Enterprise Imaging (Proof of Concept)
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Send Imaging Result [RAD-128]

Send Imaging Result [RAD-128] (IHE RAD Results Distribution) - the Report Creator or Report Manager (RIS reporting) sends the imaging result (the radiology report) to the Report Consumer (EPR and other recipients) as an HL7 v2.5.1 ORU^R01^ORU_R01. The result payload is an OBX of value type TX (text report), or ED (Base64 PDF - PDF Option; or a CDA document - CDA Option).

RAD-128 is not part of SWF.b. The older equivalent is Structured Report Export [RAD-28] (IHE RAD Simple Image and Numeric Report, SINR), which sends a DICOM SR from the Report Manager to the Enterprise Report Repository as an HL7 v2.3.1 ORU with plain ASCII text.

This guide follows the NW GMSA ORU_R01 conventions (HL7 v2.5.1).

References

Message

sequenceDiagram
    participant RM as Report Creator / Manager<br/>RIS reporting
    participant RC as Report Consumer<br/>EPR
    RM ->> RC: ORU^R01 / FHIR Message (R01) Send Imaging Result [RAD-128]
    RC -->> RM: ACK^R01 / FHIR response message

FHIR Message

The FHIR equivalent of ORU^R01 is the Imaging Result (R01) message: a Bundle Message whose MessageHeader has eventCoding v2-0003 R01 and whose focus is the Radiology Diagnostic Report, following the same pattern as Imaging Order (O19). The message also carries the report Composition and, for a PDF report, the DocumentReference and Binary (see below). ACK^R01 is a FHIR response message (MessageHeader.response).

Example: Bundle Message - Imaging Result (R01).

Segment FHIR
PID Patient
PV1 DiagnosticReport.encounter (PV1-19 visit number)
ORC / OBR Radiology Diagnostic Report - see the Radiology Report logical model (Mappings tab, Send Imaging Result [RAD-128] - HL7 v2.5.1 to FHIR) for field-level mappings. OBR-4 (NICIP) maps to DiagnosticReport.code
OBX (TX) DiagnosticReport.presentedForm or conclusion - text report
OBX (ED / RP) DocumentReference + Binary - see below

Embedded Documents (OBX Type ED, PDF Option)

Following the NW GMSA convention, a report PDF embedded in an OBX of type ED (or referenced by type RP) is not placed in Attachment.data:

  • OBX-5 (the document) becomes a Binary
  • the OBX becomes a DocumentReference whose content.attachment.url points to the Binary and whose context.related points to the DiagnosticReport
  • the DiagnosticReport points to the Binary through presentedForm.url
OBX field FHIR
OBX-2 ED / RP DocumentReference + Binary
OBX-3 DocumentReference.type (for example SNOMED CT 4201000179104 Imaging report)
OBX-5 ED-3 (data subtype, for example PDF) Binary.contentType, DocumentReference.content.attachment.contentType
OBX-5 ED-5 (data, Base64) Binary.data
OBX-5 RP DocumentReference.content.attachment.url, DiagnosticReport.presentedForm.url
OBX-11 DocumentReference.docStatus (F final)
OBX-14 DocumentReference.date, content.attachment.creation

Examples: DocumentReference, Binary and DiagnosticReport.

The NW GMSA IG also links the DiagnosticReport to the DocumentReference with the R5 DiagnosticReport.supportingInfo extension. That extension can only reference Procedure, Observation, DiagnosticReport or Citation, and the version NW GMSA pins (1.0.2) is retired, so this guide does not use it (Open - for both IGs).