|Submitted By: Deanne Kasim / Change Healthcare|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||As illustrated in the HL7 web page: https://hl7.org/fhir/imagingstudy.html
Amy, a family physician, would like to see a list of available studies for her patient, Alex. Her EHR client makes a FHIR call for all ImagingStudy objects available for Alex. In the response, she is able to see the study date, procedure, modality, and accession number, for each study returned. There is enough information provided in the response to obtain a thumbnail via a WADO-RS call, or to launch a viewer using an IHE Radiology - Invoke Image Display (IID) profile call using the url elements found in the ImagingStudy.
Joe Angina complains of shortness of breath and occasional chest pain to his primary care physician, Dr. Pat Down at Local MultiClinic, who orders a stress echocardiogram; the order is created as a FHIR Task resource to manage the workflow, with a link to a ServiceRequest resource with the details of the request. The order is scheduled and assigned to cardiologist Dr. Art Skann, also at Local MultiClinic.
On the scheduled day of the exam, Joe arrives at the echo lab to meet with Dr. Skann and have the study done. Dr. Skann’s workstation shows the daily list of Task, and he follows the link to retrieve the ServiceRequest. (He may follow the links through the referenced Patient resource to access Joe’s electronic medical record, but that is not the concern of this storyboard.)
The Task and ServiceRequest has been transcoded to a DICOM Modality Worklist Scheduled Procedure Step, and in the echo lab the equipment has downloaded the Modality Worklist. The study is performed, and the acquired images and sonographer’s preliminary measurements are stored in the Local MultiClinic Picture Archiving and Communication System (PACS). The PACS creates an ImagingStudy resource for each study it manages.
Dr. Skann interprets the study on a PACS workstation, and he selects two key image frames to be included in the diagnostic report; this selection is stored back to the PACS as a DICOM Key Object Selection with the title "For Report Attachment", and the PACS makes it available (transcodes it) as a FHIR ImagingStudy resource. Dr. Skann dictates the report using a structured data entry report writing program, including a recommendation for a cardiac catheterization procedure, and signs it. The report writing program formats the report as a CDA document, retrieves the ImagingStudy resource, and inserts the referenced key images into the report.
Dr. Down meets again with Joe, and they review the results of the stress test. Joe has a question about the findings that the key images in the report do not show, so Dr. Down uses the Local MultiClinic EMR to query the PACS for the full ImagingStudy resource and uses the references there to open an image display for the full study. Joe agrees to proceed to catheterization, and Dr. Down sends a referral to the Ginormous University Hospital cath department and triggers the PACS to share the echo study through the Metropolitan Health Information Exchange.
The PACS creates an imaging study as an ImagingStudy resource, which includes all the images but excludes the sonographer’s preliminary measurements (which as a matter of policy are not shared outside the Local MultiClinic). The imaging study is published to the Metro HIE. (In accordance with IHE XDS-I , the images themselves are not directly published to the HIE, but available for on-demand retrieval from the PACS.)
At Ginormous Hospital, Dr. Cora Plummer receives the cath referral, and looks up the study in the Metro HIE registry. She retrieves the study ImagingStudy, and uses it to access the shared images, which she uses to prepare for the cath procedure.
|Estimated number of stakeholders capturing, accessing using or exchanging||Potentially all providers, HIE/HINs|
|Link to use case project page||https://www.ihe.net/resources/technical_frameworks/#radiology|
|Maturity of Use and Technical Specifications for Data Element|
|Current Use||In limited use in test environments only|
|Number of organizations/individuals with which this data element has been electronically exchanged||N/A|
|Restrictions on Standardization (e.g. proprietary code)||It's FHIR|
|Restrictions on Use (e.g. licensing, user fees)||N/A|
|Privacy and Security Concerns||N/A|
|Estimate of Overall Burden||N/A|
|ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following 4 criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
|Maturity – Standards/Technical Specifications||Level 1/2 - Must be represented by a vocabulary standard or an element of a published technical specification|
|Maturity - Current Use||Level 1 - Used in limited production environments, 1 or 2 different systems|
|Maturity - Current Exchange||Comment Level - Demonstrates limited exchange with external organizations, on same or different EHR/HIT systems|
|Breadth of Applicability - # Stakeholders Impacted||Level 2 - Used by a majority of patients, providers or events requiring its use|
|Evaluation Comment||Use in limited test environments and no documented exchange results in the evaluation of Comment Level|