FHIR (Fast Healthcare Interoperability Resources) diagnostics is part of an innovative open source standard used to support healthcare data exchange and foster interoperability. The use of well-documented online protocols is an important step towards the future of medical technology. FHIR can benefit not only the tech part of medicine but the human side of digital health. By implementing FHIR in practice, developers will succeed to synchronize web systems and health apps; healthcare providers will be able to explore better ways to track patients and deliver treatment solutions. In fact, all parties involved in healthcare will manage to collaborate and reduce costs (“Four basics to know about the role of FHIR in interoperability,” 2016).
Most of all, the implementation of FHIR can help experts resolve all challenges that digital healthcare transformation may face. Technology and medicine have merged in one, making paper reports an outdated form of documentation. Nevertheless, standard electronic forms can also become a ‘documentation’ challenge. Let’s say that in your role as a healthcare practitioner, you’ve received a computed tomography (CT) scan results via email. To use them as an official document, you’ll have to print them out, and this way – with only one click – electronic formats become paper documents. To resolve such paradoxes, FHIR provides easy access to healthcare data, which is communicated solely on the wire. As FHIR and HL7 (Health Level Seven International) process data online, web formats facilitate data exchange, storage, and visualization – making information available in real time, at all times, and no cost.
The world of medicine is a mixture of diagnostic tests and medical procedures. From observations to lab tests, medical processes are executed to detect and monitor health problems, injuries, and chronic diseases. Consequently, diagnostic tests are used to suggest treatment (“Diagnostic tests and medical procedures,” 2015). Note that as chemistry and technology play a crucial role in medical procedures, diagnostic tests are often performed in medical labs. After tests have been performed, findings should be interpreted by experts to facilitate treatment.
Lab tests are vital, so are results and interpretations. Therefore, it’s not surprising that FHIR DiagnosticReport is a crucial part of the FHIR Specification – Clinical Diagnostics module (“FHIR,” 2017). By having access to FHIR DiagnosticReport, experts will be able to access reports and data easily, collaborate with other institutions, recommend diagnostics, present findings, and suggest treatment.
To provide a clear and complete medical picture, FHIR diagnostic reports include atomic results, images, codes, comments, and even information about the context of research. On top of that, the FHIR DiagnosticReport may include various information – about patients, groups of patients, devices, locations, and specimen (“FHIR,” 2017).As mentioned above, FHIR DiagnosticReport is an important event resource in the FHIR Workflow perspective. Note that the entity called Resource is defined as any medical content that can be exchanged via FHIR. As such, FHIR DiagnosticReport presents a complete picture of all medical activities that have been performed or are in the process of execution.
Usually, diagnostic processes contain both observations and reports. With FHIR DiagnsoticReport, experts can request medical information obtained from diagnostic tests, and consequently, the FHIR diagnostic service will deliver a medical report. In particular, the DiagnosticReport resource contains data about the report itself, the subject, and all medical tests, including specimen. As stated earlier, FHIR DiagnosticReport includes images, text presentations, and codes, depending on the procedures and investigations required.
Perhaps the most valuable feature of FHIR DiagnosticReport is that medical reports contain both written text, which is called narrative, and data, which are the actual results (observations). Therefore, reports can be obtained as text windows, coded information or full reports in written (often as PDF). Narratives are designed mainly for human use, and detailed information can facilitate practice and treatment.
Note that as diagnostic resources contain sensitive data and personal information stored online, there’s always a risk that patients’ safety might be violated. FHIR, however, guarantees safety and confidentiality, which is a powerful feature implemented in the FHIR Security and Privacy module.FHIR DiagnosticReport is an important module, which as stated earlier, can help experts retrieve medical reports, access data online, plan testing and treatment, and facilitate interoperability.
