SWF on FHIR

1. Proposed Workitem: SWF on FHIR

• Proposal Editor: Chris Lindop, Jonathan Whitby
• Editor: <Name of candidate Lead Editor for the Profile, if known>
• 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.

3. Key Use Case

The key use cases are documented in the IHE Radiology Technical Framework Volume 1 Section 3.3 Scheduled Workflow Process flow. No changes are proposed.

For this workitem, the proposed scope is to be limited. The patient Management transactions will be ignored. Primary focus should be on Orders Management and The FHIR resource ServiceRequest and Procedure. DICOM messaging will not be addressed with the exception of mapping of DICOM to FHIR.

4. Standards and Systems

Relevant Systems

Relevant systems are the same as those systems implementing Scheduled workflow. No change is proposed to the existing relevant systems.

Relevant Standards

• IHE Scheduled Workflow
• HL7 FHIR
• DICOM

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.