Xt-EHR T7.2 Sub-team for Imaging Reports Model Xt-EHR T7.2

Beyond Basic Classification

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Beyond Basic Elements Analysis

Xt-EHR Imaging Report Elements Classification

Analysis Framework: Real-world usage patterns vs. Xt-EHR model specification
Data Sources: - Xt-EHR FHIR IG v0.2.1: EHDS Logical Information Models - PARROT v1.0 Dataset: 2,738 Multi-language Reports

Based on comprehensive analysis of real-world usage patterns, this document identifies specific Xt-EHR elements that are candidates for "beyond basic" classification.

🤖 AI Analysis Attribution

EU AI Act Compliance: This classification analysis was compiled with the assistance of Claude Sonnet 4.5 (Anthropic), a General-Purpose AI model, in accordance with Article 52 transparency requirements. All element classifications are validated against source data and subject to expert review. See EU-AI-ACT-COMPLIANCE.md for details.

Model References

Methodology

Elements were classified based on: 1. Presence in real-world reports (PARROT dataset analysis) 2. Clinical necessity for core imaging report functions 3. Implementation complexity and administrative overhead 4. Use case frequency in typical clinical workflows

Classification Framework

✅ BASIC ELEMENTS

Required for core imaging report functionality

⚠️ INTERMEDIATE ELEMENTS

Valuable for enhanced clinical workflows

🔴 BEYOND BASIC ELEMENTS

Administrative, technical, or specialized use cases

Detailed Element Analysis

Header Section

Document Identity & Core Metadata

Element Classification Rationale Real-World Usage
header.subject ✅ BASIC Essential patient reference Implied in all reports
header.documentType ✅ BASIC Core document classification Implied (imaging report)
header.documentTitle ✅ BASIC Human readability Derivable from modality+area
header.language ✅ BASIC International interoperability Present in 100% (14 languages)

Authorship & Timestamps

Element Classification Rationale Real-World Usage
header.authorship.author[x] 🔴 BEYOND BASIC Administrative overhead Limited contributor codes only
header.authorship.datetime 🔴 BEYOND BASIC Workflow complexity Not present in real reports
header.lastUpdate 🔴 BEYOND BASIC Version control complexity Not present in real reports

Document Status & Workflow

Element Classification Rationale Real-World Usage
header.status 🔴 BEYOND BASIC Workflow management overhead Not present in real reports
header.statusReason[x] 🔴 BEYOND BASIC Complex workflow states Not present in real reports
header.version 🔴 BEYOND BASIC Document versioning complexity Not present in real reports
header.period 🔴 BEYOND BASIC Administrative complexity Not present in real reports
Element Classification Rationale Real-World Usage
header.attestation 🔴 BEYOND BASIC Legal process overhead Not present in real reports
header.legalAuthentication 🔴 BEYOND BASIC Legal complexity Not present in real reports
header.confidentiality 🔴 BEYOND BASIC Security policy complexity Not present in real reports

Administrative Context

Element Classification Rationale Real-World Usage
header.serviceSpecialty ✅ BASIC Clinical context essential Present in 100% (subspecialty)
header.custodian 🔴 BEYOND BASIC Administrative overhead Not present in real reports
header.accessionNumber 🔴 BEYOND BASIC RIS-specific workflow Not present in real reports
header.healthInsuranceAndPaymentInformation 🔴 BEYOND BASIC Billing complexity Not present in real reports
header.intendedRecipient[x] 🔴 BEYOND BASIC Workflow complexity Not present in real reports

Body Section - Order Information

Element Classification Rationale Real-World Usage
body.orderInformation.orderId 🔴 BEYOND BASIC RIS/HIS integration complexity Not present in real reports
body.orderInformation.orderDateAndTime 🔴 BEYOND BASIC Workflow tracking overhead Not present in real reports
body.orderInformation.orderPlacer[x] 🔴 BEYOND BASIC Provider workflow complexity Not present in real reports
body.orderInformation.orderReasonText 🔴 BEYOND BASIC Clinical workflow detail Not present in real reports
body.orderInformation.orderReason[x] 🔴 BEYOND BASIC Structured ordering complexity Not present in real reports
body.orderInformation.clinicalQuestion 🔴 BEYOND BASIC Clinical workflow detail Not present in real reports

Body Section - Supporting Information

Element Classification Rationale Real-World Usage
body.supportingInformation.observation ⚠️ INTERMEDIATE Valuable clinical context Derivable from measurements (74.3%)
body.supportingInformation.condition ⚠️ INTERMEDIATE Clinical context enhancement Derivable from content
body.supportingInformation.medicationAdministration 🔴 BEYOND BASIC Complex medication tracking Limited use case
body.supportingInformation.devices 🔴 BEYOND BASIC Specialized clinical context Limited use case
body.supportingInformation.pregnancyStatus 🔴 BEYOND BASIC Specialized clinical context Limited use case
body.supportingInformation.sexForClinicalUse 🔴 BEYOND BASIC Complex clinical parameter Limited use case
body.supportingInformation.otherSupportingInformation 🔴 BEYOND BASIC Catch-all complexity Not present in real reports

