@node-on-fhir/radiology-workflow

Inpatient radiology workflow module for Honeycomb EHR. Implements the complete imaging lifecycle from order entry through diagnostic reporting.

Overview

This package provides a multi-user workflow for radiology departments with role-based dashboards:

Actor	Dashboard	Phase	FHIR Resources
Nurse	/radiology/nursing	Order Entry	ServiceRequest
Rad Tech	/radiology/tech	Safety & Acquisition	Questionnaire, QuestionnaireResponse, Procedure, ImagingStudy
Radiologist	/radiology/reading	Interpretation & Reporting	Observation, RiskAssessment, DiagnosticReport

Installation

Enable with EXTRA_WORKFLOWS

EXTRA_WORKFLOWS=@node-on-fhir/radiology-workflow meteor run --settings configs/settings.honeycomb.localhost.json

NPM Link (for development)

cd /path/to/honeycomb-ehr
npm install
# The package is automatically linked via workspaces

Workflow Phases

Phase 1: Order Entry (Nurse)

1. Select patient from sidebar
2. Navigate to /radiology/nursing
3. Click "New Order"
4. Select modality (CT, MRI, X-ray, etc.)
5. Set priority and clinical indication
6. Submit order (creates ServiceRequest)

Phase 2: Safety Screening (Tech)

1. Navigate to /radiology/tech
2. Select order from worklist (sorted by priority)
3. Complete safety questionnaire
4. System evaluates for contraindications
5. Proceed to acquisition

Phase 3: Image Acquisition (Tech)

1. Click "Start Procedure" (creates Procedure)
2. Acquire images on modality
3. Upload via /dicom/upload (if needed)
4. Click "Complete Procedure" (creates ImagingStudy, marks ServiceRequest complete)

Phase 4-7: Reading & Reporting (Radiologist)

1. Navigate to /radiology/reading
2. Select study from worklist
3. Open in DICOM viewer (/dicom/viewer/:studyId)
4. Add findings (creates Observations)
5. Add risk assessment if needed (creates RiskAssessment)
6. Write impression and sign report (creates DiagnosticReport)

Collection Hooks

The package registers .after() hooks for workflow automation:

Collection	Trigger	Action
ServiceRequests	insert	Log new imaging order, update tech worklist
QuestionnaireResponses	insert	Evaluate contraindications, flag if issues
ImagingStudies	insert	Notify radiologist worklist
DiagnosticReports	insert	Link to Procedure, calculate turnaround time
Procedures	update (status)	Audit state transitions

User Role Detection

Roles are determined from PractitionerRole.code:

import { useRadiologyRole } from '@node-on-fhir/radiology-workflow/client/hooks/useRadiologyRole';

function MyComponent() {
  const { role, isLoading } = useRadiologyRole();
  // role: 'nurse' | 'tech' | 'radiologist' | null
}

Role Mappings

PractitionerRole.code	Radiology Role
RN, nurse, LPN, NP	nurse
RAD_TECH, technologist, radiographer	tech
RAD, radiologist, physician, MD	radiologist

FHIR Resources Used

All resources are pre-existing in Honeycomb:

• Patient - Subject of imaging
• Practitioner - Ordering provider, technologist, radiologist
• PractitionerRole - Role-based access control
• Encounter - Patient visit context
• ServiceRequest - Imaging order
• Questionnaire - Safety screening form
• QuestionnaireResponse - Completed screening
• BodyStructure - Anatomical target
• Procedure - Imaging event
• ImagingStudy - Study metadata and series
• DocumentReference - DICOM access URLs
• Observation - Individual findings
• RiskAssessment - BI-RADS, Lung-RADS, etc.
• DiagnosticReport - Final signed report
• Measure - Quality metric definitions
• MeasureReport - Quality results

API Methods

Order Entry

// Create imaging order
await Meteor.callAsync('radiology.createImagingOrder', {
  patientId: 'patient-123',
  modality: 'CT',
  modalityDisplay: 'CT (Computed Tomography)',
  priority: 'urgent',
  reasonDisplay: 'Abdominal pain'
});

Safety Screening

// Submit screening
await Meteor.callAsync('radiology.submitSafetyScreening', {
  questionnaireId: 'pre-imaging-safety',
  serviceRequestId: 'order-456',
  patientId: 'patient-123',
  items: [
    { linkId: 'allergy', answer: [{ valueBoolean: false }] }
  ]
});

Image Acquisition

// Start procedure
const procedureId = await Meteor.callAsync('radiology.startProcedure', {
  serviceRequestId: 'order-456',
  patientId: 'patient-123',
  modality: 'CT'
});

// Complete procedure
await Meteor.callAsync('radiology.completeProcedure', {
  procedureId: procedureId,
  serviceRequestId: 'order-456',
  patientId: 'patient-123',
  modality: 'CT'
});

Interpretation

// Add finding
const observationId = await Meteor.callAsync('radiology.addFinding', {
  imagingStudyId: 'study-789',
  patientId: 'patient-123',
  code: 'mass',
  codeDisplay: 'Mass identified',
  valueString: '2cm nodule in right lower lobe'
});

// Sign report
await Meteor.callAsync('radiology.signReport', {
  imagingStudyId: 'study-789',
  serviceRequestId: 'order-456',
  procedureId: 'proc-789',
  patientId: 'patient-123',
  observationIds: [observationId],
  conclusion: 'Suspicious pulmonary nodule. Recommend follow-up CT in 3 months.'
});

Integration with DICOM Viewer

The package integrates with Honeycomb's existing DICOM viewer:

• /dicom/studies - Study list
• /dicom/upload - Image upload
• /dicom/viewer/:studyId - Cornerstone3D viewer

Package Structure

npmPackages/radiology-workflow/
├── package.json
├── workflow.json
├── client.js
├── server.js
├── server/
│   ├── methods.js
│   └── hooks.js
├── client/
│   ├── RadiologyHome.jsx
│   ├── NursingDashboard.jsx
│   ├── TechDashboard.jsx
│   ├── ReadingDashboard.jsx
│   ├── hooks/
│   │   └── useRadiologyRole.js
│   └── components/
└── README.md

Future Enhancements

• Admin UI for role assignment
• Push notifications for worklist updates
• Radiation dose tracking (DLP, CTDIvol)
• HL7v2 ADT integration
• Order reconciliation workflows
• DICOM MPPS integration
• Advanced quality measures dashboard

License

Artistic 2.0

References

• react-force-graph