SDC: Modular Forms

Modular Questionnaire Background

Maintaining questionnaires can take a considerable amount of effort, particularly if they include logic to support population or extraction. At the same time, it is common for questionnaires to share content - the same questions or even the same sections might appear in multiple forms. Some organizations, particularly those with a research focus may have extensive libraries of questions intended to help drive re-use and consistency. This allows those organizations to increase consistency in how data is collected, which in turn increases the comparability of data captured, even when captured using different instruments. It also increases the quality of the data collected by encouraging the re-use of questions that have been vetted for readability, neutral phrasing and other quality considerations.

Achieving re-use with questionnaires is primarily focused on the benefit of authors. The use of modularization techniques is often transparent to the end users who must complete the questionnaires, unless they find themselves filling out many distinct forms and happen to notice the consistency of language and sections between those forms. In other words, questionnaire re-use is part of the authoring and publishing process, but generally not the form filling process.

This portion of the SDC specification describes three mechanisms for enabling re-use:

• Data Element-based Questionnaires are crafted by having items make use of the definition element. The referenced definitions include all of the metadata for the question, group or display item including the text, data type, optionality and other characteristics. Questionnaires are authored by assembling these minimal items referencing robust definitions.
• Modular Questionnaires allow one questionnaire to be composed of sub-questionnaires (which can in turn be composed of further sub-questionnaires, and so on).
• Questionnaire Library Referencing allows any item in a Questionnaire to reference a specific item in another Questionnaire using the format Questionnaire URL#linkId. This enables reuse of a specific item and its descendants (if any) without the limitations of StructureDefinition-based referencing. This is the recommended method going forward.

When using the data element-based approach, every single 'item' in the questionnaire must be specified, including all 'display' items, groups, etc. Re-use is limited to question text, value set, data type and other information that can be determined from the referenced definition element. When using the sub-questionnaire approach, multiple items can be defined along with display text, enableWhen logic and other questionnaire characteristics. The first approach is best suited for "data-element"- based questionnaires and the latter for defining collections of questions. (While defining separate modules for every single question is possible, it would be quite a bit of overhead).

These reuse mechanisms are not mutually exclusive. It is possible to create forms that mix all three techniques—for example, using subQuestionnaire for group-level reuse, as well as definitions that point to both StructureDefinition#elementId and Questionnaire#linkId for individual items.

Modular workflow

Profile:

Modular Questionnaire profile

Relevant Extensions:

• sdc-questionnaire-subQuestionnaire
• sdc-questionnaire-assemble-expectation
• sdc-questionnaire-assembleContext
• sdc-questionnaire-subQuestionnaire
• sdc-questionnaire-assembledFrom
• variable
• cqf-knowledge-capability
• package-source

Example Questionnaires:

See below

Regardless of mechanism, there are two phases. First, the questionnaire is authored in its modular form, maximizing re-use and minimizing authoring effort. Then, there is then a need to take the re-useably authored form (or collection of forms) and generate a fully 'assembled' form that contains all of the details needed for a Form Filler to properly render and capture answers for the form. While this assembly process can be undertaken by the Form Filler, it is more typically managed by the form designer as part of the publication process.

The following diagram shows the results of the assembly process with a set of questionnaires that combine both approaches: