Extended Patient Identification

The following figure shows the mapping between the HL7 Version 2.x and FHIR Patent Resource.

Mapping
source: HL7 FHIR

Post Surgery Reporting

The HL7 FHIR Procedure Resource is used to record the details of procedures performed on a patient.

This resource provides summary information about the occurrence of the procedure and is not intended to provide real-time snapshots of a procedure as it unfolds.

The following is the resource template

Reporting

The HL7 FHIR Procedure Resource is used to record the details of procedures performed on a patient.

Real-world procedure example

    {
      resourceType: Procedure,
      id: f002,
      text: {
        status: generated,
        div:  **Generated Narrative with Details**: <a>Lab results blood test</a>**followUp**: described in care plan (Details )
      },
      status: completed,
      code: {
        coding: [
          {
            system: http://snomed.info/sct,
            code: 359615001,
            display: Partial lobectomy of lung
          }
        ]
      },
      subject: {
        reference: Patient/f001,
        display: P. van de Heuvel
      },
      context: {
        reference: Encounter/f002
      },
      performedPeriod: {
        start: 2013-03-08T09:00:10+01:00,
        end: 2013-03-08T09:30:10+01:00
      },
      performer: [
        {
          role: {
            coding: [
              {
                system: urn:oid:2.16.840.1.113883.2.4.15.111,
                code: 01.000,
                display: Arts
              }
            ],
            text: Care role
          },
          actor: {
            reference: Practitioner/f003,
            display: M.I.M. Versteegh
          }
        }
      ],
      reasonCode: [
        {
          text: Malignant tumor of lung
        }
      ],
      bodySite: [
        {
          coding: [
            {
              system: http://snomed.info/sct,
              code: 39607008,
              display: Lung structure
            }
          ]
        }
      ],
      outcome: {
        text: improved blood circulation
      },
      report: [
        {
          reference: DiagnosticReport/f001,
          display: Lab results blood test
        }
      ],
      followUp: [
        {
          text: described in care plan
        }
      ]
    }

Using DICOM Modality Worklist to send/receive patient demographics.

What is Modality Worklist?

Modality Worklist is a technology or software capability associated with DICOM imaging studies that have the potential to significantly improve your workflow. When you use the Modality Worklist, the patient demographic information that has been acquired and stored in your EHR system is electronically sent to the imaging modality itself.

Continuous Integration

To achieve continuous integration, there needs to be additional information passed between the EHR and cloud PACS beyond just the patient\’s demographic information—some sort of unique identifier that connects the patient\’s exam within the EHR to the related imaging study in the cloud.

A unique identifier is generated by the EHR system and is known as the accession number or exam ID. When this number is entered into an imaging modality, it makes it much easier to implement a cloud PACS EHR integration, as the two systems are able to recognize a commonality on the given exam.

However, a unique identifier that can be up to 16 digits long is a substantial burden for many imaging technologists to enter into the modality and presents a very real possibility for human error when typing it in manually.

This is where Modality Worklist comes in.

It takes the information from the EHR system and provides it to the imaging modality electronically so that the technologist doesn\’t have to re-enter any of the information. The accession number can then pass to the cloud PACS along with the other DICOM fields when the image is sent. Receiving the accession number in the cloud closes the loop as it enables the EHR and cloud PACS to communicate regarding the specific exam through the use of this unique identifier.

With this type of usage, the benefit of the Modality Worklist is greater than simply improving your workflow. It serves as a man in the middle to making PACS/EHR integrations as painless, frictionless and error-free as possible.

Worklist Warnings

The following list serves as warnings to the Radiologic Technologist when using the worklist.

  • Radiologic technologists should verbally (or through any other means available) confirm a patient\’s identity and demographic information before beginning an exam. This is necessary to ensure that the correct exam is selected from the worklist.
  • When an exam has ended, a technologist must complete the exam on the Modality Worklist or in IDXrad. If the technologist fails to complete the exam, the exam will still appear on the Interpretation Worklist and its images will be available for review. However, the status will remain as I (In progress), which could potentially cause confusion and delayed diagnoses and treatment.
  • Technologists can begin an exam at a different resource than the one specified during exam scheduling. Technologists must ensure that the currently selected performing resource is the appropriate resource for performing the exam.
  • Technologists can link an image set to multiple exam accession numbers for the same patient and modality. If a technologist links an exam that is not part of the study, the incorrect image set is associated with the exam\’s accession number. This may result in confusion and incorrect or delayed diagnoses and treatment.
  • Technologists can unlink an image study from an exam (accession number). If a technologist erroneously unlinks an image study from its appropriate accession number, the correct image study will no longer be associated with that accession number. This may result in confusion and incorrect or delayed diagnoses and treatment.
  • Technologists can unlink an image study from an exam in D (Dictated), P (Preliminary), F (Finalized), A (Addended), or R (Revised) status. If a technologist unlinks an image study from an exam in one of these statuses, the radiologist\’s diagnostic report may be affected because the report was dictated when the images were originally linked to the exam. For example, a report may make reference to or include a diagnosis based upon the image to which it was once linked. If this were the case and the image study is no longer linked to the exam/report, the image reference is lost, and the image could be lost forever if never relinked to the appropriate exam.

Governance

HIPAA/HITRUST

The Azure Security and Compliance Blueprint – HIPAA/HITRUST Health Data and AI offer a turn-key deployment of an Azure PaaS solution to demonstrate how to securely ingest, store, analyze, and interact with health data while being able to meet industry compliance requirements. The blueprint helps accelerate cloud adoption and utilization for customers with data that is regulated.

Components
ref: Azure Secuity
Architectural diagram
ref: Azure Security

In Part 3 we will look at a solution.

Last modified: March 2, 2020

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