116IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 4, NO. 2, JUNE 2000
InternetQuestion and Answer (iQ&A): A Web-Based
Robert A. Dennis and Sanjiv S. Gambhir
Abstract—This paper presents InternetQuestion and Answer, a
Web-based survey development and implementation technology,
which has been designed for constructing on-line surveys for ed-
ucational, medical, or administrative purposes. The system, called
iQ&A, isa three-tiered database-backed Web systemthat has been
sidered as general data collection instruments and include a wide
administration which is ideally suited for biomedical research as
well as other research and educational activities. Full report man-
agement capabilities provide the survey publisher on-line access
to current information on survey responses. Current implemen-
tations of this technology in the areas of biomedical applications
of clinical trials, longitudinal research, and other research-related
systems are presented. Further refinement of the current system
should lead to a powerful general survey technology for broad-
Index Terms—Database systems, research systems, survey tech-
nology, Web software.
(WWW) to deliver instructional content shortly after the hyper-
text transmission protocol (http) supplanted gopher as the pri-
mary Internet technology. In early 1996, we began to take ad-
and particularly online assessments, to the instructional units
we had been developing for undergraduate and medical educa-
tion and delivering via the WWW. It quickly became apparent
to us that we needed a general mechanism for building on-
line selected-response tests and questionnaires, as these were a
were supporting. We therefore began to design and program a
test-building component for a Web-based authoring suite called
the Interdisciplinary Collaborative Environment for the Devel-
opment of Training and Educational Applications (Iced_Tea).1
tients and physicians better understand patient options in the
management of newly diagnosed prostate cancer.2
HE Interactive Media Group of the Crump Institute for
Biological Imaging began to utilize the World Wide Web
Manuscript received May 14, 1999; revised November 7, 1999. This work
was supported in part by the Ahmanson Foundation and the Association for the
Cure of Cancer of the Prostate (CaP Cure).
The authors are with the Crump Institute for Biological Imaging, UCLA
School of Medicine, Los Angeles, CA 90095-1770 USA.
Publisher Item Identifier S 1089-7771(00)03953-4.
1[Online]. Available: http://laxmi.nuc.ucla.edu:8888
2[Online]. Available: http://prostate.crump.ucla.edu:8008
It was clear to us that what we were calling a test builder
and the kind of question sets that made up the Prostate Cancer
Decision Support system. The key capability missing from
our early versions of a test builder was support for dynamic
branching, or contingency. The term “contingency” is used in
the context of a survey or a questionnaire to refer to dynamic
ordering of questions that are presented to respondents. The set
of questions that are presented to a respondent can be dynami-
cally determined based upon responses to previous questions.
By incorporating contingency into the authoring and back-end
portions of the system, we found we could accommodate the
operational requirements of decision support systems and also
take simple online tests to a more sophisticated “interactive”
level, sometimes referred to as adaptive testing , . Since
each set of answered questions is submitted back to a server,
and the server communicates with a relational database man-
agement system (RDBMS), the basic architecture with which
to accommodate our goal of adding support for contingency
The list of possible applications of Web-based surveys is
extremely broad. This is partially due to a loose interpretation
of a survey as “
looking over or upon
reporting the results” (Webster New International Dictionary
2nd Edition). In this broad sense of the notion of a “survey,”
any hypertext markup language (HTML) form that solicits
input from respondents can be considered a survey. Assuming
this definition, some examples of Web-based surveys include:
employer/employee satisfaction questionnaires, student ap-
plications and application-tracking reports, end of chapter
tests, product registrations, personnel performance reviews,
patient demographic information forms, product order forms,
compatibility and profile matching (dating services), patient
satisfaction forms, etc. The list of the purposes to which html
forms can be put is very large. The capability to interactively
branch through a set of questions contingent upon each re-
spondent’s replies brings new and exciting potential to a basic
capability. However, taking advantage of this potential has been
difficult and costly.
In this paper, we present an overview of our work in de-
veloping a general and flexible database-backed Web system
that manages the construction, data collection, and reporting of
HTML form-based surveys. The paper begins with a short re-
We then look at the current state of Web-based survey technolo-
gies and their limitations. We briefly present the architecture
and design of our system and its advantages over existing sys-
tems. We present several specific examples of the application of
with a purpose of
1089–7771/00$10.00 © 2000 IEEE
DENNIS AND GAMBHIR: INTERNETQUESTION AND ANSWER (iQ&A): A WEB-BASED SURVEY TECHNOLOGY 117
iQ&A, and we conclude with a discussion of our current work,
goals, and the directions we anticipate taking in the near future.
