AD30-1250, AD30-1251]

• DOWNLOAD option for FHIR export and RENDER option for using LHC Form to display Questionnaires or Questionnaire Response [AD30-1251]

• a better workflow integration of Questionnaires [AD30-1083, AD30-1125]

• option to add conditional statements ("enable when") in both the original Scenario and the Questionnaire [AD30-565, AD30-1101, AD30-1124, AD30-1228]

• consider Questionnaires as implementable artefacts (data formats) and move the menu item from the Scenario menu to the Rules menu [AD30-1208]

• enhancements of the export of ART-DECOR Questionnaires as FHIR Questionnaires [AD30-1157, AD30-1158, AD30-1163]

• enhancements of the rendition of Questionnaires with a rendering engine [AD30-604, AD30-73]

We documented what ART-DECOR is supporting with regards to FHIR Questionnaires in our Implementation Guide.

Questionnaires Panel

All Questionnaires of a Project are shown as usual in a Navigation Card to the left of the Questionnaires Panel (from Release 3.8 on, under menu item Rules). All Questionnaires are listed alphabetically. Associated Questionnaire Responses are shown as child items of the Questionnaire.

Please note that a Responses to a Questionnaire are intended to be prototyping-only in ART-DECOR. Questionnaire Responses are shown in the Navigation Card as child items of the underlying Questionnaire.

Questionnaires Details Card

The Details Card on the right shows the usual metadata for versionabel objects and a table reflecting the hierarchical list of the Items of the Questionnaire Definition. The list can be expanded or collapsed.

Groups are shown with a folder icon, items are arranged with an icon indicating their Questionnaire item type.

In the Details Card there are two green buttons DOWNLOAD and RENDER available, as long as there is a FHIR server configured for the project.

With DOWNLOAD you get a dialog to specify the FHIR Version configured for the project (e.g. "r4") and the output wire format (XML or JSON). Once specified the Questionnaire is converted to a FHIR Questionnaire export using the parameters.

Clicking on RENDER renders the Questionnaire in LHC Forms (see here for more details).

Please note that clicking on RENDER on a Questionnaire Response typically renders the original Questionnaire and populate all given answers of the Response into the Questionnaire fields.

There is now the option to add conditional statements, a so-called "enable when" behavior, that allows to define a condition under which a Questionnaire item or group is shown or not.

Structured conditional statement for a conditional element have three components

• a response item / field in the questionnaire that can carry a response (value), e. g. a quantity or a yes/no field

• an operator, e. g. equal, not equal, greater than, etc.

• a typed comparison value such as yes, or 80 kg etc., which is of the same datatype as the response item.

The creation of a structured conditional statement for, let's say the Weight gain data group in the questionnaire shown below, starts with the selection of the response item / field in the set. The idea is to only show this group and its child items when the question Weight gain is answerd with "Yes" (true).

Thus assume that we choose Weight gain in this example which yields a boolean ("yes", "no") as the response item / field in the questionnaire.

Then the Conditions table shows your selection, yet not further specified regarding the operator or the comparison value.

You can then add an operator...

...and a comparison value, offered in a list of possible types such as Boolean, Date, Date and Time, String, Coding etc.

Finally the Condition is created with all three parts. A rendition of such an "enable when" construct means that this group is shown only, when the answer to the Weight gained question is "Yes" (true).

Workflow integration of Questionnaires

A Template is an implementable artefact (data formats). We have proven features in that area that allow associations of a Scenario with a Representing Template, i. e. the Template definition that represents the functional content defined in the Scenario. Also we offer the ability to associate specific Tempates and Template Elements with a distinct functional content element adding Template Associations.

We consider Questionnaires as implementable artefacts (data formats) and similar to the Template features we added options to to the same links and ties between a Scenario and a Questionnaire. There is now an option to specify an additional Representing Questionaire for a Scenario. The associations of a Questionaire item / fields or group with the Scenario is automagically added, as a Questionnaire is typically derived from the Scenario.

In the example above, a Scenario / Transaction Summary Vital Signs, based on a Source Dataset, has a Representing Template, in this case a CDA Template definition, and a Representing Questionnaire Summary Vital Signs.

Further Achievements for Questionnaires

• A bug was fixed that a new scenario is created after the Questionnaires section in the underlying DECOR file [AD30-1139]
• Wrong behavior was fixed when deleting a representing questionnaire [AD30-1225]

Value Set Expansion Mechanism

In Release 3.8 we added new features to the Value Set Expansion mechanism

• Added an option for adding post-coordination codes to valuesets [AD30-897]
• Added an option for adding new SCT codes to valuesets [AD30-898]
• Value Set Expansion Mechanism was extended to persist an Expansion Set [AD30-1056]
• Expansion Set Store button and Value Set Panel Navigation Tree enhancements [AD30-1057]
• New Complete Code System Filters were added [AD30-1123]

Furthermore there is an announcement of our new SNO-POEM mentioned below.

Postcoordination Expression

It is now possible to add post-coordinated expressions using SNOMED. When adding or editing an item in a value set, there is also the tab "Postcoordination" offered that gives a dialog with options to enter Level and Type, a Root / focus concept and a set of Attribute-Value codes drawn from SNOMED. In the Root / focus concept and Attribute-Value code fields you can enter search terms that are looked up in the SNOMED code system (given one is installed).

The post-coordinated expression is also checked against SNOMED.

The item appears in the value set as something like in this example.

Announcement: SNO-POEM

We are working hard on a SNOMED post-coordinated expressions editor based on SNOMED's Expression Template Language (ETL). The methodology is to derive Questionnaires from official (and self-crafted) ETL expressions and render them as a form that is subsequently populated by a user. The SNOMED CT expression template is converted (once) for that purpose to a Questionnaire that is stored in a Building Block Repository and offered to the user through the post-coordination editor (POCE).

The resulting Questionnaire is part of our new SNO-POEM concept. In future Releases we will publish SNO-POEM as a proper alternative to hand-crafted SNOMED post-coordinated expressions.

Persisting Value Set Expansion Sets

Intensional Value Sets offer an EXPANSION SET button that primarily displays the resulting Expansion Set in two steps.

The Value Set Expansion Set dialog appears and first calculates the number of members (codes) in the Expansion Set, without displaying the distinct codes.

The user can click on the EXPAND + button to see all codes in the set. The list of member codes is displayed in the usual way.

Next to the CANCEL option for this dialog, a SAVE button is also offered to save the Value Set Expansion Set. Once saved (signaled by a snackbar alert), the persisted Expansion Set can be seen with its ID under the Usage tab of the corresponding original Value Set.

Technical Note: The Expansion Set could be downloaded through the API, e.g. by calling /valuesetexpansion/{id}.

Complete Code System Filters

The list of our Complete Code System Filter Operators is now including equal and exist.

Additional Complete Code System Filter operators such as is-a, descendent-of, is-not-a, regex and in will be added in future Releases.

Further Achievements for Expansion Sets in Value Sets

• Documentation for the Terminology Report was completed [AD30-1109]

• DECOR Schema additions for Expansion Sets in Value Sets [AD30-1055]

• An option was added to delete one or more associations [AD30-1090]

• Value Set flexibility is now taken into account when selecting a code system for context [AD30-1108]

• A Server error upon valueset expansion was fixed [AD30-1224]

ART-DECOR Open Tools and the ART-DECOR Expert Group