> For the complete documentation index, see [llms.txt](https://docs.snomed.org/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.snomed.org/implementation-guides/cancer-synoptic-reporting-implementation-guide/5-technical-application/5.2-standardized-model-representation-using-fhir/5.2.2-fhir-questionnaires.md).
# FHIR Questionnaires
Creating a FHIR Questionnaire for synoptic cancer reporting provides a simple and expedited way of representing custom information models with the flexibility of a dynamic specification that can adapt quickly to any required change. Each cancer type will use a new questionnaire definition in this approach, with some sections in common and some sections with specific content. Open-source tooling is [available](https://github.com/lhncbc-fhir) for authoring questionnaire definitions, and the questionnaires can be easily rendered in a clinical application for supporting data capture.
The information entered in a FHIR questionnaire can be shared as a FHIR Questionnaires Response or transformed into a bundle of specific FHIR resources like Observations Resources and others.
Creating a new questionnaire requires several methodical steps. Here’s a step-by-step guide to help you accomplish that:
1. **Define the Scope** :
* Understand the specific type of cancer and the information that needs to be captured in the synoptic report.
* Determine the purpose of the Questionnaire: Is it for diagnostic purposes, treatment monitoring, research, etc.?
2. **Gather Information** :
* Gather all the relevant clinical guidelines, standard synoptic templates, and any other resources that can guide the creation of the Questionnaire.
* Consider input from oncologists, pathologists, and other stakeholders.
3. **Design the Questionnaire** :
* Start by identifying the main sections or groups of the Questionnaire. For instance, patient information, tumor characteristics, treatment history, etc.
* For each section, define the questions, possible answers, and any constraints.
* Use the appropriate FHIR data types for each question. For instance, use `date` for dates, `string` for free text, `choice` for multiple-choice questions, etc.
4. **Use FHIR Tools** :
* Utilize tools like the [HL7 FHIR Questionnaire Designer](https://lhcforms.nlm.nih.gov/) or any other FHIR-compatible tool to help design, visualize, and test your Questionnaire.
* These tools can help ensure the Questionnaire is constructed correctly according to FHIR standards.
5. **Incorporate Conditional Logic** :
* If certain questions should only appear based on the answers to previous questions, incorporate this conditional logic. For instance, if a specific treatment is selected, additional questions related to that treatment may be necessary.
6. **Iterative Testing** :
* Test the Questionnaire in a FHIR-compatible system.
* Collect feedback from potential users, like pathologists or oncologists.
* Make necessary revisions based on feedback and testing results.
7. **Integrate with EHR Systems** :
* Ensure that the Questionnaire can be integrated into Electronic Health Record (EHR) systems or any other health IT system where it will be used.
* Consider aspects like how the data will be extracted, how it will be presented to clinicians, and how it will be stored.
8. **Training & Education**:
* Once the Questionnaire is ready, provide training to potential users.
* Create educational materials, guidelines, and best practices for completing the Questionnaire.
9. **Continuous Review & Updates**:
* As medical knowledge evolves and new guidelines emerge, the Questionnaire should be reviewed and updated accordingly.
* Set up regular intervals (e.g., annually) to review and make necessary modifications.
10. **Interoperability & Sharing**:
* Consider sharing the designed Questionnaire with the broader medical and FHIR community. This can aid in standardization and promote interoperability.
11. **Documentation:**
* Ensure you document the design choices, versions, and updates of the Questionnaire. This documentation is crucial for maintaining and updating the Questionnaire in the future.
12. **Compliance & Ethics**:
* Ensure that the Questionnaire meets legal, ethical, and regulatory standards, especially when dealing with sensitive health data.
Remember, the aim of creating a FHIR Questionnaire for synoptic cancer reporting is to capture standardized, structured, and clinically relevant information that can be easily shared, analyzed, and utilized for patient care. It’s crucial to keep end-users in mind throughout the process and prioritize clarity and ease of use.
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