Computer-based surveys are not new. There have been many
different products that allow one to develop a survey and then
print it out, conduct a phone interview, or send it to respondents
via email (for example, see , ). Most recent efforts have
been to move survey-building software applications toward the
Internet varies from simple exporting to HTML format , ,
skip patterns based on survey responses . However, most of
these products lack tight integration with a back-end relational
database and they are awkward fits at best with the Web.
There are several Web-based survey systems that currently
exist , . The 2WAY system3is a combination of a Win-
dows 32-bit client executable program that handles survey au-
thoring and a three-tiered Web-based system for the deploy-
ment of surveys, .A respondent of2WAYsurveysusesa
to accomplish navigation and limited error-checking. On the
serverside ofa 2WAYsystemare an httpserverand Microsoft’s
SQL Server version 6.5. Between these two components sits the
2WAY server that incorporates all the business logic and report
management. The 2WAY server is written in C/C++ and inter-
operates with any http server using the common gateway in-
terface (CGI). Communications between the 2WAY server and
MS-SQL is through an Open Database Connectivity (ODBC)
connection. A complete 2WAY system requires Windows NT,
and it is not available for UNIX platforms.
Another new system that attempts to take advantage of
the Web is Quiz Studio . Quiz Studio is a Java-based
client–server system.4Tests and surveys are authored using
a Java application. A separate application is used to manage
users and groups and other administration policies. Tests are
taken using a Java-enabled web browser. The test or surveys
appear in an applet window. The test taking Applet supports a
wide range of question types, and it allows for some interesting
drag-and-drop capabilities. The Applet uses Java 1.1 and
therefore does not run on all platforms. For example, it will
not run on a Macintosh system using Netscape Navigator.
Additionally, the performance of the Applet is slow, and the
response time is sluggish. There is an initial delay at the
beginning while the Applet downloads. On slower connections,
this becomes a limiting issue. A future version is promised that
supports contingency, but at the time of our review the most
current version did not appear to have this powerful capability.
An additional drawback to Quiz Studios is its lack of support
for offline use. Since all tests are administered using applets, a
network connection is a requirement.
II. iQ&A GENERAL ARCHITECTURE
iQ&A is a client–server system that is best described as a
database-backed web application (see Fig. 1). The basic archi-
tectural model of iQ&A is a three-tiered client–server system.
3[Online]. Available: http://www.2way.tm
4[Online]. Available: http://www.quizstudio.com
browser to set up and publish a survey. Others respond to the survey using a
Web browser. Also depicted is the architecture of the iQ&A server. Requests
for an HTML page come in to the server from clients. The server answers the
request. If the page has embedded TCL scripting code in it, the server parses the
code before sending the document back to the client. A page may also request
information from the database or post information into the database.
The client–server architecture of iQ&A. A survey author uses a Web
a web browser running on a respondent’s computer (the client).
On the back-end are the http server, the database server, and a
TCL interpreter and application programming interface (API)
that executes all the business logic as well as brokers communi-
cation betweenthetwo servers.The databaseand thehttp server
can reside on the same physical computer, or they can be run on
The web (http) server at the heart of iQ&A is the freely
available AOLserver. America Online (AOL) bought the
original company, NaviSoft, which was the developer of a
software product called NaviServer in 1996. AOL currently
uses AOLserver as the heart of its online web hosting business,
as well as for www.aol.com, one of the highest traffic sites on
the Internet today. The AOLserver is a fast multithreaded web
server. It has C and Tcl API’s that allow for rapid application
development and the construction of dynamic pages that can
query a database. An additional advantage of the AOLserver is
the availability of source code. The source has been released to
the public domain and is available at aolserver.lcs.mit.edu.
