Cumbersome Section Structure - BC #12

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    • Type: Change Request
    • Resolution: Persuasive
    • Priority: Medium
    • US Breast Cancer Radiology Reporting (FHIR)
    • Clinical Interoperability Council
    • (NA)
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      As per Graham Grieve's recommendations, we intend to use Diagnostic Report as the root and Observations as the section headers. Based on feedback from the next ballot we may revisit this.
      We are not confident that this is a complete or sufficent solution to this problem, and are likely to continue to evolve this over several ballot cycles.

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      As per Graham Grieve's recommendations, we intend to use Diagnostic Report as the root and Observations as the section headers. Based on feedback from the next ballot we may revisit this. We are not confident that this is a complete or sufficent solution to this problem, and are likely to continue to evolve this over several ballot cycles.
    • Clarification
    • Compatible, substantive

      Comment:

      Disclosure: This negative comment was entered by the authors of the Breast-Radiology ballot.

      The Breast-Radiology FHIR Profiles use an awkward strategy to define the root-entities that identify the report in terms of its entirety. Existing Radiology reports are delivered as a 'document' which contains sections and sub-sections and any FHIR solution that does not preserve these concepts on context of content has little chance of being adopted by the Radiology community.

      Content in the Findings section has different meaning than content in the Impressions section, so the Composition resource was used to group Observations and Conditions into the established hierarchical section / sub-section structure.

      The Composition resource is not referenceable by many of clinically and treatment important related FHIR Resources, such as:

      CarePlan, ChargeItem, ClinicalImpression, Communication, CommunicationRequest, Condition, Contract, DeviceRequest, DeviceUseStatement, FamilyMemberHistory, GuidanceResponse, ImagingStudy, Immunization, MedicationAdministration, MedicationStatement, Procedure, RequestGroup, RiskAssessment, ServiceRequest and SupplyRequest.

      All of these resources can reference a DiagnosticReport but not Composition.

      Since the DiagnosticReport resource can be legitimately referenced by the above resources, we have profiled it to define our procedure related metadata and then reference a single Composition instance to contain the report content. This then allows for treatment related resources to reference the Radiology report in its entirety as a reason for treatment choices.

      Our team found this 'hybrid' approach awkward and prefer that changes be made either to the DiagnosticReport or Composition resource to act as a single, fully sufficient, root resource for a clinical report in its entirety.

      We hope to work with the Orders and Observations group to propose changes to these resources that would improve their use for the hundreds of similar FHIR use cases that exist across Radiology, Pathology and many other consultative medical specialties.

      Summary:

      Cumbersome Section Structure

            Assignee:
            Kurt Allen
            Reporter:
            Richard R. Esmond
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved: