{ "resourceType" : "Questionnaire", "id" : "CancerTestAdditionalAskAtOrderQuestions", "meta" : { "profile" : ["https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"] }, "language" : "en", "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire CancerTestAdditionalAskAtOrderQuestions

Profile: Questionnaire

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" **This Questionnaire is a proposal, not an active or planned project.**\n\n**Test Specific Additional Ask At Order Entry Questions** for Cancer\norders - used *alongside* the [common core order\nform](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry\nQuestions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the\nsame "Test Specific" tier pattern [WGS Test Additional Ask At Order Entry\nQuestions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already\nfollows for WGS orders - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions).\n\nIts content is **inferred**, not yet confirmed against a live order-entry\nscreen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below\nis a concept that recurs independently across the two Cancer-category NW\nGLH paper forms - [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS\nWGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national\nform) - see [NW GLH Paper Test Request\nForms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms).\nNeither of those two Questionnaires has been changed to actually use this\none yet - both remain independent, standalone Questionnaires, each already\ncarrying its own copy of the fields proposed here.Questionnairehttps://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions#2.2.0
\".\"\".\"\".\" AskAtOrderEntryAsk At Order Entry Questions0..1group
\".\"\".\"\".\"\".\" NOS/PresentationStatusPresentation status0..1choiceDefinition: Observation.valueCodeableConcept
Options: 3 options
\".\"\".\"\".\"\".\"\".\" NOS/PresentationStatus-designNoteInferred from [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s own\n`NOS/PresentationStatus` item. Generalises the same distinction [HRD\nand Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)\nmakes via its own `Pathway` choice (HRD test = newly diagnosed,\nTumour BRCA-only = relapsed) plus separate\n`NewlyDiagnosedAdvancedDiseaseConfirmation`/`RelapsedDiseaseConfirmation`\nbooleans - that form conflates presentation status with test\nselection itself, since the pathway and the presentation are the same\nchoice on that specific form; here they are kept separate, as GMS WGS\nCancer already does.0..1display
\".\"\".\"\".\"\".\" NOS/NeoplasticCellContentNeoplastic/malignant cell content (%)0..1quantityDefinition: Observation.valueQuantity
\".\"\".\"\".\"\".\"\".\" NOS/NeoplasticCellContent-designNoteThe same underlying concept is independently modelled three times\ntoday, each under its own linkId despite sharing this same\n`NWGMSA` code: [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent` ("Approximate % neoplastic nuclei in\ntumour area highlighted"), [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent-gms` ("% Malignant nuclei / blasts (or\nequivalent)"), and [WGS Local Test\nOrder](Questionnaire-WGSLocalTestOrderAskAtOrderEntry.html)'s own\n`NOS/NeoplasticCellContent-wgs`. Proposed here as the single shared\nfield this tier is for, rather than each Cancer-adjacent form\ncontinuing to reinvent its own suffixed linkId for the same value.0..1display
\".\"\".\"\".\"\".\" NOS/PathologistNamePathologist0..1stringDefinition: Observation.valueString
\".\"\".\"\".\"\".\"\".\" NOS/PathologistName-designNotePresent as its own named field on [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html). [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) doesn't ask\nfor the pathologist by name, only a Histopathology Lab ID (see\n`Pathology hospital / laboratory` below) - proposed here as a\ngenuinely Cancer-wide concept even though only one of the two source\nforms currently asks for it.0..1display
\".\"\".\"\".\"\".\" NOS/PathologyHospitalPathology hospital / laboratory0..1stringDefinition: Observation.valueString
\".\"\".\"\".\"\".\"\".\" NOS/PathologyHospital-designNoteGeneralises [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s own\n`NOS/PathologyHospital` and [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/HistopathologyLabID` ("Histopathology Lab ID", under that form's\nown Solid tumour sub-group) - both identify where the pathology\nspecimen/report the order relies on came from, just at different\ngranularity (a named hospital vs. a lab identifier). Kept as free\ntext pending a decision on whether an\n[Organisation Code](StructureDefinition-OrganisationCode.html)\nreference would be more appropriate.0..1display
\".\"\".\"\".\"\".\"\".\" NOS/PathologyHospital-futureQueryAccessThis item, and Pathologist above, most directly relate to the\n[Cheshire and Merseyside\nPathology](CheshireAndMerseysidePathology.html) reflex use case, where\na genomic order follows on from a prior pathology order/report\n(`LAB-1`/`LAB-3`) rather than starting the clinical episode itself.\nThat page's own [Current\nProcess](CheshireAndMerseysidePathology.html#current-process) still\nmodels the pathology-to-genomics handoff entirely as HL7 v2/FHIR\nmessaging (`LAB-1`/`LAB-35`/`LAB-3`/`LAB-36`), which is why today's\nanswer is free text naming the pathologist/hospital rather than a\nmachine-resolvable reference.\n\nA query-based alternative may remove the need to duplicate pathology\ncontent into the genomic order/message at all: some NW pathology LIMS\ndeployments (e.g. Medicus) already support the Australian [AU\neReq](https://hl7.org.au/fhir/ereq/index.html) FHIR IG for on-demand\nquery access to pathology orders (and potentially reports), and MFT\nseparately exposes pathology data through Epic's own [FHIR Query\nAPI](https://fhir.epic.com/). If a genomics laboratory can query\npathology directly, these two free-text fields could be replaced by a\n**reference** instead - the Pathology Order Filler Number, Pathology\nPatient Identifier and/or Pathology Specimen Identifier - letting the\ngenomic order carry a pointer for on-demand lookup rather than the\npathology detail itself.0..1display

\"doco\" Documentation for this format

Options Sets

Answer options for NOS/PresentationStatus

" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm", "valueCoding" : { "system" : "http://hl7.org/fhir/version-algorithm", "code" : "semver" } }], "url" : "https://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions", "version" : "2.2.0", "title" : "Cancer Test Additional Ask At Order Entry Questions", "derivedFrom" : ["https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder"], "_derivedFrom" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType", "valueCoding" : { "system" : "http://hl7.org/fhir/questionnaire-derivationType", "code" : "extends" } }] }], "status" : "draft", "date" : "2026-09-20T05:53:36+00:00", "publisher" : "NHS North West Genomics", "contact" : [{ "telecom" : [{ "system" : "url", "value" : "https://www.nwgenomics.nhs.uk/contact-us" }] }], "description" : "**This Questionnaire is a proposal, not an active or planned project.**\n\n**Test Specific Additional Ask At Order Entry Questions** for Cancer\norders - used *alongside* the [common core order\nform](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry\nQuestions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the\nsame \"Test Specific\" tier pattern [WGS Test Additional Ask At Order Entry\nQuestions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already\nfollows for WGS orders - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions).\n\nIts content is **inferred**, not yet confirmed against a live order-entry\nscreen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below\nis a concept that recurs independently across the two Cancer-category NW\nGLH paper forms - [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS\nWGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national\nform) - see [NW GLH Paper Test Request\nForms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms).\nNeither of those two Questionnaires has been changed to actually use this\none yet - both remain independent, standalone Questionnaires, each already\ncarrying its own copy of the fields proposed here.", "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "GB", "display" : "United Kingdom of Great Britain and Northern Ireland" }] }], "item" : [{ "linkId" : "AskAtOrderEntry", "text" : "Ask At Order Entry Questions", "type" : "group", "item" : [{ "linkId" : "NOS/PresentationStatus", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept", "text" : "Presentation status", "type" : "choice", "answerOption" : [{ "valueCoding" : { "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "PresentationFirstDiagnosis" } }, { "valueCoding" : { "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "PresentationRecurrenceRelapse" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA4489-6", "display" : "Unknown" } }], "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/PresentationStatus-designNote", "text" : "Inferred from [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s own\n`NOS/PresentationStatus` item. Generalises the same distinction [HRD\nand Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)\nmakes via its own `Pathway` choice (HRD test = newly diagnosed,\nTumour BRCA-only = relapsed) plus separate\n`NewlyDiagnosedAdvancedDiseaseConfirmation`/`RelapsedDiseaseConfirmation`\nbooleans - that form conflates presentation status with test\nselection itself, since the pathway and the presentation are the same\nchoice on that specific form; here they are kept separate, as GMS WGS\nCancer already does.", "type" : "display" }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding" : { "system" : "http://unitsofmeasure.org", "code" : "%", "display" : "%" } }], "linkId" : "NOS/NeoplasticCellContent", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "NeoplasticCellContent" }], "text" : "Neoplastic/malignant cell content (%)", "type" : "quantity", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/NeoplasticCellContent-designNote", "text" : "The same underlying concept is independently modelled three times\ntoday, each under its own linkId despite sharing this same\n`NWGMSA` code: [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent` (\"Approximate % neoplastic nuclei in\ntumour area highlighted\"), [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent-gms` (\"% Malignant nuclei / blasts (or\nequivalent)\"), and [WGS Local Test\nOrder](Questionnaire-WGSLocalTestOrderAskAtOrderEntry.html)'s own\n`NOS/NeoplasticCellContent-wgs`. Proposed here as the single shared\nfield this tier is for, rather than each Cancer-adjacent form\ncontinuing to reinvent its own suffixed linkId for the same value.", "type" : "display" }] }, { "linkId" : "NOS/PathologistName", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "PathologistName" }], "text" : "Pathologist", "type" : "string", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/PathologistName-designNote", "text" : "Present as its own named field on [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html). [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) doesn't ask\nfor the pathologist by name, only a Histopathology Lab ID (see\n`Pathology hospital / laboratory` below) - proposed here as a\ngenuinely Cancer-wide concept even though only one of the two source\nforms currently asks for it.", "type" : "display" }] }, { "linkId" : "NOS/PathologyHospital", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "PathologyHospital" }], "text" : "Pathology hospital / laboratory", "type" : "string", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/PathologyHospital-designNote", "text" : "Generalises [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s own\n`NOS/PathologyHospital` and [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/HistopathologyLabID` (\"Histopathology Lab ID\", under that form's\nown Solid tumour sub-group) - both identify where the pathology\nspecimen/report the order relies on came from, just at different\ngranularity (a named hospital vs. a lab identifier). Kept as free\ntext pending a decision on whether an\n[Organisation Code](StructureDefinition-OrganisationCode.html)\nreference would be more appropriate.", "type" : "display" }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/PathologyHospital-futureQueryAccess", "text" : "This item, and Pathologist above, most directly relate to the\n[Cheshire and Merseyside\nPathology](CheshireAndMerseysidePathology.html) reflex use case, where\na genomic order follows on from a prior pathology order/report\n(`LAB-1`/`LAB-3`) rather than starting the clinical episode itself.\nThat page's own [Current\nProcess](CheshireAndMerseysidePathology.html#current-process) still\nmodels the pathology-to-genomics handoff entirely as HL7 v2/FHIR\nmessaging (`LAB-1`/`LAB-35`/`LAB-3`/`LAB-36`), which is why today's\nanswer is free text naming the pathologist/hospital rather than a\nmachine-resolvable reference.\n\nA query-based alternative may remove the need to duplicate pathology\ncontent into the genomic order/message at all: some NW pathology LIMS\ndeployments (e.g. Medicus) already support the Australian [AU\neReq](https://hl7.org.au/fhir/ereq/index.html) FHIR IG for on-demand\nquery access to pathology orders (and potentially reports), and MFT\nseparately exposes pathology data through Epic's own [FHIR Query\nAPI](https://fhir.epic.com/). If a genomics laboratory can query\npathology directly, these two free-text fields could be replaced by a\n**reference** instead - the Pathology Order Filler Number, Pathology\nPatient Identifier and/or Pathology Specimen Identifier - letting the\ngenomic order carry a pointer for on-demand lookup rather than the\npathology detail itself.", "type" : "display" }] }] }] }