III. RELATIONAL DATABASE LINKAGE
The most powerful aspect of the AOLserver is its tightly
integrated database capabilities. Connections to databases are
pooled and managed by AOLserver, so that setup and takedown
of connections are fast and efficient. In addition, the proxy
daemon (for a nonthread-safe RDBMS like Sybase) and the Tcl
API allow for development of the business logic of a web-based
application to be abstracted from the specifics of a particular
RDBMS. Many of the most popular RDBMS’s are supported,
for example, Oracle, Sybase, Informix, MS-SQL, Postgres,
and Borland’s Interbase. The AOLserver is one of the most
flexible, powerful, and extensible web application development
environments available on any platform , .
proof-of-concept system first developed in the fall of 1996. As
work on iQ&A has progressed, we have had to face different
118IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 4, NO. 2, JUNE 2000
of questions. The user browses the collection and then “adds” an item to the currently active section. In this figure, the user is working on a survey called “Lung
Cancer” and the visible question is being added to the “demographics” section.
The basic user interface of iQ&A as viewed in Netscape. Across the top are the controls. Shown along the left is a listing of the user’s private collection
limitations and constraints with the various database products
we have used, for example, reliability and cost. With the growth
of interest in the free UNIX-like Linux operating system,
many database companies have released free or inexpensive
versions of their products. Sybase has made available for free
the Adaptive Server version 11.03.3 for Linux. We have ported
iQ&A to Sybase. However, since the free version of Sybase
for Linux does not include management tools, we have had
to turn to third party applications. We use DBArtisan from
iQ&A is entirely web-based. All interactions are conducted
using a web browser.Authors set up, publish, manage,and view
reports of surveys using a web browser (see Fig. 1). A survey in
our system consists of one or more sections (pages) with one
or more items (questions) in each section. Work within iQ&A
normally begins with setting up a databank of questions. Ques-
collections. The iQ&A system was designed to allow questions
to be easily reused and, in certain cases, shared across authors.
Many question types are supported: radio buttons, check boxes,
cial purpose item types (e.g., a date item and file upload item).
Additionally, each question in an author’s collection can be as-
sociated with an image, animation, or any object that a browser
5[Online]. Available: http://www.embarcadero.com
Once a set of questions with possible responses has been au-
thored, preparation of a survey is trivial. A new survey is cre-
ated with a click of a button and a specification of a unique title
for the survey. By default, the author is provided with an empty
section (a blank page) to which to add questions. Questions are
“added” to a section, and a survey author can add new sections
at any time (see Fig. 2). The order of questions within a section,
and the order or sections within a survey can easily be sorted
using a graphical sorting tool (see Fig. 3).
When the content and structure of the survey are determined,
author select a template that will specify the look and format of
the final survey. Once a survey is published, it exists as HTML
pages. A survey can be published so that respondents are re-
quired to login before proceeding, or it can be an anonymous
survey with no login requirements.
Once a survey is published and data are associated with it, it
cannot be altered. If changes are required, the survey must be
duplicated, modified, and then published again. We are adding
supports in iQ&A for carrying forward data that are common
across altered forms of a survey.
Any published survey can have one or more reports associ-
ated with it. Reports are active HTML pages. When a report
is accessed, the current state of the data are reported. A re-
port can present any combination of the questions presented in
a survey. When a report is set up, the author can select from
a number of different graphic representations (e.g., bar charts,
DENNIS AND GAMBHIR: INTERNETQUESTION AND ANSWER (iQ&A): A WEB-BASED SURVEY TECHNOLOGY119
around within a section, or it can be moved to a different section. Sections can also be reordered. In this example, the demographics section has been expanded,
revealing the question items that make up this section.
The iQ&A item sorting interface. This is a dynamic HTML page. The user can move a question with a click-and-drop motion. A question can be moved
column charts, pie charts, line charts, or numeric tables). Charts
are dynamically generated images. On the iQ&A back-end, a
Java servlet is passed data and parameters for labels and leg-
ends, and it returns a gif-encoded image which is sent back to
the client’s browser. Reports are treated like all iQ&A objects.
Reports are stored in the author’s reports directory. An iQ&A
author can create new subdirectories and move reports around
according to any filing schema. When a report is viewed, it is
presented in a new browser window (see Fig. 4).
An advanced feature of iQ&A is support for contingent
branching between pages in a survey. Contingency allows our
system to support an additional class of applications, such as
adaptive testing, interactive performance-based instruction, and
decision support systems, etc. This one feature represents the
defining capability that distinguishes online database-backed
systems from static paper-based data collections and simple
HTML forms that merely accept data and return a fixed reply.
