We have started implementing FHIR Questionnaire and QuestionnaireResponse for our commercial survey application (QuestLink) and intend to make that the primary API.

In our system but also all other survey systems that I am aware of, the first step in a Questionnaire workflow is to create a record that identifies that a certain Questionnaire has been created for a person to respond to. That in my view is what QuestionnaireResponse is intended for. At that time, we consider the questionnaire as "assigned". Only when the responder actually opens the questionnaire and has submitted the first answer, the status of the QuestionnaireResponse moves to "in-progress".

As an implementer, I am seriously limited by the fact that there is no initial status of "assigned". The current option we have chosen is to extend QuestionnaireResponse.status with an extra boolean indicating whether a questionnaire is "in-progress" has already been opened by the responder:

_status": { "extension": [

] }

Our preference would be that instead, valueset QuestionnaireResponseStatus is extended with a code "assigned", which should be the initial status.