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Connectathon Jan 2021 Tentative Imaging Use Cases

  • FHIRcast imaging use cases
    • Coordinating with FHIRcast
  • AI Imaging Results 
  • VNA sharing data with EMR
  • EMR access to imaging study
  • Comprehensive imaging SWF
  • Linking between observation, diagnosticreport, documentreference and imagingstudy
    • ImagingStudy reference in DiagnosticReport

Examples:

Scenario: Linking between observation, diagnosticreport / composition, documentreference and imagingstudy – coordinate with FHIRcast

Actors:

  • EMR
  • VNA / EIR / PACS
  • EMR viewer
  • Enterprise imaging viewer

Steps

  • EMR viewer retrieves DiagnosticReport from EMR
  • EMR viewer discovers associated ImagingStudy
  • EMR viewer displays report and launches Enterprise Viewer w/ ImagingStudy context
  • Enterprise imaging viewer displays ImagingStudy 
  • Option: Imaging Viewer creates observation and makes it available to EMR, which links to diagnostic report
  • Option: Report creation variant of this?

Scenario: FHIR-enhanced Diagnostic Reading

  • Links between ImagingStudy and other FHIR resources (ServiceRequest, Reason, etc.) provide additional relevant context to reading clinician

Actors:

  • Diagnostic Viewer
  • EMR
  • VNA / PACS

Steps

  • DV loads DICOM study
  • DV loads ImagingStudy associated with the DICOM study
  • DV follows links in ImagingStudy to access additional study context
    • BasedOn
    • Reason
    • ...

Examples

  • TODO – add examples of relevant information and how it would be related to the ImagingStudy

Scenario: Encoding AI results and radiology reports in FHIR

Actors

  • Report creator
  • EMR
  • Report viewer

Steps

  • Report creator creates radiology report
  • Report creator extracts Observations from radiology report
  • Report creator stores report in FHIR in one of
    • Set of observations
    • DiagnosticReport
    • Composition
  • Report viewer finds / presents information stored in above encodings
  • Option: Report viewer handles conflicting observations?
    • Filter by status
  • Option: Report creator looks at existing observations before storing output
    • See if existing data needs to be updated / deprecated

Scenario: AI Results (see previous workflow)

  • FHIR results creator
  • Follows AI result to imaging as per above scenario
  • Option: Does this require linking back from FHIR result to DICOM result?

Scenario: FHIR-based SWF (not part of initial scenarios)

  • Open questions:
    • What resource(s) go into MWL content?
    • What resource(s) are used by archive to reconcile study?
    • What resource(s) are used to notify EMR of study complete
      • ImagingStudy as EMR notification
      • VNA creates ImagingStudy in EMR as equivalent to ORU 'study complete' message

Scenario: MHD / MHD-I (not part of initial scenarios)

Other notes:

  • FHIRcast mechanism to indicate a resource has been updated
  • EMR could create ImagingStudy via QIDO to VNA
  • Possible MWL equivalent model
    • Patient = DICOM Patient
      • ServiceRequest = DICOM Requested Procedure
        • Task= DICOM Requested Procedure Step
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