Dynamic branching in a survey is authored using a custom
set of interfaces. Fig. 5 shows the iQ&A dynamic branching au-
page. In a survey with no dynamic branching, this default next
section determines the ordering of pages. However, when the
nextpage of a surveyis contingentupon a respondent’s answers
to one or more questions in the current (or previous) pages(s),
then the default next section is only invoked when none of the
tions that determine the flow of pages “branching items.” The
first step in authoring a dynamic branching survey is specifying
the branching questions.
combinations. For example, a survey author can specify that a
respondent who indicates she is a woman and has an immediate
relative who has had breast cancer should be taken to a specific
set of questions and information (i.e., a different section than
other respondents). In this example, the branching item would
actually be a combination of two actual survey questions. The
survey author must identify all the response patterns of interest
using the interfaces depicted in Fig. 5. One additional feature
we support is the delay of a branching event. By specifying that
a branching event is to occur after some subsequent section, a
survey author can build a survey where the branching is tied to
some response pattern to some question in the front part of a
survey but is delayed until further into the survey. In this way,
a branching item can be made up of questions from several dif-
ferent sections in a survey. This capability allows for the au-
thoring of a great many different branching and skip patterns.
In addition to the capabilities outlined above, iQ&A has con-
siderable support for and control over the management of sur-
veys. Management of surveys refers to control over the pro-
grammatic uses to which surveys are put. A number of these
120IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 4, NO. 2, JUNE 2000
bar chart, line graphs, etc.).
An iQ&A generated report page. The author can select which questions from a survey are to be included in a report, as well as the representation (i.e.,
features are presented below in the context of real systems de-
veloped using iQ&A, but it is worth noting the more general
ones here. For the purpose of administering and managing the
context (i.e., the project) in which surveys are taken, iQ&A has
a general mechanism for specifying a sequence of surveys that
are to be presented to a group of users. There is a users and
groups manager thathandles users’ login names and passwords.
iQ&A has a general scheduling manager that monitors when
each member of a group is due to respond to a survey. There
is also a messaging manager that handles automated email re-
minders that are sent out to users who are due to respond to a
particular survey. Various standard reports are maintained con-
cerning the status of each respondent who is part of the project.
There is also a general field notes component for use in re-
search settings. Field notes are miscellaneous text that is related
to members of a project. Some examples of the way in which
field notes can be used in iQ&A-based systems are to record
patient–researcher contacts or teacher notes regarding student
IV. PLATFORM REQUIREMENTS
The iQ&A system relies upon the freely available AOLserver
version 2.3. The capabilities upon which iQ&A depends are
the AOLserver’s Tcl API and database proxy daemons. Begin-
platforms, and the popular Linux OS is supported. We run the
AOLserver on Sun Sparc, Dec Alpha, and Intel-based Linux
computers, but other platforms are supported as well. We also
run a number of databases on NT and connect to these using
database proxy daemons. This allows us to use AOLserver on
UNIXbutstilltake advantageofcertain RDBMS’sthatare only
available for Windows, such as MS-SQL 6.5.
Setup of the system is straightforward. The AOLserver
comes with an installation script. Once the install is complete,
a bootstrap program will launch a startup server that is used to
configure and create all virtual servers. The AOLserver allows
multiple virtual web servers to run on a single computer, each
listening on different network interfaces or port addresses.
All administration of the http server and the iQ&A system
is accomplished via web pages. The database server can be
a process running on the same physical computer or on a
completely different platform. With the database server up
and running, feeding the iQ&A data model to the server either
directly or via the AOLserver will generate the iQ&A table
structure. Finally, the iQ&A interface and business logic are
all contained in special active HTML pages and a package of
registered procedures. These files need to be copied over to an
appropriate directory. For someone with a little experience with
UNIX administration, the entire setup can be accomplished in
about an hour.
If both the http server and the database server are run on the
same computer, the amount of RAM installed in the computer
should be increased. Since the density/price ratio of RAM con-
tinues to improve, adding more memory is a cost-effective so-
lution to improving performance. Depending upon the amount
DENNIS AND GAMBHIR: INTERNETQUESTION AND ANSWER (iQ&A): A WEB-BASED SURVEY TECHNOLOGY121
respondent’s answers to key questions, called branching items. In this example, there are two branches, one in section 1 and one in section 2. Based upon a person’s
answers to the branching item in section 1, he will be taken to either section 2a or 2b.
