Most of us will have an MRI at some point in our lives.
Have you ever stopped to consider what such a simple procedure might look like in FHIR? Each resource type tells a story.
Shawna Sachs, 28 years old, has been suffering from severe headaches for a number of weeks following a fall. She visits a neurologist who sends her for an MRI the following week.
Here’s what the sequence of events might look like in FHIR.
- Practitioner
The neurologist starts the process for the MRI. - ServiceRequest
He places an order for the scan and fills out various details that appear in subsequent resources. - Patient
Shawna’s personal details, along with her MRN are recorded. - Appointment
An appointment at the MRI clinic is booked for a specific time and date. - Organization & Location
The name and address of the MRI clinic are connected to the ServiceRequest.
On the assigned day Shawna arrives at the clinic for her MRI, checking in at reception.
- RelatedPerson
A contact person is recorded for Shawna as she may need to be collected after the scan. The last time she had an MRI she had to be lightly sedated due to claustrophobia. - Encounter
Now that she’s arrived and filled out the paperwork, the Encounter begins. It will span the length of her stay at the clinic and various FHIR resources will reference it.
Four Task resources are created automatically once the receptionist finishes checking her in. This kicks off a step by step process and ensures nothing is missed.
- Task [1]
Vital signs are to be taken and recorded in Observations. - Task [2]
Contrast dye is to be injected into Shawna to help deliver clearer results. - Task [3]
The MRI itself is to be carried out - Task [4]
The radiologist is to prepare the report to send back to the neurologist. - Consent
Three consent resources are created, each one capturing Shawna’s signature. One agrees to the contrast injection, another to the scan and another to allow the clinic to store her data. - Practitioner
A nurse helps Shawna get ready for the scan and takes some more details. - MedicationStatement
These details include a list of medications she’s taking to ensure there are no contra indications with the dye. - AllergyIntolerance
As well as checking to ensure she is not allergic to any of the agents in the dye. - Observation [n]
Finally, the nurse carries out Task 1, taking Shawna’s blood pressure, pulse and respiration rate. - Practitioner
A junior doctor arrives to inject the contrast dye, carrying out Task 2. - Medication & MedicationAdministration
The dye is administered. - Practitioner
A radiology technician carries out the scan from an adjacent room. - Procedure
The scan takes about half an hour. - ImagingStudy
As DICOM images are captured, instance references are stored in an ImagingStudy resource linked to the Procedure.
Shawna leaves the clinic a few minutes after the scan ends. The claustrophobia didn’t kick in this time around, so no sedation was required.
- Practitioner
Later in the day a radiologist examines the results and fails to see anything of significance. - DiagnosticReport
She prepares a report that triggers a HL7 ORU message back to the hospital. The message includes a PDF file with her findings. - AuditEvent
From the moment the neurologist placed the order until the final report ends up back in his inbox a week later a stream of AuditEvent resources are created capturing each interaction with the FHIR server. - Provenance
Every update to a FHIR resource included a Provenance resource identifying who was making the change. A full record of who did what, and when.
In total, 21 different FHIR resource types were used — many more than once. All for what was an everyday MRI scan.
I chose to leave out what would have been a large set of financial resources covering Shawna’s health insurance and payments. The insurance and payment side of FHIR is very country specific. What happens in an Irish clinic would bear little resemblance to what might happen for a similar procedure in a similar US clinic or hospital.
So, can you really map every healthcare event to a set of FHIR resources?
Pretty much, yes.
Most of the resource types used above require little explanation. Others such as Task, AuditEvent and Provenance are more complicated, but their use helps make FHIR a working standard capable of managing real world events such as an MRI scan.
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