Priority information

In telediagnostic services, is necesary asign a priority to a patient workflow when study analisis was made, which of fhir resources you think is correct for this notification?

Can you expand on your use-case a bit? Are you looking for the priority of the analysis that was done or the priority of the next steps coming afterward?

Sure, have this case:
1 Healthcare service make a imaging exam and sends a fhir imaginstudies message to teleradiology area
2 This area get study from central pacs server
3 Teleradiology area make a report that is loaded to pacs, for notification a imagingstudies message is sent to heathcare service
4 This is the issue, if i need to send a priority for worklist reorganzation in Healthcare service when images was reported from teleradiology area, which resource should be used?

Thank you very much

Interesting problem.

Let me expand on the description a bit, if I understand it correctly.

There are two phases to a Radiology exam: the technologist performs the imaging, then a radiologist reads the images and dictates a report. The radiologist typically does not work entirely in a first in-first out fashion: it is more urgent to read some studies than others, for a number of reasons. For example, suspected stroke should be read immediately; for teleradiology, where a radiologist reads remotely for a number of sites, one site may have a higher SLA than another; or an AI may have been run on the imaging and scored it as more or less urgent. The studies for the radiologist to read are typically presented to them in a (usually) prioritized worklist.

Options for indicating urgency are:

  • Each read request could be represented as a Task, with the appropriate priority code.
  • A Flag could be created with the procedure as the subject, coded to indicate priority.
  • An extension on Procedure, ImagingStudy, or DiagnosticReport to indicate the priority.
  • An Observation that the AI has found something about the study that Indicates it should be read soon.

I think either the Observation route or the Task route seem most appropriate (or both). In part, I’d question whether we want the ”server” or “client” making the decision. If I hook up my reading work list client to the institutional FHIR server, do I just display the list in the order of priority another system has determined, or do I use my own internal algorithms and information I gather from various sources (like Observations) to order the studies in my preferred way.

I don’t think this has been discussed in the Imaging WG, but I’m sure the general issue has been discussed elsewhere. I’d love to hear other’s thoughts.

Yes that is the situation: AI scored images as more or less urgent before been readed by radiologist, but worklist system is external, for that reason i can not do a direct procedure, only a notification. I like option o using Observation resource becouse i wont need create a extension, thank you