The dynamic branching section of the sorter. Using these interfaces, a survey author can specify the branching that will occur based upon a survey
of stored data, it has often been possible for us to hold an entire
database in RAM allowing for very fast read access.
In general, we have come to prefer running both the
AOLserver and the database server on Intel-based computers
using the Linux OS. This allows us to assemble very high-per-
formance systems very inexpensively. We still run a couple of
databases on Windows NT; however, we see little reason to
prefer this situation. In the future, we will most probably run
all our servers on computers running Linux OS.
V. iQ&A INTERFACE ISSUES
All users of the iQ&A system, both authors and respondents,
work entirely within a web browser. Certain functionality of
iQ&A is achieved with dynamic HTML (DHTML), and thus
a minimum requirement is a 4.x version of either Microsoft’s
Internet Explorer (IE) or Netscape’s Communicator. The im-
plementation of DHTML is different in these two browsers, but
the capabilities are roughly equal. We conduct our development
and testing with Netscape’s Communicator and then go back
and redo programs to work under IE.
The iQ&A system is essentially a database-backed web ser-
vice that relies upon client–server communications. However,
we haveencountered research situations where Internet connec-
tivity has not been available. There are times when information
must be collected from subjects in settings where connectivity
is not available, for example, in consultation rooms at hospitals.
To accommodate these situations, we have added some limited
“offline” options to published surveys. We refer to these situa-
tionsas off-linedata collections.When a surveyis published for
122IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 4, NO. 2, JUNE 2000
offline use, we prepare for download to the client’s computer
porarily stored on the client’s hard drive. When network access
becomes available, all collected data are uploaded to the iQ&A
server in batch. All issues of unique ID’s are appropriately han-
dled such that data collection of the online version of the survey
of ID conflicts or data loss.
VI. EDUCATIONAL APPLICATIONS
iQ&A began as a test builder for use in instructional settings
and as part of a more general authoring suite (Iced_Tea). Much
of the design decisions and requirements come from this foun-
dation. For example,in educational environments, questions are
very often reused in alternative forms of tests. Teachers often
prepare several versions of a test that may have a number of
common questions. The emphasis in iQ&A is on reuse of ques-
interface is built around the concept of a collection of questions
that become associated with a survey. Some general questions
that get reused often in educational settings are the course and
instructor evaluation questions. These questions are available to
all authoring users of iQ&A. The course and instructor evalua-
tion questions are stored in a “public” library of questions.
Since iQ&A began as a simple test builder, it is quite well
suited for the assembling, administering, and reporting of tests
and is now a very sophisticated web-based application devel-
opment environment. It has implications beyond its early be-
ginnings. One immediate implication for education is adaptive
VII. ADMINISTRATIVE APPLICATIONS
We consider any HTML form to be a survey. The iQ&A
system is indifferent to the purpose of the survey and the
meaning of the data it collects, manages, and reports. In our
own department, we have used iQ&A in administrative settings.
One example is our faculty search survey. Our department
was accepting applications for a junior-level faculty position
in Medical Imaging. In order to facilitate internal reviews by
current faculty members, a survey was set up and published
allowing an administrative assistant to input all information
received from applicants. Once all the resumes, letters of
recommendation, and application forms were input into an
iQ&A survey, it was easy for reviewers to visit a report and
supply feedback regarding their choices of the best candidates.
More recently, we have begun to shift the application procedure
for the graduate degree programs in molecular and medical
pharmacology over to an iQ&A-based system. In the future,
applicants will apply online by filling out a set of iQ&A-gener-
VIII. DETAILS OF SPECIFIC IMPLEMENTATIONS
With each application of iQ&A beyond simple ques-
tionnaires, opinion polls, and administrative uses, we have
We present two special purpose systems that we havedeveloped
around iQ&A. Development of these systems has brought new
capabilities to the iQ&A system. What was accomplished
through considerable custom coding for these special purpose
systems is now part of the standard features and authoring
options of iQ&A.
