Summary

Below highlights a working example of transforming both FHIR Questionnaire Resource and a corresponding Questionnaire Response Resource into a simple notional ANF logical representation. This is achieved utilizing the Saxon XSLT engine (https://www.saxonica.com/documentation/index.html#!using-xsl/commandline) against version 3.0 XSLT and version 3.1 XPath.

Example FHIR Questionnaire Resource

<?xml version="1.0" encoding="UTF-8"?>
<Questionnaire xmlns="http://hl7.org/fhir">
    <id value="3141"/>
    <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">
            <pre>1.Comorbidity?
              1.1 Cardial Comorbidity
                1.1.1 Angina?
                1.1.2 MI?
              1.2 Vascular Comorbidity?
              ...
            Histopathology
              Abdominal
                pT category?
              ...
          </pre>
        </div>
    </text>
    <url value="http://hl7.org/fhir/Questionnaire/3141"/>
    <title value="Cancer Quality Forum Questionnaire 2012"/>
    <status value="draft"/>
    <subjectType value="Patient"/>
    <date value="2012-01"/>
    <item>
        <linkId value="1"/>
        <code>
            <system value="http://example.org/system/code/sections"/>
            <code value="COMORBIDITY"/>
        </code>
        <type value="group"/>
        <item>
            <linkId value="1.1"/>
            <code>
                <system value="http://example.org/system/code/questions"/>
                <code value="COMORB"/>
            </code>
            <prefix value="1"/>
            <text>Does patient have a Comorbidity?</text>
            <type value="choice"/>
            <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/>
            <item>
                <linkId value="1.1.1"/>
                <code>
                    <system value="http://example.org/system/code/sections"/>
                    <code value="CARDIAL"/>
                </code>
                <type value="group"/>
                <enableWhen>
                    <question value="1.1"/>
                    <operator value="="/>
                    <answerCoding>
                        <system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
                        <code value="Y"/>
                    </answerCoding>
                </enableWhen>
                <item>
                    <linkId value="1.1.1.1"/>
                    <code>
                        <system value="http://example.org/system/code/questions"/>
                        <code value="COMORBCAR"/>
                    </code>
                    <prefix value="1.1"/>
                    <text>Does patient have Cardial Comorbidity?</text>
                    <type value="choice"/>
                    <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/>
                    <item>
                        <linkId value="1.1.1.1.1"/>
                        <code>
                            <system value="http://example.org/system/code/questions"/>
                            <code value="COMCAR00"/>
                            <display value="Angina Pectoris"/>
                        </code>
                        <code>
                            <system value="http://snomed.info/sct"/>
                            <code value="194828000"/>
                            <display value="Angina (disorder)"/>
                        </code>
                        <prefix value="1.1.1"/>
                        <type value="choice"/>
                        <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/>
                    </item>
                    <item>
                        <linkId value="1.1.1.1.2"/>
                        <code>
                            <system value="http://snomed.info/sct"/>
                            <code value="22298006"/>
                            <display value="Myocardial infarction (disorder)"/>
                        </code>
                        <prefix value="1.1.2"/>
                        <type value="choice"/>
                        <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/>
                    </item>
                </item>
                <item>
                    <linkId value="1.1.1.2"/>
                    <code>
                        <system value="http://example.org/system/code/questions"/>
                        <code value="COMORBVAS"/>
                    </code>
                    <prefix value="1.2"/>
                    <text>Does patient have Vascular Comorbidity?</text>
                    <type value="choice"/>
                    <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/>
                </item>
            </item>
        </item>
    </item>
    <item>
        <linkId value="2"/>
        <code>
            <system value="http://example.org/system/code/sections"/>
            <code value="HISTOPATHOLOGY"/>
        </code>
        <type value="group"/>
        <item>
            <linkId value="2.1"/>
            <code>
                <system value="http://example.org/system/code/sections"/>
                <code value="ABDOMINAL"/>
            </code>
            <type value="group"/>
            <item>
                <linkId value="2.1.2"/>
                <code>
                    <system value="http://example.org/system/code/questions"/>
                    <code value="STADPT"/>
                    <display value="pT category"/>
                </code>
                <type value="choice"/>
            </item>
        </item>
    </item>
</Questionnaire>

Example FHIR Questionnaire Response Resource

<?xml version="1.0" encoding="UTF-8"?>

<QuestionnaireResponse xmlns="http://hl7.org/fhir">
    <id value="3141" />
    <text>
        <status value="generated" />
        <div xmlns="http://www.w3.org/1999/xhtml">
            <pre> 
            Comorbidity? YES
              Cardial Comorbidity? YES
                Angina? YES
                MI? NO
              Vascular Comorbidity?
                (no answers)
              ...
            Histopathology
              Abdominal
                pT category: 1a
              ...
          </pre>
        </div>
    </text>
    <contained>
        <Patient>
            <id value="patsub" />
            <identifier>
                <system value="http://cancer.questionnaire.org/systems/id/patientnr" />
                <value value="A34442332" />
            </identifier>
            <identifier>
                <type>
                    <text value="Dutch BSN" />
                </type>
                <system value="urn:oid:2.16.840.1.113883.2.4.6.3" />
                <value value="188912345" />
            </identifier>
            <gender value="male" />
            <birthDate value="1972-11-30" />
        </Patient>
    </contained>
    <contained>
        <ServiceRequest>
            <id value="order" />
            <status value="unknown" />
            <intent value="order" />
            <subject>
                <reference value="#patsub" />
            </subject>
            <requester>
                <reference value="Practitioner/example" />
            </requester>
        </ServiceRequest>
    </contained>
    <contained>
        <Practitioner>
            <id value="questauth" />
            <identifier>
                <type>
                    <text value="AUMC, Den Helder" />
                </type>
                <system value="http://cancer.questionnaire.org/systems/id/org" />
                <value value="AUMC" />
            </identifier>
        </Practitioner>
    </contained>
    <!--     TODO: decide how to do this
  <contained>

