---
title: Obgyn FHIR SR
tags: fhir-project
---

[DRAFT] <font color="red">FHIR</font> SR - Obstetric Report System
===

## Table of Contents
[TOC]

## 1. Background

Prenatal Down syndrome screening is an important aspect of prenatal care for pregnant individuals. Down syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of an extra copy of chromosome 21. It is one of the most common genetic disorders, occurring in about 1 in 700 live births worldwide. The prenatal down syndrome screening aims to identify pregnancies that are at an increased risk of having a baby with Down syndrome. Screening tests do not provide a definitive diagnosis of Down syndrome but rather assess the likelihood of the condition. If the screening indicates an increased risk, further diagnostic tests may be recommended for confirmation.

The First-Trimester Combined Screening is one of the prenatal screening methods that can provide a high Down syndrome detection rate (85%~91%) along with a relatively high specificity (95%). This screening method includes:
**1. Blood test**
- Serum PAPP-A (Pregnancy associated plasma protein A)
- Serum free β-hCG (free beta-human chorionic gonadotrophin)

**2. Ultrasonography (USG)**
- Nuchal Translucency (NT): Measurement of fluid-filled space at the back of the baby's neck
- Nasal Bone (NB): Check the presence of fetal nasal bone
- Annotation may be marked on the USG image

**3. Risk assessment**
Blood test and USG result will be used as parameter in AI machine learning which results in risk assessment value in the screening report. Next the overall report will be reviewed by the obstetrician.

In a large scale of maternal and child hospital, this screening involves 3 departments to generate the Trisomy screening risk evaluation report:
1. Laboratory department (internal or external): Blood test
2. Radiology department: Ultrasonography (USG)
3. Obstetrician: Review the risk assessment generated by AI, blood test, and USG image exam data

Currently, these data will be input manually into this report creator system:

In practice, in Taiwan, most of the healthcare institutions that provide screening reports are clinics. Consultations and USG exam are conducted by doctors, while blood serum tests are outsourced to external lab centers. Consequently, once the blood serum results are received from the lab center, the lab result data will be manually input by a nurse together with other related data in the report creator system.
Manual data entry can indeed be cumbersome, prone to human errors, and time-consuming. Leveraging FHIR (Fast Healthcare Interoperability Resources) as a standard format for data exchange offers a powerful solution to integrate medical records, radiology, and lab exam data from different departments into a comprehensive screening report, aiming for automatic data input.

In addition, another challenge to be addressed is the FHIR standard specification of trisomy screening risk evaluation report is not developed yet. Through this article, we will provide a standardized FHIR Structured Report (SR) specification for trisomy screening risk evaluation report.

## 2. Goals
- Develop a standardized FHIR Structured Report specification for Obstetric Report

## 3. Method
### Step 1. Define variable used in the report
We will reference to fetal chromosomal abnormality screening report provided by WeMED Bio Tech Inc.

### Step 2. Mapping variable into FHIR Path
Begin by mapping the data fields from lab, radiology, and obstetrician systems to FHIR resources.
Variable mapping spreadsheet can be accessed [ here](https://docs.google.com/spreadsheets/d/18z3qWqjQzV-SfWn1p9Aki-RlSYtEi7ji5mWOCflekEA/edit?usp=sharing)

### [CURRENT] Step 3. Discuss and review with expert
### Step 4. Finalize implementation guide documentation
### Step 5. Promote the specification
- Webinar
- MISAT connectathon
- Paper publication

## References
- [Shared Google Drive](https://drive.google.com/drive/folders/1R_i-JG9xUqUi_x2dxV9scRNnTaTWk113?usp=sharing)