IX. LONGITUDINAL RESEARCH
One example of the application of iQ&A comes from a med-
ical research setting. The Quality-of-Life (QoL) study is an on-
going longitudinal study that seeks to fill a gap in knowledge of
cancer patients’ quality of life following treatment for prostate
–. This study examines how the treatment of prostate
cancer affects patients’ self-reported perceptions of the quality
of life of themselves and their families using a repeated mea-
sures research design . The most important physical effects
of prostate cancer treatment are on urinary, sexual, and bowel
functions. However, prostate cancer and its various treatments
also have a tremendous effect on a patient’s emotions, stress
level, family relationships, and social interactions. In order to
uncover this important information, patients treated for early
a patient has consented to participant, and they have chosen (in
of a research assistant (RA), using an offline-published version
of an iQ&A survey. The same questionnaire is then presented
to participants at specific time intervals over a two-year period
to see how their quality of life changes, and how quickly they
return to their pretreatment baseline quality of life. Patients are
encouraged to participate by completing the questionnaires on-
line. Those who agree to participate online are sent automated
email reminders each time they are due to respond to a ques-
tionnaire. Most patients participate using coded paper copies of
the questionnaire, and then one of the RA’s enters the data into
the QoL research management system. There are currently 182
patients participating, and 18 patients are replying online.
iQ&A was modified to meet the needs of this research ef-
fort. Specifically, we added a general mechanism to create a
longitudinal study by specifying a string of published surveys.
A string of surveys can be either repeated administrations of a
single questionnaire or it can be any arbitrary sequence of dif-
the administration of a formal course of study as well as many
different kinds of research projects. In addition to general sup-
port for longitudinal data collection, we added a host of man-
agement features for tracking compliance and scheduling ad-
ministration. We added an alert manager to handle automated
emailreminders. Tosupport theRA’srolein research, we added
events, such as phone conversations, and relates these events to
both the patient and the RA. Fig. 6 shows the RA’s administra-
tion page. Each of these links is a function or a report to which
RA’s have direct one-click access.
DENNIS AND GAMBHIR: INTERNETQUESTION AND ANSWER (iQ&A): A WEB-BASED SURVEY TECHNOLOGY123
and whether they have responded to each of the nine surveys that make up this study.
Shown are several pages of the adminstrator side of the QoL research system. The Survey Status report page (center) lists all active patients’ schedules
X. MEDICAL TECHNOLOGY ASSESSMENT
A second example of the use of iQ&A is a system developed
for conducting biomedical research related to new technology
assessment. In this application of iQ&A, we have worked with
nuclear medicine physicians to design surveys that help to un-
derstand the utilization of positron emission tomography (PET)
in the management of various cancer patients , . This
technology is rapidly expanding as an imaging tool that helps
to diagnose and manage cancer patients. In this application of
iQ&A, it is desirable to understand the referral patterns for PET
and the impact this new technology has on better managing pa-
tients. The survey is a set of questions which helps to delineate:
1) why the PET scan is being ordered; 2) the disease state of
the individual patient; 3) the results of the PET scan; 4) results
of other tests performed on the patient; 5) the surgical or med-
ical management of the patient; and 6) the final outcome(s) for
the patient. The survey in this case is in part taken by the physi-
cian(s) referring the patient for the PET study and in part by
the physician(s) performing the PET study. The patient is not
directly involved in this survey. Through ongoing use of this
the significant impact that PET is having on the management of
various cancers. Online reporting allows continued tracking of
theimpactof PET incancer management.Further refinement of
this particular application of iQ&A should lead to flexibility for
applications in which several individuals fill out portions of the
124IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 4, NO. 2, JUNE 2000
XI. SOLUTIONS OFFERED BY iQ&A
There are a growing number of survey-service providers on
the Internet. It is clear that more people and enterprises are
taking advantage of the WWW as a medium in which to con-
duct inquiry and research. General-purpose products that sup-
port such work have begun to appear. However, the field is still
a challenge to most systems. Commercial products, like 2WAY,
have an appealing polish and are excellent solutions for simple
questionnaires and surveys, but for more sophisticated applica-
tions the only answer is custom programming. Another limita-
tion is platform support. Forexample,2WAYhaschosen to sup-
port the PC platform exclusively for survey authoring and man-
agement. While the PC is the predominant platform, a signifi-
cant number of people use Macintosh or Unix computers. Quiz
Studio holds cross-platform promise, but Java is still unevenly
supported within browsers. Quiz Studio, for example, does not
run on a Macintosh using the latest Netscape browser. Clearly,
the safest approach is to stay within the capabilities of a web
iQ&A does not have the same weaknesses as those cited
above. iQ&A was designed and engineered to support so-
phisticated branching through a multipage survey. We have
developed a flexible and powerful set of interfaces for spec-
ifying branching patterns. To accomplish the authoring of
dynamic branching, we have stayed within straight HTML.
