FHIR Imaging ServiceRequest Profile IG, published by HL7 International / Imaging Integration. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/imaging-service-request-ig/ and changes regularly. See the Directory of published versions

Background

This chapter describes the scope of this guide, provides background information, key concepts, and describes the use cases supported by this implementation guide.

1. ​Problem - Description of the Problem
2. Scope - Scope of the IG
3. Intended Readers - Intended readers of the IG
4. Relationship to IHE Scheduled Workflow - Relationship to IHE Radiology Scheduled Workflow Profile
5. Use cases - Key use cases covered by the IG
6. Glossary - Glossary of terms used in this IG
7. References - Useful references

Problem

The DICOM Modality Worklist (MWL) service provides DICOM acquisition devices with information from the ordering system (patient, visit, procedure, etc.).

The mapping between HL7 V2 and DICOM Modality Worklist (MWL) is well-defined. However, the mapping from equivalent FHIR resources is not.

Scope

In Scope

• Resource profiles
  • Imaging Service Request as ServiceRequest
  • Requested Procedure as either a ServiceRequest
  • Scheduled Procedure Step as Task
• Content maps
  • ORM, OMI, OMG to Imaging Service Request and child resources
  • Imaging Service Request to DICOM MWL C-FIND RSP

Out of Scope

• Mapping DICOM MPPS to FHIR
• Modelling entire image ordering workflow

Intended Readers

This Implementation Guide is intended for

To be created

Relationship to IHE Scheduled Workflow

Actors

The following SWF actors are relevant to this profile:

• Order Placer
• Department System Scheduler / Order Filler (DSS)
• Image Manager / Image Archive
• Acquisition Modality

Transactions

The following SWF transactions are relevant to this profile.

Placer Order Management [RAD-2]

• Order Placer communication to DSS / Order Filler
• Order message content is relatively sparse
• Messages:
  • New Order From Order Placer
  • Order Cancelled by Order Placer

Filler Order Management [RAD-3]

• DSS / Order Filler communication to Order Placer
• Updates Order Placer on changes made to orders by the DSS
• Messages:
  • New Order From Order Filler or Change Order Form
  • Order Status Update
  • Order Cancelled By the Order Filler

Procedure Scheduled [RAD-4] / Procedure Updated [RAD-13]

• DSS / Order Filler communication to Image Archive / Image Manager
• Used to match / reconcile orders with images

Query Modality Worklist [RAD-5]

• Acquisition Modality queries DSS / Order Filler for worklist entries
• Used to populate the modality worklist

Mapping to FHIR Operations

This implementation guide includes FHIR operations to cover:

• Creation of orders from Order Placer to DSS / Order Filler ([RAD-2])
• Cancellation of orders by the Order Placer ([RAD-2])
• Provision of order details and status updates from DSS / Order Filler to Order Placer ([RAD-3]) and the Image Archive / Image Manager ([RAD-4] / [RAD-13])

The following SWF transactions are not modelled in FHIR:

• Schedule Procedure and / or Assign Protocol
  • It is expected that the MWL service can populate this information based on the order creation request
  • The mechanism by which it does so is out of scope
• Modality Worklist Query
  • Modality Worklist Query remains a DICOM operation
  • The operation by which the Order Filler and Image Manage / Image Archive retrieve order details may be a suitable basis for this query

Use cases

Two use cases were identified.

Use case 1: Populate DICOM MWL C-FIND Responses from FHIR

Use case 2: FHIR-based MWL query

Glossary

The following terms and acronyms are used within the Radiation Dose Summary IG:

Term	Definition
ATNA	Audit Trail and Node Authentication
CID	Context Identifier
DICOM	Digital Imaging and Communications in Medicine
EHR	Electronic Health Record
EMR	Electronic Medical Record
FHIR	Fast Healthcare Interoperability Resources
HL7	Health Level Seven
IG	Implementation Guide
IHE	Integrating the Healthcare Enterprise
IOD	Information Object Definition
MWL	Modality Worklist
RIS	Radiology Information System
TLS	Transport Layer Security
UID	Unique identifier
URL	Uniform Resource Locator
URN	Uniform Resource Name

References

1. DICOM,DICOM PS3.4 Section K.6: Modality Worklist SOP Class
2. IHE Radiology (RAD), HL7 Order Mapping to DICOM MWL), Appendix B
3. IHE Radiology (RAD), Scheduled Workflow (SWF), Section 3
4. HL7 IG HL7 Version 2 to FHIR
5. HL7 IG Clinical Order Worfklows Implementation Guide
6. HL7 IG Order Catalog Implementation Guide