## Minutes Of Meeting (MoM) Record
### 20230813
:::info
- **Date:** Aug 13, 2023 20:00 - 22:00 (Taiwan TIme)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. FHIR Specification of USG exam in Indonesia SATUSEHAT Maternal and Perinatal Care use-case
> [name=Victoria]
2. iScreen, a cloud-based machine-learning risk assessment for Down Syndrome Screening
> [name=Courant Tseng (WeMED Bio-Tech Inc.)]
3. [additional discussion topic] Patient portal for long term health care and EHR integration
> [name=Jack Hsiao]
- **Participants:**
- Courant Tseng ([e-mail])
- Jack Hsiao
- Jeshika
- Richard Holman Matanta
- Thalia
- Victoria
- Yu Ting (黃宇婷)
:::

:pushpin: **Points of Discussion**

- Develop FHIR SR (Structured Report) for Obgyn Down Syndrome Screening Report
- Prenatal Down Syndrome Screening can be implemented by performing 1st Trimester Combined Test, which include:
- Blood test from internal or external Laboratory deparment:
- Serum pregnancy associated plasma protein A (PAPP-A)
- Serum free β-human chorionic gonadotrophin (free β-hCG)
- Ultrasonography (USG) from Radiology department to check:
- Nuchal Translucency (NT)
- Nasal Bone (NB)
- Some annotation will be marked on the USG image
- Blood test and USG result will be used as parameter in AI machine learning which results in risk assessment value in the screening report
- AI machine learning data in WeMed mainly focus on Taiwan people data prevalence
- Document sharing in down-syndrome report using FHIR DocumentReference and XDS concept
- Abortion is illegal in Indonesia even when fetus diagnosed with down syndrome
- [FHIR USG exam in SATUSEHAT Antenatal Use-Case](https://www.postman.com/satusehat/workspace/satusehat-public/collection/27201552-bcb83802-dde7-4bb6-82bf-5d504a38f466?action=share&creator=19625975)
- Shared Google Drive -> [click here](https://drive.google.com/drive/folders/1R_i-JG9xUqUi_x2dxV9scRNnTaTWk113?usp=sharing)

- Elderly Long-Term Healthcare Support Program
- Description: Comprehensive long-term healthcare system for elderly individuals within a social or tribal community involves various services and coordination. ([chatgpt description](https://chat.openai.com/share/df4d830f-1c07-4b3e-a320-0e6b9f4ba2e0))
- Goals: Aims to provide elderly individuals within a social or tribal community with healthcare monitoring and support, addressing their medical, nutritional, and daily needs through a coordination with healthcare professionals, such as case manager and doctors.
- Background:
- Currently, social community system is not integrated with healthcare EMR system
- Taiwan's government targeting Elderly Long-Term Healthcare Support Program program in 2025，but currently not really familiar with the system architecture and healthcare standard
- Method
- Using standardized FHIR for data exchange
- Data source:
- Healthcare facility EMR system (Precision medicine dan healthcare)
- Integrated Services System for Social Community (for long term healthcare)
- [System Architecture](https://docs.google.com/presentation/d/1PhWZ0wsIfsCbndCnimDdmYsQIa2Xecit/edit?usp=drive_link&ouid=110312090265634540872&rtpof=true&sd=true)
- Shared Google Drive -> [click here](https://drive.google.com/drive/folders/1R_i-JG9xUqUi_x2dxV9scRNnTaTWk113?usp=sharing)

:pushpin: **Action Item**

**FHIR SR Obstetric Project**
<i> <font color="red">* </font>Notes: please update task status in -> [follow up record](https://docs.google.com/spreadsheets/d/1JfQh64zjnXOIUVLk4JByofohEUjb3xgs/edit?usp=sharing&ouid=102706494438870645457&rtpof=true&sd=true)</i>

| No. | Task | PIC | Deadline |
| -------- | -------- | -------- | ------- |
|1| Sharing session about document sharing using FHIR DocumentReference and XDS concept. | Jeshika|2023-08-20|
|2|Get DICOM file for USG down syndrome fetus from Obstetrician | Jack Hsiao |2023-08-19|
|3|Create draft document specification for FHIR SR-Down Syndrome Screening| Victoria |2023-08-19|
|4|Define variable mapping for Down Syndrome Screening Report| Victoria |2023-08-19|
|5|Check definition of Z-Score in perinatal growth & development (tumbung kembang) use-case in SATUSEHAT. What's the difference compare to the z-score calculation in BMD?| Richard |2023-08-17|
|6|Share Maternal & Perinatal Care related use-case in SATUSEHAT| Saldi |2023-08-19|

