MyHealth@Eu Medical Imaging Report
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## About this guide

### Overview

This guide:

- specifies a set of rules to be applied to HL7 FHIR to define how to represent a Medical Imaging Report for the European cross-borders exchange, coherently with the European eHN Guidelines (see the European eHealth - Key documents ).
- provides a representation of the Medical Imaging Report Content specified in the MyHealth@EU Functional Requirements 15.01 Create the MyHealth@EU Medical Imaging Studies and Report content expressed as HL7 FHIR Logical Model.
- is adapted from the HL7 Europe Imaging Diagnostic Report HL7 FHIR IG fulfilling the MyHealth@EU Functional Requirements.

The following figure shows how the eHN guidelines, MyHealth@EU Functional Requirements and HL7 FHIR specifications are documented through the different used HL7 FHIR IGs

Figure 1 - From the eHN guidelines to the MyHealth@EU specifications

The eHN guidelines is documented in the HL7 Europe Imaging Diagnostic Report as HL7 FHIR Logical Models, including how this data set is implemented in HL7 FHIR; while this guide documents cross-borders reuqirements and associated profiles.

### What is in

This guide includes three main kinds of content (see figure below)

1. HL7 FHIR Logical Models representing the MyHealth@EU Functional Requirements. Logical Models are not supposed to be implemented and exchanged.
2. HL7 FHIR Conformance Resources (e.g. profiles, value sets) describing how to implement HL7 FHIR for the purpose of this guide.
3. HL7 FHIR ConceptMap describing models to profiles forward mapping.

Figure 2 - Guide Content

The design choices adopted for representing MyHealth@EU Functional Requirements are described in the Imaging Models Overview page; those used for HL7 FHIR Conformance Resources and ConceptMap below

### Conformance Resources

Most of the design choices adopted by this guide are detailed in the parent guide HL7 EU Imaging Diagnostic Report Design choices page.

A detailed description on how to read HL7 FHIR Implementation Guides is provided in the Reading Implementation Guides guide.

#### Flagging elements

This guide doesn't use the Must Support flag, however, to highlight the elements realizing the fields identified by the MyHealth@EU Functional Requirements a generic handle obligation is used in the profile.

For the purpose of this guide handle elements are supposed to be:

- displayed when received by a displaying systems
- transcoded/translated as needed if the element is a Coding or a CodeableConcept

More detailed Obligations will be defined in the future.

#### Representing functional requirements

Implementers should be aware about the differences in the design of HL7 FHIR and HL7 CDA. This explains the different appoaches followed on the way mandatory, required, or optional elements are represented in the implemantable specification.

In HL7 CDA, unless explicitly flagged otherwise, elements can be always nullflavored. This is not what is expected to be done in general in HL7 FHIR, where there is not a nullFlavor attribute and the "1.." cardinality is supposed to be used only for the mandatory elements.

For this reason required field are not necessarily mapped into "1.." elements, unless it has been decided otherwise and the data-absent-reason extension used.

Obligations are expected to be adopted to enforce the functional requirements; the inclusion of warning invariants may also be considered in the future to highlight missing required elements.

### Models to profiles forward mapping

This guide uses ConceptMap to formalize the models to profiles forward mapping.

Author are aware that ConceptMaps have been designed for managing the terminology concept maps; but it is recognized that they may be used for mapping concepts model-to-model, when the scope is not a structural mapping (for which StrcutureMap shoudl be used).

This choice has been made to:

- decouple the mapping from the models
- specifying the kind of Relationship between the concepts (e.g. if concepts are equivalent or only somehow related )