Enabling SWF on FHIR

1. Proposed Workitem: Enabling SWF on FHIR

Proposal Editor: Brian Bialecki
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 - DOC_SOURCE?
FHIR Resource Repository - DOC_REPOSITORY?

Relevant Standards

IHE Scheduled Workflow
IHE Mobile access to Health Documents
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 be limited to a focused component of the overall transformation to a FHIR-based workflow. The initial proposed scope is to focus on enabling SWF on FHIR by ensuring there is a consistent process for creating and managing the basic FHIR resources required for SWF as well as USCDI compliance.

This project needs to collaborate with existing profiling work that is either in progress or completed by other IHE domains, for example "MHD" and HL7.

The joint DICOM WG20/HL7 Imaging Integration Working group has a workitem to address gaps with the HL7 v2/FHIR mapping relevant to imaging. An initial draft of the Imaging Orders mapping to FHIR is in the HL7 Confluence page "FHIR Imaging Service Request Resource Mapping"

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 basic resource creation and management.

Actors for creating and hosting FHIR resources are proposed. Potentially these would be DOC_SOURCE and DOC_REPOSITORY and how they are used to manage these transactions.

There has been some work to do basic testing and implantations at "FHIR Connectathons" and with SMART Imaging Access through the Argonaut Project, see the "draft specification."