**Patient Portal Project** -> [click here](https://hackmd.io/@misac/patient-portal)

---

### 20230819
:::info
- **Date:** Aug 19, 2023 12:30 - 14:30 (Taiwan TIme)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. Previous action items follow-up and task updates `10min`
> [name=Victoria]
2. FHIR SR for Down Syndrome Screening Report draft documentation `10min`
> [name=Victoria]
3. Maternal & Perinatal Care SATUSEHAT use-case `20min`
> [name=Mr. Saldi]
4. DocumentReference for document sharing `20min`
> [name=Jeshika]
5. Discussion `30min`
> [name=Jack Hsiao]
- **Participants:**
- Brain
- Courant Tseng
- Jack Hsiao
- Jeshika
- Richard Holman Matanta
- Saldi
- Thalia
- Victoria
- Yu Ting (黃宇婷)
:::

:pushpin: **Points of Discussion**
1. [Question from Mr. Saldi] Does the FHIR SR specification developed in this project focus specific on Down-Syndrome or can be used for general abnormality report for prenatal screening? We will start focus on FHIR SR for down-syndrome first. After published the specification for FHIR SR Down-Syndrome, next we can collaborate with other experts to discuss the next specific report type.

2. [Question from Mr. Saldi] Does the screening result entered manually by physician? Currently, it's manually input by physician.

4. There is a need to ensure proper prenatal care and support, especially in remote areas, Some challenges, such as young pregnancies, lack of access to healthcare providers and running out of medical doctors and nurses, are unfortunately not unique to Indonesia or Taiwan and can be found in various parts of the world. Implementing a system involving certified or qualified case managers for pregnant care can potentially address some of these challenges.
- Case managers can play a crucial role in providing holistic care for pregnant individuals, including coordinate appointments, ensure necessary tests and screenings are conducted, provide education on prenatal care, and offer emotional support throughout the pregnancy journey.
- Case managers can work closely with healthcare providers to develop individualized care plans based on the specific needs and circumstances of each pregnant woman.
- Case managers can help ensure continuity of care by being a consistent point of contact throughout the pregnancy.

5. For now, the role of case manager does exist in Taiwan for chronic disease management. In Indonesia, most of the time, the case manager role is represented by community health worker.

5. While USG modality is kind of limited in remote area, the other challenge which is important to be addressed is the limitation of radiologist who can read the USG result. Tleradiology can be a valuable solution to help bridge these gaps and ensure that individuals in remote areas receive timely and accurate medical imaging interpretations. Hence, teleradiology use-case will be added to this project scope.

6. In Indonesia, there are 6 systems which related to maternal and perinatal care. The approach to integrate these systems using SATUSEHAT platform and the implementation of the WHO Smart ANC Code system show a commitment to enhancing healthcare services for pregnant individuals and improving overall maternal and perinatal outcomes.

7. [Question from Dr. Richard] For this project, does the specification developed will considered the general workflow or scneario in all country? For this phase, focus on scenario in East Asia and Southeast Asia.

8. Compared to Europe, in Asia, currently there are no NGO focused on health data standardization, some factor may due to politic or language aspect. Using Medical Informatics Standard Application Consortium (MISAC) community to initiate discussions on health data standardization is a commendable approach

9. Jeshika shared PPT related to DocumentReference can be accessed [here](https://docs.google.com/presentation/d/1CwqyXXI3LR1D8tiaEoO4_yVijApbkFPM/edit?usp=sharing&ouid=107442712582267456958&rtpof=true&sd=true)

