1. Standards Based DICOM  FHIR Gateway  Based purely on DICOM and FHIR No “inside knowledge” available  Could be implemented with or without assistance of PACS vendor  Could be a useful model in early adoption Mirrors what was done with DICOM, XDS etc.  Should be stateless for simplicity and scalability PACSGatewayClient DICOMFHIR

2. FHIR “id” issue  FHIR “id” is based on guid (but loosely!) a-z + 0-9 + “-” Max 36 characters (whether as guid or not)  DICOM Patient ID All characters (inc. extensions) Max 64 characters  DICOM Study UID OID Max 64 characters  10 56  >10 154  10 66

3. What to use as “id” for a gateway?  Native Unique identifier NO – does not obey formatting rules  Transformed Unique identifier NO – not enough unique values  Mapped Value NO – needs a stateful map  What else could be used?