iQ&A is an HTML-based application. iQ&A works on any
platform that can run a 4.0.x version web browser. Another im-
portant strength of iQ&A is its emphasis on reuse of questions
and sets of questions. One does not need to setup every question
with each new survey. Many questions in a typical survey are
common items that can be reused, such as name and email
address. Since setting up questions does take some additional
effort, this can be a true timesaving aspect. All questions that
each iQ&A author creates and uses in a survey are stored for
reuse in a private collection. In addition to each author’s private
collection, all authors have access to a public collection of
questions and sections. This aspect of the system provides an
element of collaboration and sharing between members.
An additional aspect of iQ&A that is an area of important
strength is the architecture and software upon which it is built.
The core of iQ&A is a freely available web application devel-
and improve. The iQ&A relational data model can be imple-
mented in many different RDBMS’s. Although all our current
work is with Sybase and Oracle8i, iQ&A could be set up and
run using a free relational database such as Postgres.6
XII. DISCUSSION AND FUTURE WORK
and programmatic uses to which surveys are put: for example,
longitudinal research, and other clinical trials. iQ&A has grown
from beinganeasy-to-usesurveyandtest builderintoa full-fea-
tured research project authoring and management system. We
6[Online]. Available: http://db.cs.berkeley.edu
are concentrating on robustness, ease of use, and thoughtful in-
tegration of the various enhancements derived from the various
to a project environment like the two cases presented above, we
haveimprovedand enhanced thesystem. Thearea of iQ&A that
remains in need of further development attention is reporting.
iQ&A lacks sophisticated interactive reporting capabilities. We
have been reluctant to pursue complex statistical analysis ca-
pabilities. We have, however, added data exporting support for
both SAS and SPSS data file formats. The need for more flex-
ible online reporting is clear. One example of where iQ&A is
lacking is the capability to define a variable for reporting pur-
poses that is a composite of several questions from a survey.
One area of work we see ourselves actively pursuing in the
authoring support feature of iQ&A will allow us to quickly as-
semble adaptive tests . We currently do not store item diffi-
culty or item response theory parameters, but this would be a
simple addition to the iQ&A data model. In addition, we will
continue to develop decision support systems like the Prostate
Cancer Decision Support system.
We have developed and tested an Internet-based survey tech-
nology with potential for wide-based applications in education,
administration, and bio-medical research. iQ&A is a flexible
software system capable of running on many different UNIX
server platforms with various different back-end databases. The
simplicity of survey construction and publishing, WWW access
to published surveys with an Internet browser, and powerful on-
line report capabilities provide a unique environment in which
to construct, administer, and analyze surveys for various appli-
cations. Continued refinement of iQ&A should lead to an even
more powerful system with a large array of applications.
The authors wish to thank members of the Interactive Media
Lab of the Crump Institute for Biological Imaging for their
contributions to this work. They thank T. Hong and K. Huang
for their programming efforts and G. Lacson and P. Zaslov
for their design and graphic contributions. They also thank
Dr. M. Litwin, Dr. J. Banderis, and I. Chand for their support
and contributions to the Quality of Life system. The authors
are especially grateful to Dr. M. E. Phelps for his support and
 H. Wainer, Computerized Adaptive Testing: A Primer.
Erlbaum Associates, 1990.
 N. S. Petersen, Computerized Adaptive Testing: From Inquiry to
Operation , 1st ed, W. A. Sands, B. K. Waters, and J. R. McBride,
Eds. Washington, DC: Amer. Psycholog. Assoc., 1999.
 J. P. Mello, “Survey software automates electronic polling,” PC World,
vol. 14, p. 78, 1996.
 T. Powell, “Do-it-yourself survey software,” Marketing Computers, vol.
16, p. 30, 1996.
 B. Simon, “Two ways to take stock,” PC Magazine, vol. 17, p. 73, 1998.
 S. Borden, “Poll your customers the easy way,” Computer Shopper, vol.
17, p. 452, 1997.
DENNIS AND GAMBHIR: INTERNETQUESTION AND ANSWER (iQ&A): A WEB-BASED SURVEY TECHNOLOGY125 Download full-text
 M. Kramer, “These results just in,” PC Week, vol. 14, p. 39, 1997.
 M. Hammond, “2Way enables Web customer feedback,” PC Week, p.
26, Nov. 15, 1998.