Body Section - Technical Elements

Element Classification Rationale Real-World Usage
body.specimen 🔴 BEYOND BASIC Specialized workflow Limited specimen imaging
body.serviceRequest 🔴 BEYOND BASIC Complex service specification Not present in real reports
body.exposureInformation.effectiveDose 🔴 BEYOND BASIC Regulatory/technical complexity Not present in real reports
body.exposureInformation.equivalentDoseInformation 🔴 BEYOND BASIC Technical radiation tracking Not present in real reports

Body Section - Examination Report (Core Clinical)

Element Classification Rationale Real-World Usage
body.examinationReport.modality ✅ BASIC Essential clinical information Present in 100% (10 modalities)
body.examinationReport.bodyPart ✅ BASIC Essential clinical information Present in 100% (126 areas)
body.examinationReport.imagingProcedures ⚠️ INTERMEDIATE Clinical detail enhancement Variable complexity
body.examinationReport.medication ⚠️ INTERMEDIATE Contrast/sedation context Present in 37.4% (contrast)
body.examinationReport.adverseReaction 🔴 BEYOND BASIC Specialized safety tracking Limited use case

Body Section - Results & Conclusion

Element Classification Rationale Real-World Usage
body.examinationReport.resultData.resultText ✅ BASIC Core clinical content Present in 100%
body.examinationReport.resultData.observationResults ✅ BASIC Quantitative findings Present in 74.3% (measurements)
body.examinationReport.conclusion.impression ✅ BASIC Core clinical interpretation Present in 100%
body.examinationReport.conclusion.conditionOrFinding[x] ✅ BASIC Structured clinical findings Present in 100% (ICD codes)

Body Section - Clinical Actions

Element Classification Rationale Real-World Usage
body.recommendation.description ⚠️ INTERMEDIATE Valuable clinical guidance Present in 36.4%
body.recommendation.carePlan 🔴 BEYOND BASIC Complex care coordination Limited structured use
body.comparisonStudy ⚠️ INTERMEDIATE Valuable clinical context Present in 23.7%

Technical Metadata

Element Classification Rationale Real-World Usage
dicomStudyMetadata 🔴 BEYOND BASIC Technical DICOM complexity Not present in clinical reports
attachments[x] 🔴 BEYOND BASIC File management complexity Not present in real reports
presentedForm 🔴 BEYOND BASIC Document format complexity Not present in real reports

Summary Statistics

✅ BASIC ELEMENTS (10 elements)

Essential for core imaging report functionality - 80%+ real-world usage

  1. header.subject - Patient reference
  2. header.documentType - Report type
  3. header.documentTitle - Human-readable title
  4. header.language - Language specification
  5. header.serviceSpecialty - Medical specialty
  6. body.examinationReport.modality - Imaging technique
  7. body.examinationReport.bodyPart - Anatomical region
  8. body.examinationReport.resultData.resultText - Report narrative
  9. body.examinationReport.resultData.observationResults - Measurements
  10. body.examinationReport.conclusion.impression - Clinical interpretation
  11. body.examinationReport.conclusion.conditionOrFinding - Structured findings

⚠️ INTERMEDIATE ELEMENTS (6 elements)

Valuable for enhanced workflows - 20-50% usage or high clinical value

  1. body.supportingInformation.observation - Clinical observations
  2. body.supportingInformation.condition - Clinical context
  3. body.examinationReport.imagingProcedures - Procedure details
  4. body.examinationReport.medication - Contrast/medications
  5. body.recommendation.description - Clinical recommendations
  6. body.comparisonStudy - Prior study references

🔴 BEYOND BASIC ELEMENTS (31+ elements)

Administrative, technical, or specialized - <5% usage or high implementation complexity

Administrative Overhead (12 elements):

Order Management (6 elements):

Technical Metadata (8 elements):

Specialized Clinical (5+ elements):

Implementation Recommendations

Phase 1: Basic Implementation

Focus on 10-11 core elements covering 90%+ of real-world imaging report value: - Essential header metadata - Core examination content - Clinical findings and interpretation

Phase 2: Enhanced Implementation

Add 6 intermediate elements based on specific use case needs: - Clinical context enhancement - Recommendation tracking - Prior study comparison

Phase 3: Full Implementation

Include beyond basic elements only for: - Comprehensive institutional workflows - Legal/regulatory compliance requirements - Advanced research and quality management - Multi-institutional exchange scenarios

This evidence-based classification enables pragmatic implementation prioritization while maintaining the option for comprehensive functionality when needed.

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