Enabling SWF on FHIR

1. Proposed Workitem: Enabling SWF on FHIR

• Proposal Editor: Brian Bialecki, Jonathan Whitby
• Editor: Brian Bialecki
• Domain: Radiology

2. The Problem

FHIR is the emerging clinical information standard that industry has adopted world-wide. Scheduled Workflow is the most widely adopted IHE profile throughout the world. However, it provides no guidance on implementing FHIR. HL7 provides minimal guidance with regards to implementing FHIR for Imaging.

This leaves vendors and users to develop their own implementations for deploying FHIR-based imaging workflows. The result is apparent. Each deployed site will be unique. Vendors will need to adopt and implement a unique configuration for every clinical site's deployed environment.

The key to enabling SWF on FHIR will be the creation and management of the ImagingStudy resource.

USCDI V4 includes updates to Diagnostic Imaging to include Imaging Reference. Community guidance will be essential in assisting Radiology practices to be compliant and vendors to ensure systems follow best practice standards for their implementations.

3. Key Use Case

The key use cases are:

• Create the ServiceRequest resource
• Update the ServiceRequest resource
• Host the ServiceRequest resource
• Search for existing ServiceRequest resources
• Create the ImagingStudy resource
• Update the ImagingStudy resource
• Host the ImagingStudy resource
• Search for existing ImagingStudy resources

For this workitem, the proposed scope is to be limited. Primary focus should be on the creation and management of the FHIR resources ServiceRequest and ImagingStudy. DICOM messaging will not be addressed with the exception references to existing parallel transactions or as event triggers.

4. Standards and Systems

Relevant Systems

• Image Manager
• ADT
• Department System Scheduler/Order Filler
• FHIR Resource Creator
• FHIR Resource Repository

Relevant Standards

• IHE Scheduled Workflow
• HL7 FHIR
• DICOM
• USCDI

5. Discussion

A comprehensive inclusion of FHIR with the existing SWF is a major effort. This level of effort should not inhibit IHE Radiology from starting this project. This project proposal scope needs to limited to a focused component of the overall transformation to a FHIR-based workflow. The initial proposed scope is to focus on the Imaging Orders to FHIR Data Model.

This project needs to leverage and collaborate with existing profiling work that is either in progress or completed by other IHE domains and HL7.

HL7 Orders and Observations currently has an IG in progress for v2 to FHIR mapping which includes a General Order Message. This work can be leveraged and can help O&O with usage of the implementation guide.

The joint DICOM WG20/HL7 Imaging Integration Working group has a workitem to address gaps with the HL7 v2/FHIR mapping relevant to imaging.

IHE PCC has a profile QEDm which utilized FHIR for query of existing Data. While the profile does have an option for procedures, it is missing an option for ServiceRequests. This project could utilize the Procedures option to be refined for imaging and add a Query for Imaging ServiceRequests.

An initial draft of the Imaging Orders mapping to FHIR is in the HL7 Confluence page "FHIR ServiceRequest Mapping to Imaging Order"

IHE is the owner of SWF. IHE is the appropriate venue for incorporating FHIR with the profile. IHE has the most expertise on this subject.

Realizing that this is an extensive and most significant update requested of SWF, the level of effort should be constrained in the first cycle to resource mapping with no changes to the existing Transactions. This will ensure backward compatibility and support of mixed environments.

No new Actors are proposed. The profile will add the applicable FHIR resources and the mapping of the existing HL7 v2.5 messaging fields.

For transactions, propose to leverage existing QEDm transactions with refinements to imaging.