 M. Heck, “Survey package gives polling flexibility; decisive software
establishes dialogue via e-mail, Web site,” InfoWorld, vol. 19, p. IW2,
 D. Drucker, “Software enables interactive surveys (Mazda North
America uses 2Way’s 2Way Enterprise Suite,” InternetWeek, p. 22,
Nov. 1, 1999.
 M. Heck, “Quiz studio conducts distance test taking and polls,”
InfoWorld, vol. 20, p. 78, 1998.
 P. Greenspun, Philip and Alex’s Guide to Web Publishing.
cisco, CA: Morgan Kaufmann, 1999.
, Database Backed Web Sites: The Thinking Person’s Guide to Web
Publishing.Emeryville, CA: Ziff-Davis, 1997.
 M. S. Litwin, A. I. Shpall, F. Dorey, and T. H. Nguyen, “Quality-of-life
outcomes in long-term survivors of advanced prostate cancer,” Amer. J.
Clin. Oncol., vol. 21, pp. 327–332, 1998.
 M. S. Litwin, R. D. Hays, A. Fink, P. A. Ganz, B. Leake, G. E. Leach,
and R. H. Brook, “Quality-of-life outcomes in men treated for localized
prostate cancer [see comments],” J. Amer. Med. Assoc., vol. 273, pp.
 M. S. Litwin, J. T. Fine, F. Dorey, R. A. Figlin, and A. S. Belldegrun,
“Health related quality of life outcomes in patients treated for metastatic
kidney cancer: A pilot study,” J. Urol., vol. 157, pp. 1608–1612, 1997.
 M. E. Phelps,“PET: A biological imaging technique,” Neurochem.Res.,
vol. 16, pp. 929–940, 1991.
 C. K. Hoh, C. Schiepers, M. A. Seltzer, S. S. Gambhir, D. H. Silverman,
J. Czernin, J. Maddahi, and M. E. Phelps, “PET in oncology: Will it
replace the other modalities?,” Seminars in Nuclear Medicine, vol. 27,
no. 2, pp. 94–106, Apr. 1997.
Robert A. Dennis was born in Hollywood, CA.
He received the B.S. degree in philosophy from the
University of California at Santa Cruz and the M.A.
and Ph.D. degrees in educational psychology from
the University of California Los Angeles (UCLA).
He is currently the Co-Director of the Interactive
Media Group at the Crump Institute for Biological
Imaging in the Department of Molecular and Med-
ical Pharmacology at the UCLA School of Medicine.
His research interests center around interactive ed-
ucational technology. He has conducted research in
mathematical modeling of cognitive structures for the purpose of driving online
support tools. Prior to joining the Crump Institute, he was a Project Director at
the National Center for Research on Evaluation, Standards, and Student Testing
(CRESST), a research and development center funded by the Office of Educa-
tional Research and Improvement of the Department of Education.
Sanjiv S. Gambhir was born in Ambala, India. He
received the B.S. degree in physics from Arizona
and the M.D. degree from the Medical Scientist
Training Program at the University of California Los
He is currently an Assistant Professor in the De-
partment of Molecular and Medical Pharmacology at
the UCLA School of Medicine. He is Co-Director
of the Communication/Computational Sciences Di-
vision of the Crump Institute for Biological Imaging.
He also has a joint appointment in Biomathematics and is a clinical attending
in Nuclear Medicine. His research interests center around mathematical mod-
eling in positron emission tomography (PET) and functional magnetic reso-
nance imaging. He is developing new assays for imaging gene expression in
vivo using PET. Furthermore, he has research interests in multimedia educa-
tional tool development including Internet-based decision support tools.
Dr. Gambhir has received numerous honors including Summa Cum Laude
in Physics, Phi Beta Kappa, The UCLA Alumni Association Gold Medal
Outstanding Graduate Student Award, UCLA Graduate Distinguished Scholar
Award, Mary Lenora Schulte Award, Dr. Ursula Mandel Award, Edith & Carl
Lasky Memorial Award, National Institutes of Health (NIH) Medical Scientist
Fellowship, NIH Systems & Integrative Biomathematics Training Grant, and
the Alexander Hollaender Fellowship from the Department of Energy.