    <Observation>
      <id value="obs.pt-category"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="53786006"/>
          <display value="pT1 category"/>
        </coding>
      </code>
      <subject>
        <reference value="#patsub"/>
      </subject>
      <performer>
        <reference value="#questauth"/>
      </performer>
      <valueCodeableConcept>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="443357004"/>
          <display value="pT1a category"/>
        </coding>
      </valueCodeableConcept>
    </Observation>
  </contained>   -->
    <identifier>
        <system value="http://example.org/fhir/NamingSystem/questionnaire-ids" />
        <value value="Q12349876" />
    </identifier>
    <basedOn>
        <reference value="#order" />
    </basedOn>
    <partOf>
        <reference value="Procedure/f201" />
    </partOf>
    <status value="completed" />
    <subject>
        <reference value="#patsub" />
    </subject>
    <encounter>
        <reference value="Encounter/example" />
    </encounter>
    <authored value="2013-02-19T14:15:00-05:00" />
    <author>
        <reference value="#questauth" />
    </author>
    <item>
        <!--     COMORBIDITY     -->
        <!--     First main section of the form, questions about comorbidity     -->
        <!--     section contains one question: whether there is comorbidity     -->
        <linkId value="1" />
        <item>
            <linkId value="1.1" />
            <answer>
                <valueCoding>
                    <system value="http://cancer.questionnaire.org/system/code/yesno" />
                    <code value="1" />
                    <display value="Yes" />
                </valueCoding>
                <item>
                    <!--     COMORBIDITY/CARDIAL     -->
                    <!--     Subsection about specific comorbidity: cardial     -->
                    <linkId value="1.1.1" />
                    <item>
                        <linkId value="1.1.1.1" />
                        <answer>
                            <valueCoding>
                                <system value="http://cancer.questionnaire.org/system/code/yesno" />
                                <code value="0" />
                            </valueCoding>
                        </answer>
                    </item>
                    <item>
                        <!--     This answer carries both the questionnaire-specific name and an equivalent SNOMED
             CT code     -->
                        <linkId value="1.1.1.2" />
                        <answer>
                            <valueCoding>
                                <system value="http://cancer.questionnaire.org/system/code/yesno" />
                                <code value="3" />
                            </valueCoding>
                        </answer>
                    </item>
                    <item>
                        <linkId value="1.1.1.3" />
                        <answer>
                            <valueCoding>
                                <system value="http://cancer.questionnaire.org/system/code/yesno" />
                                <code value="0" />
                            </valueCoding>
                        </answer>
                    </item>
                </item>
            </answer>
        </item>
    </item>
    <!--     HISTOPATHOLOGY     -->
    <!--     TODO: decide how to do this
  <item>

    <item>
      <item>
       <dataResource>
          <reference value="#obs.pt-category"/>
        </dataResource>
      </item>
    </item>
  </item>     -->
</QuestionnaireResponse>

Notional Logical ANF XSTL Transformation

<?xml version="1.0" encoding="UTF-8"?>
<xsl:stylesheet version="3.0" xmlns:xsl="http://www.w3.org/1999/XSL/Transform" xpath-default-namespace="http://hl7.org/fhir">
    <xsl:output indent="yes" omit-xml-declaration="no"/>
    <xsl:variable name="presentRange">(0,INF)</xsl:variable>
    <xsl:variable name="absentRange">[0,0]</xsl:variable>
    <xsl:variable name="indeterminateRange">[0,INF)</xsl:variable>
    <xsl:template match="/">
        <anf>
            <xsl:for-each select="//item">
                <xsl:if test="./type/@value = 'choice'">
                    <xsl:variable name="questionId" select="./linkId/@value"/>
                    <xsl:variable name="questionTopic" select="./code/code/@value"/>
                    <xsl:variable name="questionNarrative" select="./text"/>
                    <xsl:for-each select="document('questionnaireResponse.xml')//item">
                        <xsl:if test="./linkId/@value = $questionId">
                            <statement>
                                <narrative>
                                    <xsl:value-of select="$questionNarrative"/>
                                </narrative>
                                <topic>
                                    <xsl:value-of select="$questionTopic"/>
                                </topic>
                                <circumstance type="performance">
                                    <status>Complete</status>
                                    <result>
                                        <xsl:choose>
                                            <xsl:when test="./answer/valueCoding/code/@value = 1">
                                                <xsl:value-of select="$presentRange"/>
                                            </xsl:when>
                                            <xsl:when test="./answer/valueCoding/code/@value = 0">
                                                <xsl:value-of select="$absentRange"/>
                                            </xsl:when>
                                            <xsl:when test="./answer/valueCoding/code/@value = 3">
                                                <xsl:value-of select="$indeterminateRange"/>
                                            </xsl:when>
                                        </xsl:choose>
                                    </result>
                                </circumstance>
                            </statement>
                        </xsl:if>
                    </xsl:for-each>
                </xsl:if>
            </xsl:for-each>
        </anf>
    </xsl:template>
</xsl:stylesheet>

Notional Logical ANF Output

Solor

ANF XSLT Transformation

Summary

Example FHIR Questionnaire Resource

Example FHIR Questionnaire Response Resource

Notional Logical ANF XSTL Transformation

Notional Logical ANF Output