11. Review and evaluate manual for Testing Indexing Documents using FHIR DocumentReference in Repository/Registry provided by Jeshika. ([Manual in chinese version](https://docs.google.com/document/d/1e7UEdA-x214dxVW5Vh5aH4bWP_e3fHPDvyiCyHUclNQ/edit?usp=sharing), [manual in english version](https://docs.google.com/document/d/1De_sgd1dWjpMNx_FKpXTn7tByquTQqPEzEFsgBMvaKw/edit?usp=sharing))

:pushpin: **Action Item**
Follow up record can be accessed [here](https://docs.google.com/spreadsheets/d/1JfQh64zjnXOIUVLk4JByofohEUjb3xgs/edit?usp=sharing&ouid=102706494438870645457&rtpof=true&sd=true)

---
### 20230826
:::info
- **Date:** Aug 26, 2023 10:00 - 11:00 (Taiwan TIme)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. Previous action items follow-up and task updates `5min`
> [name=Victoria]
2. Brief introduction to FHIR SR Obgyn Specifications `10min`
> [name=Victoria]
3. DICOMweb + FHIR tel-radiology standardization and internationalized integration framework requirement `15min`
> [name=Jack Hsiao]
5. Discussion `30min`
> [name=Jack Hsiao]
- **Participants:**
- Brain
- Chung-Yu Lai
- 黃小雅
- 黃威達
- Jack Hsiao
- Victoria
- Viking Tang
:::

:pushpin: **Points of Discussion**
- In a scenario where the EMR data in a country is not stored into a national EMR platform, for some specific use-cases like lab or radiology outsourcing, the patient demography for information exchange doesn't really need to store all of the existing fields in FHIR Patient. For example we can exclude the address, contact person, etc -> Define FHIR resource Patient specification per use-case

:pushpin: **Action Item**
Follow up record can be accessed [here](https://docs.google.com/spreadsheets/d/1JfQh64zjnXOIUVLk4JByofohEUjb3xgs/edit?usp=sharing&ouid=102706494438870645457&rtpof=true&sd=true)

---
### 20230902
:::info
- **Date:** Sep 2, 2023 10:00 - 11:00 (Taiwan TIme)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. Previous action items follow-up and task updates `5min`
> [name=Victoria]
- **Participants:**
- Brain
- Jack Hsiao
- Jeshika
- Richard Holman Matanta
- Saldi
- Victoria
- Yu Ting (黃宇婷)
:::

:pushpin: **Points of Discussion**
- Healthcare terminology condition in Taiwan, China, and Indonesia
- In Taiwan
- Doctor type report in english and traditional mandarin.
- Taiwan doesn't have a single centralized terminology standardization organization
- In Indonesia, medical term (e.g. body site) use Latin, the rest of them use Indonesia language. Current condition, terminology between different province in Indonesia use different code. Therefore standardize terminology need to implemented using loinc, snomed, etc.
- In China, most of the medical record use chinese language. But the chinese terminology use is also different. DICOM China try to standardize the radiology finding code in https://chinadicom.org.cn/0701.html

