---
tags: CDEX
title: CDex Workflow Using Questionnaire/QuestionnaireResponse
---

# CDex Workflow Using Questionnaire/QuestionnaireResponse

Proposal is a mash up of CDex and DTR to leverage DTR which is being or will be implemented by EHRs.


|Way to Specify Data Requested|Task-Based Queries|Attachments|
|---|---|----|
code|:heavy_check_mark:|:heavy_check_mark:|
fhir query syntax|:heavy_check_mark:|:X:|
free text|:heavy_check_mark:|:X:|
:new: questionnaire|:heavy_check_mark:|:heavy_check_mark:|

## General Task-based Query + DTR

DTR is a SMART on FHIR app or equivalent native EHR app

### Summary of Steps


1. Data Consumer requests data with a :new: input parameter in the CDex Task Request Profile that points to a *url of a Questionnaire*
- This associated with a :new: Task.code
- The Questionnaire may or may not be standardized- i.e., it can ask anything
- The Task can *only* contain a Questionnaire, no mixing codes, search queries, etc with Questionnaires
1. Data Source Launch DTR and gives access to the Task
- Trigger for the Data Source to launch DTR is the url to a Questionnaire and the Task.code
- Task lives on Data Source
3. DTR app loads and answer questionnaire (See [DTR](https://hl7.org/fhir/us/davinci-dtr/2022May/index.html) especially [Launch outside of CRD](https://hl7.org/fhir/us/davinci-dtr/2022May/specification__behaviors__launch_outside_of_CRD.html))
5. DTR Return QuestionnaireResponse link as a `Task.output` parameter and updates the Task as "completed"
6. Data Consumer either polls and fetches the completed questionnaire, or the Data Source sends a subscription notification once the Task is completed

### Sequence Diagram

participant Data Consumer
participant Data Source
participant DTR
participant User
#entryspacing 0.4
note over Data Source: Provider acts as both\n EHR/HIT FHIR Server and DTR Client
note over DTR: DTR is SMART App or native EHR app
note left of Data Consumer: 1) Prepare Task\nincluding link to Questionnaire
Data Consumer->Data Source: 2) POST CDEX Task\nto complete Questionnaire
Data Source->DTR: 3) Launch DTR
DTR -> Data Source: 4) GET Task
Data Source --> DTR: Return Task
DTR -> Data Source: 5) GET Questionnaire
Data Source --> DTR: Return Questionnaire
note over Data Consumer, Data Source: 6) ...Polling for Task updates...
DTR --> DTR: 7) extracts answers\ncreates FHIR QuestionnaireResponse
note over DTR, Data Source: 7) ...Fetching Data to Complete\n QuestionnaireResponse...
note over DTR,User: 8) Manual Review and Completes form\nif necessary
DTR -> Data Source: 9) POST completed QuestionnaireResponse
DTR -> Data Source:10) Update Task with link to\nQuestionnaireResponse\nand "completed" status
Data Consumer->Data Source:6)  Poll for Task updates
Data Source-->Data Consumer: complete!
Data Consumer->Data Source: 11) Get QuestionnaireResponse
Data Source-->Data Consumer: Return QuestionnaireResponse

## Request Attachments + DTR

### Summary of Steps


Same sequence as Task-Based Query above "except":

5. Data Source (Provider) returns QuestionnaireResponse to Data Consumer (Payer) as a $submit-attachment parameter

### Sequence Diagrams

Note right of Payer: Ask provider to \nfill out Questionnaire
Note right of EHR/HIT: EHR also acts as DTR Client
Payer->EHR/HIT: request data via Task.input\nlink to Questionnaire
Note right of EHR/HIT: EHR/HIT thinks
EHR/HIT->DTR: Here do this!
Note right of DTR: DTR works
DTR -> DTR: fetches CQL (rules\nand FHIR Questionnaire
DTR -> DTR: extracts answers creates\nFHIR QuestionnaireResponse
DTR -> User: Review this!
Note right of User: Manual Review
User -> User: Complets form\nif necessary
User --> DTR:
DTR --> EHR/HIT: 
EHR/HIT -> EHR/HIT: add QuestionnaireResponse\nto payload
EHR/HIT -> Payer: Send $submit-attachment with\nto Payer endpoint 

<!-- ### Flow Charts

Flow charts can be specified like this:

st=>start: Start
e=>end: End
op=>operation: My Operation
op2=>operation: lalala
cond=>condition: Yes or No?

st->op->op2->cond
cond(yes)->e
cond(no)->op2

### DTR SMART App Launch from CDex

- Assuming [Smart Version 2.0.0](http://hl7.org/fhir/smart-app-launch/STU2/)


<!--
### Flow Charts

Flow charts can be specified like this:

st=>start: Start
e=>end: End
op=>operation: My Operation
op2=>operation: lalala
cond=>condition: Yes or No?

st->op->op2->cond
cond(yes)->e
cond(no)->op2

-->