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What are 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 coming soon.The new questionnaires will have both now released and available for customers to use via our FHIR APIs and via the user interface (UI).
The currently released functionality allows:
Clinical teams to send questionnaire requests via the API
Clinical teams to retrieve questionnaire responses via the API
Professionals to send questionnaire requests to individual patients via the UI
Professionals to view completed questionnaires inside a patient’s record
Professionals and coordinators to export questionnaire responses as a CSV
Advanced questionnaires have an improved UI for patients completing the questionnaires and improved functionality for clinical teams to customise inside the questionnaires; such as including calculated fields, questionnaire scoring, branching, and coded data.
Advanced questionnaire 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
Clinical teams will be able to send questionnaires to patients that have not yet registered for PKB, as long as the patient has a PKB record with an email address and date of birth.
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.See our Advanced questionnaires features page for an overview of all the new features.
When can I use advanced questionnaires?
We are rolling out advanced questionnaires functionality iteratively. See the Development Plan below for details about what is going to change and when.
As of November 2024, your team can use advanced questionnaires as long as your use case does not rely on any of the following functionality:
Professionals or coordinators sending a ‘mass questionnaire’ to an entire team
Professionals editing the answers to a submitted questionnaire
Patients initiating a questionnaire via the UI
To begin using advanced questionnaires, PKB will need to rebuild your existing questionnaires as advanced questionnaires and then move your team over. To arrange this, please discuss with your Customer Success PM.
Development and rollout plan
Released functionality
FHIR APIs (Released December 2023)
This phase of the project made new FHIR API endpoints available for clinical teams to send questionnaires to patients and retrieve their responses.
The patient’s answers will be stored in our database as FHIR QuestionnaireResponse resources and can be retrieved using the QuestionnaireResponse endpoint.
When questionnaires are triggered via the API, patients receive an email notification containing a link to complete the questionnaire. Once the patient has completed the questionnaire, they are directed to a landing page which confirms they have completed the questionnaire. For unregistered patients, this page has an option for them to register via NHS login.
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Patients can see questionnaires on the Events & messages page (Released January 2024)
Patients can see questionnaire requests on the Events & messages page, where they can answer the questions in the questionnaire, continue answering questions on a questionnaire they’ve saved or view their answers to completed questionnaires.
Other users with the required access, such as professionals and carers, cannot answer questions on behalf of a patient but can see the questionnaire request and view their answers.
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Professionals can send questionnaires to individual patients (Released July 2024)
This stage of the project introduced the advanced questionnaire functionality to the UI for professionals, who can now send advanced questionnaires to individual patients if their team has advanced questionnaires enabled. This stage does not include mass questionnaires, which have not yet been released for advanced questionnaires. This stage of the project had both UI and functional changes:
The ‘Consultations’ tab on in the professional and coordinator UI changed to ‘Questionnaires’ and the ‘Start consultation’ button changed to ‘Send questionnaire’. This changed for all teams, even those who have not moved to advanced questionnaires.
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Professionals can send advanced questionnaires to patients via the PKB UI by clicking ‘Send questionnaire’. Patients will get an email notification asking them to complete the questionnaire and will see the questionnaire request in the Events & messages section.
Currently, professionals can send advanced questionnaires to individual patients. In early 2025, we will be releasing the ‘mass questionnaire’ feature for advanced questionnaires, which will allow coordinators and professionals to send the questionnaire to every patient in a team.
At this stage of the project, teams began moving to advanced questionnaires. Once a team has moved to advanced questionnaires:
Professionals can only send advanced questionnaires via the UI. They cannot send the consultations that they were sending before the move, but they can still export historic answers.
Patients can not initiate questionnaires via the UI. These patients will not see the ‘Start consultation’ button until we allow the patient to initiate the questionnaire via the UI, unless they are also in teams that have not moved to advanced questionnaires.
At this stage, teams can move to advanced questionnaires as long as they do not require the following features:
Mass questionnaire
Patient trigger
Professionals and coordinators can export questionnaire answers as a CSV (Released October 2024)
Professionals and coordinators can now export their patients' answers to advanced questionnaires as a CSV file, via the ‘Questionnaires’ page. Professionals and coordinators will see a list of advanced questionnaires that are linked to their team on the ‘Questionnaires’ page.
The CSV file is formatted differently to the CSV export for simple questionnaires, with one row per question, rather than per patient. This allows the export file to contain other information about a question, such as any clinical codes associated with it or any formula that were used to calculate a score.