Challenge in adoption and implementation of SNOMED CT
1. State government agencies may have legitimate concerns and constraints when considering its use in real-world healthcare settings
3. Dari sisi expertise professional, apakah di realword beneran bisa pake? di fhir SR, ying xiang fa xian pake Internasional dicom pake RSNA? measurement dan finding obgyn bisa dipake?
- anatomy:
- Data exchange btween cina n taiwan: telehealthcare scenario, shang ren taishang (2, 3 taon yg lalu), businessman dari taiwan ke cina. byk org cina ke taiwan MCU, operasi,
- hampir smua negara beli snomed mahal2, tp akhirny gbsa implementasi krn tidak sefleksible itu menjawab permslhan klinik yg ada. Diusecase kecil kyk trisomy 21 ini ada. snomed loinc masi kurang, who adaption kit smart ANC, tb. (url: https://pubmed.ncbi.nlm.nih.gov/25160179/)
- chaoyinbo -> loinc, snomed, radlex, anc. Last option: custom
- di indo jg lagi progress bsa ga diconvert ke bahasa2 lokal? siapa yg mantain, hrs lembaga kenegaraan institutional? setara BUMN, KPK (independent) pny wewenang
- maintain n sustainable: bkn lembaga kenegaraan yg maintain. Kbykn pasti lembaga kyk DICOM, HL7, IHE.
- Cina: weisheng zixun zuigao de zhangguan (kemenkes dept IT pusdatin 兼任) jadi kepala community DICOM ini. Kalo di taiwan, kemnenkesny gmau peduli krn terlalu expertise hrs ngerti DICOM, jd yg initiate NGO. ganti kemenkes kepala pusdatin, ganti kepala DICOM. Cmn kendala mrk krg ngerti DICOM. Solution: ada chair of the secretary (kita MISAC akan masuk lwt org ini), lokasi di SeChuan, mrk default lama posisinya, ada posisi GDPACS yg terus bantuu. DICOM ini di Beijing, tp yg benran ngerjain itu yg di SeChuan.
- Misalny secretary di sechuan ini ud ada define specification, mrk wajib direview di beijing dulu agk repot, dikasi dana. Taiwan jg kondisiny sama, bu wen krn thn ini oleh TCU yg define, next year univ lain. Kalo di cina selalu yg ngurus pasti CIMICS melalui 1 wadah. Kalo kita collabs sama secretary (prusahaan Jin Pan), gaperlu melalui verifikasi dan review dari pusat, jd kita kek buat working group sndri yg diluar control DICOM CINA
- Beijing support GD PACS bbrp tahun, ada tim isinya < 10 org kerja full timer. Kita melalui MISAT initiate, smua org yg kerja part time. Org jin pan liat ini g. Pertanyaan2 yg krg jelas di list di hackmd, snin dpn tgl 4 diskusi sm org se chuan itu.
- Yg agk aneh di asia kyk gni, klo di meiguo , ouzhou, riben: lewat NGO
- In Indonesia, Pusdatin - pusat data dan teknklogi informati - centre of data and information technology. But budget is limited to support this job task,
- DICOM CHINA sbnrnya fokus ke DICOM SR instead of FHIR SR. Mrk adany HL7 China, tp blm ada komunitas yg kerjain FHIR (ad chairman li pao luo, 3-4 tahun yg lalu meninggal trus gatau siapa yg akn lanjut. Lasoe jd mikir hidup lebih lama jg ada gunanya), klo kita collabs GD pacs. jd kita bahasny mapping
- Change cari lebi byk org untuk bantu spesifikasi FHIR ini, ada materi2 yg brsangkutan, tp bhs mndrin (4 bab FHIR, 4 bab HTML), butuh org bntu translate ini ke inggris. Ad pay
- FHIR course: https://hackmd.io/dMUkWuKyQDWxkr3IMe-yWQ
- CIMICS (chinadicom.org.cn)
- Will discuss variation of topic
- FHIR SR Obgyn will try to raise this topic with them
- Next 9/4 meeting dengan slh satu expert

:pushpin: **Action Item**
Follow up record can be accessed [here](https://docs.google.com/spreadsheets/d/1JfQh64zjnXOIUVLk4JByofohEUjb3xgs/edit?usp=sharing&ouid=102706494438870645457&rtpof=true&sd=true)
* Victoria : provide kendala or issue2 yg kita ktemu saat ini
---
### 20230904
:::info
- **Date:** Sep 4, 2023 13:00 - 14:00 (Taiwan Time)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. Presentation of FHIR implementation in Indonesia and FHIR SR Obgyn `5min`
> [name=Victoria]
- **Participants:**
- Brain
- CMC-Li Wei
- Jack Hsiao
- 国际 DICOM 标准
- Victoria
- Yu Ting (黃宇婷)
:::

:pushpin: **Points of Discussion**
* CDA (Clinical Document Architecture) for Reporting format
* Current collaboration topic: code terminology used in Radiology
* Next collaboration topic: Teleradiology with GDPACS (Goldisc Healthcare)
* Does Indonesia member of International LOINC? No, LOINC is freely to use