Some of the popular tests represented in the FHIR DiagnosticReport are laboratory, pathology, and imaging procedures. Laboratory reports, for instance, include information collected from lab tests, such as clinical chemistry, microbiology, and hematology (Wians, 2015). To be more precise, clinical chemistry studies involve medical investigations, such as DNA and cells analyses; hematology studies focus on blood diseases in particular, and microbiology focuses on microorganisms, such as bacteria and fungi. On the other hand, pathology tests cover a vast range of diseases. From cholesterol samples to cancer diagnoses, pathology tests provide valuable information. Such tests also include liver function checks, iron studies, and urinalysis for metabolic disorders. Imaging tests are also widely used in practice. Examples are X-rays and other popular radiographic tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scan. Last but not the least, other medical tests may cover gastroenterology, cardiology, and much more.
Although FHIR is a standard designed mainly for programmers, medical experts can only benefit from its features communicated freely on the web. Therefore, to help experts understand how FHIR Specification works, here’s the right moment to differentiate observations from reports with their benefits in practice. In contrast to observations, diagnostic reports present a comprehensive medical picture. They include not only atomic data and codes but additional text, information about the context of research, interpretations, and representations. Note that on top of that, experts may request procedure queries, which links reports to the clinical workflow as a whole.To facilitate use and implementation, FHIR provides clear search options implemented in the system. There’s no need to search in piles of documents or perform tests repeatedly. Searching can be based on some of the following types: code for the whole report, category, context, date, diagnoses codes, etc. To give an example, the “based-on” search option is related to the procedure request, which can be, for instance, a referral request.
As reports can contain data, a mixture of narrative and data, or only narrative, FHIR DiagnosticReport provides three different presentations. Reports that contain data only present a hierarchic set of information and codes. Reports that contain narrative provide a convenient XHTML presentation. Reports that are defined as a “presented form” show a full-text representation of the report, often in PDF. In other words, conclusions can be shown as a text blob, a set of codes or an informative report (often in PDF).
Note that if the diagnostic report has been canceled, status codes should indicate changes and the system would provide some narrative to explain the reasons behind the cancelation. Usually, narratives are extremely helpful to experts and benefits practice.
To sum up, FHIR DiagnosticReport, in particular, can facilitate data exchange, cut costs, benefit practitioners, and most of all, improve patients’ well-being – which altogether are the main promises of today’s healthcare digital transformation.Atomic data: Atomic data can be defined as the most basic piece of information. Based on the scientific understanding of the atom, the smallest particle of matter – atomic data is the smallest set of information in research. Without atomic data, the complete picture in medicine and businesses would be unclear.
CT: CT or CAT scans are diagnostic imaging tests used to generate images of organs, blood vessels, and bones. By using combinations of X-ray measurements from various angels, CTs allow experts assess patients before planning a surgery or radiation treatment.
HL7: HL7 or Health Level Seven International is an international set of standards used to support data exchange and retrieval of electronic health information. HL7 provides a comprehensive picture on how medical information should be communicated, including codes, languages, and safety.
MRI: Magnetic resonance imaging (MRI) is a noninvasive test used to show a detailed picture of the body and all processes that are taking place inside. Note that MRIs use powerful magnetic fields and radio waves.
Referral: The term referral is used in medicine to describe the transfer of care for a patient, usually from one clinician to another. Often patients need to see a specialist other than their primary care practitioner, and if they want the service to be covered, they need a document/referral authorizing that.
Specimen: Specimen can be defined as a laboratory or biological sample used widely in medicine and research in general.
XHTML presentation: XHTML is a programming language. XHTML stands for Extensible Hypertext Markup Language. Note that this language is widely used in Web pages formulation.Diagnostic tests and medical procedures (November, 2015). Retrieved from https://www.health.harvard.edu/diagnostic-tests-and-medical-procedures
FHIR (April 19, 2017). Retrieved from https://www.hl7.org/fhir/diagnosticreport.html
Four basics to know about the role of FHIR in interoperability (March 22, 2016). Retrieved from https://healthitanalytics.com/news/4-basics-to-know-about-the-role-of-fhir-in-interoperability
Wians, F. (2015). Clinical Laboratory Tests: Which, Why, and What Do The Results Mean? Laboratory Medicine, 40 (2), p. 105-113.