RetinaIntegration
0.5.0 - ci-build

RetinaIntegration - Local Development build (v0.5.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

OperationDefinition: Retina Append AI Result Operation

Official URL: http://dips.no/fhir/RetinaIntegration/OperationDefinition/append-retina-ai-result Version: 0.5.0
Draft as of 2025-12-18 Computable Name: AppendRetinaAIResult

OperationDefinition for appending retina AI results to an existing DiagnosticReport.

Append results from AI analysis of retina images to a existing DiagnosticReport

Overview

The $append-retina-ai-result operation is used to add AI analysis results to an existing DiagnosticReport. This operation is invoked after an AI system has analyzed retinal images and needs to submit its findings back to the DIPS system.

Usage

POST {baseUrl}/DiagnosticReport/{id}/$append-retina-ai-result

Where {id} is the identifier of the DiagnosticReport to update.

Parameters Overview

The operation accepts multiple types of parameters organized into logical groups:

Input references

  • sectraStudyId (1..1): The image study that was input for the AI system

Observation Resources

These observations contain the AI's clinical findings.

There are three observations for each eye.

The effectiveTime is repeated in each observation, because that is FHIR best practice.

  • rightDiabeticRetinopathyFinding, rightDiabeticMacularEdemaFinding, rightImageQualityAssessment
  • leftDiabeticRetinopathyFinding, leftDiabeticMacularEdemaFinding, leftImageQualityAssessment

Conclusion

  • conclusionCode (1..1): Overall conclusion code for the analysis
  • daysUntilNextExamination (0..1): Recommended days until next examination

AI Metadata (1..1 required)

Required information about the AI system and analysis:

  • aiDevice (1..1): The AI device that performed the analysis in the device element. We assume that alle the observations are performed by the same AI device. (TODO: Verify this assumption.)
  • fullReport (1..1): Complete report of AI and supporting system an Attachment.
  • metaTags (0..*): Workflow tags, such as VALIDATION to indicate data for validation review

Example

See RetinaAppendAIResultOperation-Example for a complete example of the operation parameters.

URL: [base]/DiagnosticReport/[id]/$append-retina-ai-result

Parameters

UseNameScopeCardinalityTypeBindingDocumentation
INsectraStudyId1..1Identifier

Sectra study identifier for the retinal images that were analyzed. System: http://dips.no/fhir/RetinaIntegration/sectra-image-study-id

INconclusion1..1CodeableConcept

Conclusion code for the AI analysis, added to DiagnosticReport.conclusionCode. MUST use codes from RetinaDiagnosticReportConclusionCodeValueSet (http://dips.no/fhir/RetinaIntegration/ValueSet/retina-diagnosticreport-conclusioncode-vs)

INdaysUntilNextExamination0..1integer

Number of days until next examination, stored in extension http://dips.no/fhir/StructureDefinition/days-until-next-examination-extension

INaiDevice1..1Device

AI Device that performed the analysis. MUST conform to RetinaAIDevice profile (http://dips.no/fhir/RetinaIntegration/StructureDefinition/retina-ai-device). Should include deviceName with AI product name, and version elements for algorithm version and protocol.

INrightDiabeticRetinopathyFinding0..1Observation

Right eye diabetic retinopathy finding. MUST conform to RetinaDiabeticRetinopathyFinding profile with bodySite set to right eye (SNOMED CT: 5597008).

INrightDiabeticMacularEdemaFinding0..1Observation

Right eye diabetic macular edema finding. MUST conform to RetinaDiabeticMacularEdemaFinding profile with bodySite set to right eye (SNOMED CT: 5597008).

INrightImageQualityAssessment0..1Observation

Right eye image quality assessment. MUST conform to RetinaImageQualityAssessment profile with bodySite set to right eye (SNOMED CT: 5597008).

INleftDiabeticRetinopathyFinding0..1Observation

Left eye diabetic retinopathy finding. MUST conform to RetinaDiabeticRetinopathyFinding profile with bodySite set to left eye (SNOMED CT: 58443009).

INleftDiabeticMacularEdemaFinding0..1Observation

Left eye diabetic macular edema finding. MUST conform to RetinaDiabeticMacularEdemaFinding profile with bodySite set to left eye (SNOMED CT: 58443009).

INleftImageQualityAssessment0..1Observation

Left eye image quality assessment. MUST conform to RetinaImageQualityAssessment profile with bodySite set to left eye (SNOMED CT: 58443009).

INfullReport1..1Attachment

Technical details for further reference about the AI grading, stored in DiagnosticReport.presentedForm

INmetaTags0..*Coding

Workflow tags. Add code http://terminology.hl7.org/CodeSystem/v3-ActReason#VALIDATION when data is for validation purposes only and the result from the AI analysis will not be used in clinical decision making.