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

While I have looked at the QuestionnareReponse resource definition already hundreds of times, it was only when I was coding the mapping of survey responses to QuestionnaireResponse.item.answer that I was faced with the fact that the element QuestionnaireResponse.item.answer.item exists for which there seems no clear explanation, given that nested items are conveyed via QuestionnaireResponse.item.item. Also, given that there is no possible way to create a Questionnaire that has nested items under an answer, I believe that QuestionnaireResponse.item.answer.item is superflouws, and it should be removed entirely.

If instead the community feels that there are use cases in which an answer can have nested items, please provide a clear use case and example for that.