Imaging

Introduction

The HIE portal provides an imaging module to order Imaging investigation, create and review the imaging report. This function is enable for both internal and external type or ordering.

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Resource Breakdown

Using HIE, FHIR resources are used to store the ordering process up to the result and reporting process.

Based on the diagram below, the FHIR resources is broken down and used as described;

Imaging Service Request

Using HealthcareService (MY Core), each facility will define what Imaging orderable are available for their respective healthcare worker to request.

Imaging Request List | Phlebotomy Station

When a request is made, it will be stored using ServiceRequest (MY Core) and ImagingStudy (MY Core). The ServiceRequest status will be "draft" ServiceRequest.status:"draft"

Once user confirms and intiates their request a Task (MY Core) will be created.

• The ServiceRequest status will be updated to "active" ServiceRequest.status:"active"
• The Task status will be initiate with status "initiate" Task.status:"initiate"

Imaging Console

Task (MY Core) will then track and execute the operational business flow up until its intended or alternate destination is achieved.

As the Task moves to each check point it will update its status as defined in the diagram.

Report Form

Once a report is to be stored in HIE, it will be stored as DiagnosticReport (MY Core). The imaging result itself inside DICOM where user can view the result using a DICOM link.

Source System Integration Point

There are 2 possible use case where a source system can consider exchanging imaging records between HIE. During;

1. External Ordering
2. Retrieving Imaging Report & Result

For further details on the flow of sending data and/or retrieving can refer to Integration Overview under Care Coordination (CC) category.

External Order (Integration Point 1)

An external order towards another facility/source system can be done through HIE using the MY Core Standard. The profile related to imaging ordering is ServiceRequest (MY Core). The record must have;

1. A status fix as "active" status:"active"
2. An intent intent
3. The category fix as "363679005" (imaging order) category.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/servicerequest-category-my-core').code:"363679005"
4. The imaging modaility category.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/imaging-modality-my-core').code
5. The imaging region category.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/imaging-region-my-core').code
6. The imaging code code.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/imaging-my-core').code
7. A subject referenced subject
8. An encounter referenced encounter
9. Date order authored authoredOn
10. Type of order fixed as "affiliate" performerType:"affiliate"
11. Practitioner who requested requester
12. Requesting facility referenced performer.where (identifier.value = 'requester-facility').reference
13. Performing facility performer.where (identifier.value = 'requester-facility').reference

Imaging Report & Result (Integration Point 2)

An imaging report and result can be sent to HIE for record exchange or to fulfil another requesting source system order (Integration Point 1). The profile related to imaging reporting is DiagnosticReport (MY Core)

The imaging report (DiagnosticReport) must have;

1. A status fixed as "final" status:"final"
2. The category fixed as "363679005" (imaging order) category.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/servicerequest-category-my-core').code:"363679005"
3. The imaging modaility category.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/imaging-modality-my-core').code
4. The imaging region category.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/imaging-region-my-core').code
5. The imaging code code.coding.where (system = 'http://fhir.hie.moh.gov.my/CodeSystem/imaging-my-core').code
6. A subject referenced subject
7. An encounter referenced encounter
8. A report conclusion conclusion