1. Challenges with current definitions Options to address
Media - Observation
Challenges with current definitions
Options to address

2. CURRENT STATE Observation Patient Media Binary identifier basedOn
status
category
code
subject
context
effective
issued
performer
value
dataAbsentReason
interpretation
comment
bodySite
method
specimen
device
referenceRange
related
component
identifier
basedOn
type
subtype
view
subject
context
occurrence
operator
reasonCode
bodySite
device
height
width
frames
duration
content
note
Identifier :
photo
contentType
securityContext
Content
Attachment DT
contentType
language
data
url
size
hash
title
creation

3. Challenges & Needs
Media and Observation look a lot alike. Unclear when to use Observation vs. Media.
Should Observation include the image, photo, video, audio recording as well, or only address the observations about the picture, video, audio recording?
Need to access image, photo, video, audio recording separate from the observations regarding them in systems such as Document Management System or Blob servers.
Current structure one cannot make an Observation about a Media as the source.
The attachment data type only contains the in-line data, cannot reference a Media instance with its metadata.
The Attachment data type seems overloaded where it really seems to need to be a relationship to something else.
Unclear what the role of DocumentReference is in all this as it looks like Media as well.
Generally it seems the Observation, Patient, Media, Binary, and Attachment resources/data type need to be cleaned up one way or another to better related them to each other

4. Option Zero – Do Nothing
If these challenges are not critical, keep it as-is
But we think something needs to be addressed.

5. Option One
The premise of Option One is that the observation includes the image, photo, video, audio as well as the observations about them.
Therefore the primary change is to collapse Media into Observation for observation like data, and
Option 1.A – create a new Media Data Type
Option 2.A – update Attachment Data Type
Open question whether either data type .data should actually point to Binary.

6. PROPOSED STATE – OPTION ONE - A
Observation
Patient
Binary
identifier
basedOn
status
category
code
subject
context
effective (occurrence)
issued
performer
Value
dataAbsentReason
interpretation
comment (note)
bodySite
method (subtype)
specimen
device
referenceRange
related
Component
Ext:reasonCode
Ext:view
Identifier :
Photo
contentType
securityContext
Content
Media DataType
category
(image/video/audio)
contentType
language
data
url
size
height
width
frames
duration
hash
title
creation

7. PROPOSED STATE – OPTION ONE - B
Observation
Patient
Binary
identifier
basedOn
status
category
code
subject
context
effective (occurrence)
issued
performer
Value
dataAbsentReason
interpretation
comment (note)
bodySite
method (subtype)
specimen
device
referenceRange
related
Component
Ext:reasonCode
Ext:view
Identifier :
Photo
contentType
securityContext
Content
Attachment DataType
category
(image/video/audio)
contentType
language
data
url
size
height
width
frames
duration
hash
title
creation
Or is this in the end just an enhanced attachment?

8. Option One - Steps All at once.
It seems difficult to do this in multiple steps.

9. Option Two
The premise is that an image, photo, video, or audio recording is not an observation in itself, but rather that it is like the patient or specimen something separate about which observations can be made.
That means that the Media resource stays, while changing:
Observation.value not including valueAttachment
Patient.photo having a choice of using Attachment data type of going to Media
Consider that the Attachment data type goes to either Media (if metadata is needed) or Binary.
Various other removals and adjustments
The end-state would look like the next slide, but incremental steps could be taken to get there, identified after the next slide.

10. PROPOSED STATE – OPTION TWO
Observation
Patient
Media
Binary
identifier
basedOn
status
category
code
subject
context
effective
issued
performer
value (valueAttachment)
dataAbsentReason
interpretation
comment
bodySite
method
specimen
device
referenceRange
related (Ref: Media….)
Component
Identifier :
Photo (Ref:Media)
identifier
type (photo/video/audio /docRef?)
subtype
subject
context
basedOn (Ref: Procedure, ProcedureRequest)
view
occurrence
operator
device
reasonCode
bodySite
height
width
frames
duration
fileSize
content
data (Ref: Binary)
note
contentType
securityContext
content
Attachment DataType
contentType
language
data
url
content (Ref:Media) data or content, not both
size
hash
title
creation
Same
New
Remove

11. Option Two - Steps
Not all steps need to be take at once. We do not need to do all. Which ones are best done before Normative?
Step One
Replace Media.basedOn (Ref: ProcedureRequest) with Ref: Procedure)
Change cardinality on Media.basedOn to 0..1
Step Two
Remove valueAttachment from Obsevation.value
Add Media to Observation.related
Step Three
Point Attachment.data to Binary and add Attachment.content with Reference to Media with constraint that Attachment can only have .data or .content, but not both.
Step Four – STILL NEEDED WITH STEP THREE?
Replace Photo Attachment Data Type with Reference to Media
Step Five
Remove .content from Media and replace with .data that points to Binary.
Step
Shrink Attachment Data Type by removing contentType, title, and creation
Add Media.fileSize or Binary.fileSize
Consider renaming Media.occurrence to acquisition or creation or whenAquired
Remove Media.bodySite as it seems that once interesting, the Observation or the Media.basedOn Procedure would have this.
Remove Media.view as it exist elsewhere, we think…

12. Document Reference vs. Media
We don’t think there is value in collapsing DocumentReference and Media
A Document typically represents a series observations/procedural/etc. data about other things, including media, and is organized based on the author and/or target audience’s needs.
Media is the raw data about which observations can be made, but not an observation on its own.
A Document seems to require substantially different metadata than Media, although they both can point to a Binary for the actual data.
Therefore, would want to keep Media and DocumentReference separate and define boundaries better.

13. Questions Is Media.view already on other II resource?
Can Attachment.data point to Binary?
Should DocumentReference become a type of Media?