---
### 20230910
Action Item
* Join [World Congress on Pediatric and Neonatology (WCPN-2023)](https://pediatrics-neonatology.com/agenda) as a speaker presenting “Creating a Medical Imaging Workflow Based on FHIR, DICOMweb, and SVG” publication on Nov 6-7, 2023 ==[Victoria will present via online, upload abstract to https://pediatrics-neonatology.com/abstractsubmission]==
* MITW Presentation on Oct 6 (friday) 10:00-14:00 (Taiwan Time)
* 20 mins presentation (in English) + 5 mins QnA
* Topic:
* FHIR SR
* Implementation of FHIR in Indonesia
* Teleradiology requirement for Indonesia (Radiology USG background in indo)
* FHIR SR Obgyn: Victoria rapiin final specs hackmd, masing2 expert obgyn bntu kasi review
* Translate document [Radiology workflow](https://hackmd.io/RrrVG92wTUaRI1BSwUqTfw) into english
* Scenario for using only 1 encounter: in ophthalmology, which require below step:
* Patient arrival in admission
* Eye related imaging exam
* Generated image in DICOM (store in PACS) or JPG (store in media server) format

---
### 20230920
:::info
- **Date:** Sep 20, 2023 20:00 - 21:00 (Taiwan Time)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. Previous action items follow-up and task updates `10min`
> [name=Victoria]
- **Participants:**
- Brain
- Jack Hsiao
- Jeshika
- Richard [absence]
- Thalia [absence]
- Victoria
- Yu Ting (黃宇婷)
:::

:pushpin: **Points of Discussion**
* MITW: Medical informatics dancing with ChatGPT
* fhir physical activity

:pushpin: **Action Item**
Follow up record can be accessed [here](https://docs.google.com/spreadsheets/d/1JfQh64zjnXOIUVLk4JByofohEUjb3xgs/edit?usp=sharing&ouid=102706494438870645457&rtpof=true&sd=true)
*

---
### Next Meeting? 202309
:::info
- **Date:** Sep 16, 2023 10:00 - 11:00 (Taiwan Time)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. Presentation of FHIR implementation in Indonesia and FHIR SR Obgyn `5min`
> [name=Victoria]
- **Participants:**
- Brain
- Jack Hsiao
- Jeshika
- Victoria
- Yu Ting (黃宇婷)
:::

:pushpin: **Points of Discussion**
* Based on limited time and sdm, instead of using snomed or loinc with , we can create custom (mapping in future)
* Plan for MISAC Connectathon in 2023 or 2024
* melibatkan Multiple country
* Doesn't need to define a lot of tracks, but have a meaningful impact.
* Can start from FHIR Patient (because even this base resource within country will have different specification. E.g. marital status extension, identity card system terminology). Another resource to be consider FHIR Document
* 戶籍地址 vs 通訊地址
* Teleradiology Workflow (build a gateway)
* Ada modality, 1 PC (connect internal network). PC not available for 24 hours, RAM not too large
* Image will be upload to cloud with secure access control (use FTP or google cloud protocol for the transfer protocol, instead of DICOM protocol xu chuan de gong neng)
* gambar dari modality disimpan di 1 PC.
* can use freeware: orthanc
* develop system: how to store HIS data into teleradiology,

:pushpin: **Action Item**
Follow up record can be accessed [here](https://docs.google.com/spreadsheets/d/1JfQh64zjnXOIUVLk4JByofohEUjb3xgs/edit?usp=sharing&ouid=102706494438870645457&rtpof=true&sd=true)
* Sharing session about snomed implementation in HIS . Targe: lin chuang zi xun ke Mr. Pan Qi Guang 主任 台中榮中 做臨床研究分析的需求 ngumpulin dokumen medical record pasien trus diolah jd bahan analisis (Secondary use) include using AI or publication. kerja sama dengan dokter2 dari berbagai spesialis. beliau ckp familiar dengan terminology. Department establish since 2011 (PIC: Victoria)
* Thalia translate document Image from chinese to english