See our manual page for an example CSV file containing one patient’s answers to a GAD7 questionnaire.
Clinical teams can suppress email notifications when sending advanced questionnaires via the API (Released October 2024)
The notificationFlag parameter can be used in API calls to the $send-questionnaire-request endpoint to suppress the email notifications that a patient receives when sent a questionnaire. Clinical teams may choose to use this if they are sending the patient their own notifications; e.g. via SMS or email.
Professionals can configure whether patients are allowed to edit the answers to a completed questionnaire (Released November 2024)
When a professional sends a questionnaire request to a patient, they will now see a checkbox called ‘Allow patient to edit answers after submission'. If the professional ticks this box, the patient will be able to edit the answers to their questionnaire after they have submitted it. If the professional does not tick the box, the patient will not be able to edit their answers after submission.
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Currently, the professional who sent the questionnaire does not get an email notification when the patient submits or amends a questionnaire. However, these email notifications will be added in Q4 2024/Q1 2025.
When a completed questionnaire is edited, the status of the questionnaire is changed to amended and the message thread shows this status as ‘Amended’, with the date and time of the most recent edit.
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Clinical teams can also configure whether a patient is allowed to edit a completed questionnaire when sending questionnaires using the FHIR API, using the amendableBy parameter.
Unreleased functionality
Professionals can edit the answers to a completed questionnaire (Q1 2025)
Professionals will be able to configure whether they, or other professionals, can edit the responses of a questionnaire completed by a patient.
A second checkbox will be added to the ‘Send questionnaire’ modal where a professional chooses the questionnaire they would like to send. If the professional ticks the ‘Allow professionals to edit patient’s answers after submission' box, professionals will be able to edit a patient’s answers after the patient has submitted them. If the professional leaves the box unticked, professionals will not be able to edit completed questionnaires.
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When a professional edits a completed questionnaire, the QuestionnaireResponse is updated and the professional is added to the author field. The name of the professional is also displayed in the UI, next to the ‘Amended’ status and date and time of the last edit. This provides an audit trail of who has updated the questionnaire and when.
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Clinical teams will also be able to configure whether a professional is allowed to edit a completed questionnaire when sending questionnaires using the FHIR API, using the amendableBy parameter.
Email notifications for professionals when questionnaires are submitted or amended (Q4 2024)
Professionals will receive an email notification when a patient submits or edits a questionnaire that the professional sent. The email notification will take the professional to the questionnaire in their inbox, where they can view the answers by clicking the ‘View’ button.
Patients can initiate questionnaires via the UI (Q1 2025)
Teams will be able to configure whether patients can initiate questionnaires via the UI. Patients will initiate these questionnaires by clicking ‘Start consultation’.
Only questionnaires that have been marked by the team as patient-facing will appear to the patient; meaning the patient will not see a ‘Start consultation’ button if the team has no questionnaires or if the team only has questionnaires that the patient is not allowed to initiate.
The button will remain ‘Start consultation’, as the patient is consulting their team online when they choose to initiate a questionnaire.
Patients will then only be able to initiate advanced questionnaires via the user interface. All teams that have patient-initiated questionnaire workflows will be moved to advanced questionnaires at this point.
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At this stage, teams that have workflows that require the patient to initiate a questionnaire begin using advanced questionnaires.
Professionals and coordinators can send mass questionnaires (2025)
Professionals and coordinators will be able to send an advanced questionnaire to their whole team, using the ‘mass questionnaire’ feature.
Professionals and coordinators will be able to send a questionnaire to their whole team by clicking ‘Send questionnaire' on the ‘Questionnaires' page. The professional or coordinator is asked to confirm that they are sure they want to send the questionnaire to the entire team. This warning message is being improved as part of the advanced questionnaire project (please see the section titled ‘Questionnaires UI upgrade’).
When a professional or coordinator sends a mass questionnaire, it is sent to every patient in their team. Professionals and coordinators will not receive email notifications or inbox items for mass questionnaires.
Questionnaires can be completed by professionals and carers (2025)
Professionals and carers will have the option of completing questionnaires on behalf of patients. When a user who isn’t the patient completes a questionnaire, the user is added to the author field of the QuestionnaireResponse (whereas the patient is still recorded in the subject field). This user will also be displayed in the UI next to the status of the questionnaire and the date and time it was last updated.
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Future work (Unscheduled)
We will then move onto development of other features related to Advanced Questionnaires, including:
Making the QuestionnaireResponse available via our APIs as a PDF
Allowing patients and professionals to send secure messages about an Advanced Questionnaire