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What are
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advanced questionnaires?
PKB’s questionnaires feature is being updated to make it easier for clinical teams to gather information from their patients, including patients who have a PKB record but are not yet registered. The new questionnaires feature is now available via our FHIR APIs.
The new questionnaires will have both an improved UI for patients completing the questionnaires and improved functionality for clinical teams to customise the questionnaires; such as including calculated fields, questionnaire scoring, branching, and coded data.
This page outlines the new features that are introduced by Advanced Questionnaires and the phases of development.
Features
Scoring
Questionnaire scoring allows clinical teams to send scored questionnaires, such as the PHQ9, to patients. These scored questionnaires will apply simple calculations to patients' responses and generate an overall score, which can be viewed in the questionnaire response or retrieved via our APIs.
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Branching
Organisations can configure sections of questionnaires to be displayed conditionally to patients, based on their answers to previous questions. For example, showing a set of pregnancy-related questions to a patient only after they had responded ‘Yes’ to a question asking if they are pregnant.
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Coded data
Questions in Advanced Questionnaires can be mapped to clinical codes. For example, a question asking a patient for their blood pressure can be mapped to the clinical code for blood pressure.
When PKB creates the questionnaire template, we can add a clinical code for a question and/or a list of coded answer options. Organisations can then extract the relevant coded fields into their local systems via the FHIR R4 Questionnaire resource (see image above). The questionnaire questions are linked to the relevant responses in the QuestionnaireResponse resource via the ‘linkId’.
In a later development phase, PKB will map the coded data from questionnaires to other FHIR resources, e.g. measurements -> Observations resource. This would mean the measurements will be visible in the questionnaire response and also in the Measurements section of PKB.
Questionnaire scores can also be mapped to clinical codes where appropriate. For example, the score generated from a PHQ-9 depression questionnaire could be mapped to the SNOMED code for that score.
Mandatory questions
Organisations will be able to set individual questionnaire questions as mandatory, meaning the patient will not be able to submit the questionnaire if they are not complete. This will reduce time spent by clinical teams communicating with the patient if an important field is left unanswered. The patient will see an error message if they click Submit on a form with unanswered mandatory questions.
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Drafts
Patients will be able to save their questionnaire in draft form and exit the questionnaire, before returning later and carrying on where they left off.
When a patient clicks ‘Save and close’ on a questionnaire, they will be directed back to the PKB home screen (if logged in) or the PKB login screen. Draft questionnaires will have an associated questionnaire response with a status of ‘In progress’.
When a patient returns to the questionnaire, they can continue completing the questionnaire and their previous responses will be saved. When the patient clicks ‘Submit’, the associated questionnaire response will have a status of ‘Completed’.
Images
Embedded images
Organisations will be able to embed images in questionnaires. Clinical teams can use images in questionnaires to guide the patient how to answer the questions and provide additional information and context to the questions.
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Patient-uploaded images
Patients will be able to upload images in response to questions in questionnaires. This can be used by clinical teams, for example, when collecting information about the patient, where they can upload a photograph of themselves, or for uploading images related to their health such as injuries or skin rashes.
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Sending questionnaires to unregistered patients
Patients will be able to complete questionnaires without first registering for PKB, as long as they have a PKB record that contains an email address.
Unregistered patients will be sent an email explaining that they have been sent a questionnaire, which contains a link to the questionnaire. When they click on the link, they will be asked to provide their date of birth. This is to confirm they are the patient that the questionnaire has been sent to..
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Once the date of birth check is complete, the patient is taken to the questionnaire.
When the patient clicks ‘Save and close’ or ‘Submit’, they are redirected to a confirmation page, with instructions about how to register. The completed questionnaire is saved in their PKB record even if they do not go on to register.
Development Plan
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See our Advanced questionnaires features page for an overview of all the new features.
When can I use Advanced Questionnaires?
We will be rolling out advanced questionnaires functionality iteratively. See the Development Plan below for details about what is going to change and when.
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Development and rollout plan
December 2023 - APIs (Complete)
The first phase of development for advanced questionnaires, which has now been released, has made new FHIR API endpoints available. Clinical teams can use these endpoints to send questionnaires to patients and retrieve their responses.
The patient’s answers, as well as the questionnaires themselves, will be stored in our database and can be retrieved as Questionnaire and QuestionnaireResponse FHIR resources.
Whilst clinical teams can send advanced questionnaires and retrieve responses now that we have released the new API endpoints, the new questionnaires will not be immediately available in PKB’s UI.
When questionnaires are triggered via the API, patients will receive an email notification containing a link to complete the questionnaire. Once the patient has completed the questionnaire, they will be directed to a landing page which confirms they have completed the questionnaire. For unregistered patients, this page will have an option for them to register via NHS login.
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Functionality relating to existing PKB questionnaires will not be affected by these changes.
At this point, teams who send questionnaires only via integration (and not via the user interface) can begin using advanced questionnaires.
February 2024 - Patients can see questionnaires on the Events & messages page
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March 2024 - Professionals and coordinators can send questionnaires and export responses via the UI
Q2 2024 - Completed questionnaires can be edited
Q2 2024 - Patients can initiate questionnaires via the UI
Next steps
In the months after making the new Advanced Questionnaire API endpoints available, we will introduce important Advanced Questionnaire functionality into the UI. This includes:
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We will then move onto development of other features related to Advanced Questionnaires, including:
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Making the QuestionnaireResponse available via our APIs as a PDF
Allowing organisations to retrieve a link to an Advanced Questionnaire, so that it can be sent to patients via SMS
Allowing patients, and other users, to edit completed questionnaires from the PKB UI
Allowing carers to complete Advanced Questionnaires on behalf of patients
Allowing patients and professionals to send secure messages about an Advanced Questionnaire
Can I use Advanced Questionnaires?
Advanced questionnaires can currently only be sent to patients using our questionnaire APIs. This means that your clinical team can only send advanced questionnaires to patients if your Trust has built an integration with these new APIs.
If you have an existing integration for sending questionnaires, you can continue to use that until your Trust has built the new integration.
If you send questionnaires to patients via the user interface (UI), you can keep sending these questionnaires via the UI until we move your team to advanced questionnaires.