---
### 20231001
:::info
- **Date:** Oct 1, 2023 14:00 - 15:15 (Taiwan Time)
- **Location:** [Google Meet](https://meet.google.com/gie-hphd-zxd)
- **Agenda**
1. Presentation of FHIR implementation in Indonesia and FHIR SR Obgyn `5min`
> [name=Victoria]
2. Description of key points to be present by Richard as speaker for MI-TW 2023 Connectathon
> [name=Jack Hsiao] `15min`
4. Small Clinic Challenge and Solution for Storing Medical Image
> [Thalia and Meriske ] `15min`
5. Teleradiology Reads and Reporting Workflow using FHIR Standard
> [Victoria] `10min`
6. Discussion
> [Jack Hsiao ] `30min`
- **Participants:**
- Brain
- Jack Hsiao
- Jeshika
- Victoria
- Yu Ting (黃宇婷)
:::

:pushpin: **Points of Discussion**
* MI-TW wil be held in 1 week, some speaker including ad dari pihak kemenkes taiwan, Fintech,
* main goals: if using FHIR specification, banyak dokumen yg perlu di provide, ada yg perlu di provide ke dokter2 tuk bantu dari sisi medis nya, atau ke tim IT tuk bantu dari sisi teknis. Dgn adanya CHAT GPT cukup membantu dalam provide dokumen draft spesifikasi, bantu mempercepat promote FHIR.
* ini speakerny ad topik PHR, kbtulan organisasi utama yg hold kegiatan ini
* Content yg dipresentasi di kegiatan MITW:
* Kondisi implementasi FHIR di Indonesia
* Teleradiology specification using FHIR standard
* Gaperlu terlalu detail, e.g. contoh workflow radiology gaperlu
* Waktu: 12:10-12:40
* Target attendance: org IT, klo ad requirement/ topik2 lain yg pengen dibahas lebi lanjut
* Simulate SATUSEHAT DICOM Router to send image
* DICOM file kalau mau dikirim ke Cloud/ DICOM Web server gabisa pakai protokol DICOM, krn size gambar terlalu besar. Saran bisa pakai protokol FTP atau Google cloud solution
* Mekanisme akses control tidak include di dalam protokol DICOM (hanya based on IP address)
* DICOM association apakah bisa restrict client server hanya bisa upload gambar mana aja? (role-based control? access control?)
* DICOM can be restricted by **modality code**, e.g. hanya untuk gambar dari USG, bisa set kode "US". Depends on the modality setting itself. #challenge Tp restriction ini keliatannya belom ada di SATUSEHAT DICOM Store.
* Hualian dinkes build 1 DICOM PACS Server untuk warga hualien yg total orgnya mgkn 300,000 & 400,000
* IHE Scheduled Workflow
* Semua vendor alat radiology pake architecture yg ini, tp ini workflow khusus workflow pemeriksaan radiology di dalam faskes.
* Alat medis di TCH n Taiwan gaada setting performed procedure step manager (FHIR Procedure)

:pushpin: **Action Item**
Follow up record can be accessed [here](https://docs.google.com/spreadsheets/d/1JfQh64zjnXOIUVLk4JByofohEUjb3xgs/edit?usp=sharing&ouid=102706494438870645457&rtpof=true&sd=true)
* dokumentasi teleradiology share ke DICOM China -> yue jiao liu
* Create TOR (Term of Reference) for project "SATUSEHAT DICOM Router Simulation" referensi ke workflow SATUSEHAT Radiology image exam untuk coba kirim dicom ke SATUSEHAT (DICOM router akan otomatis create ImagingStudy ke SATUSEHAT FHIR Server)
* Project 2. HL7 mapping to DICOM MWL or DICOMWeb UPS: Build standard building block (Previously only mapping Patient resource) [Thalia (PIC), Meriske]