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Pattern Co-Usage Map

This page shows how the FHIR implementation patterns commonly work together in real-world deployments.

Overview

Healthcare interoperability systems rarely use patterns in isolation. Instead, they combine multiple patterns to address complex, multi-faceted challenges.

Pattern Usage by Scenario

The following diagrams show how patterns work together in specific healthcare workflow scenarios:

Clinical Workflow Integration

Clinical Workflow Integration

Real-time coordination between EMR systems, imaging viewers, and mobile applications.

Research Data Export

Research Data Export

Large-scale data extraction with de-identification and audit trails.

Legacy System Modernization

Legacy System Modernization

Gradual migration from legacy systems to modern FHIR-based architectures.

Alternative Views

Architectural Layers

How patterns fit into Application, Integration, Platform, and Foundation layers.

Architectural Layers

Complete Co-Usage Map

Comprehensive overview of all pattern relationships.

Complete Co-Usage Map

Common Pattern Combinations

1. Federated Clinical Access

Purpose: Enable secure, federated access to patient data across multiple healthcare organizations.

Pattern Combination:

Key Interactions:

  • Broker uses Naming/Trading for endpoint discovery
  • SMART Strategy provides authentication context to Broker
  • Privacy Enforcement applies consent rules through Broker
  • All patterns leverage shared Audit & Provenance Chain

2. Population-level Research Export

Purpose: Extract large-scale, de-identified datasets for research and analytics.

Pattern Combination:

Key Interactions:

  • Population Export uses Async Invocation for job management
  • Backend Strategy provides system scopes for bulk operations
  • De-Identification Adapter transforms exported data
  • Capability Facade validates $export support

3. Imaging-enabled EMR/EHR

Purpose: Integrate medical imaging capabilities into electronic medical record systems.

Pattern Combination:

  • Imaging Bridge - Connect FHIR-based clinical systems with DICOM imaging syste...
  • IID Facade - Provide simplified, URL-based launching of imaging viewers w...
  • Event Observer - Enable real-time synchronization of clinical context across ...

Key Interactions:

  • Imaging Bridge provides metadata and image access
  • IID Facade enables simple viewer launching
  • Event Observer synchronizes clinical context across applications

4. Legacy Modernization

Purpose: Gradually modernize legacy healthcare systems while preserving workflows.

Pattern Combination:

  • Legacy Adapter - Transform legacy data formats (HL7v2, CDA, DICOM SR) to FHIR...
  • Broker - Provide a unified entry point for FHIR operations that route...
  • Security Strategy - Provide pluggable authentication and authorization strategie...

Key Interactions:

  • Legacy Adapter exposes legacy systems as FHIR endpoints
  • Broker provides unified access point for mixed environments
  • Audit Chain tracks migration and modernization progress

Shared Services

Audit & Provenance Chain

  • Used By: All pattern combinations
  • Purpose: Comprehensive audit logging and data lineage tracking
  • Standards: IHE ATNA/BALP, FHIR AuditEvent and Provenance
  • Used By: Federated Access, Research Export
  • Purpose: Apply patient consent and data use restrictions
  • Standards: FHIR Consent, Security Labels, Data Access Policies IG

Capability Facade

  • Used By: Federated Access, Research Export, Imaging Integration
  • Purpose: Simplified capability discovery and negotiation
  • Standards: FHIR CapabilityStatement, SMART configuration

Terminology Service (Flyweight)

  • Used By: All combinations (especially De-ID and Legacy Adapter)
  • Purpose: Efficient terminology lookup and value set expansion
  • Standards: FHIR Terminology Services, value sets, code systems

Implementation Sequence

Foundation

Start with Audit & Provenance Chain and Security Strategy

Core Integration

Implement Broker and Capability Facade

Specialized Functions

Add domain-specific patterns (Imaging, Research, etc.)

Advanced Features

Implement Event Observer and Legacy Adapter as needed

Pattern Synergies

The patterns in this collection are designed to work together. Start with a core pattern like Broker or Security Strategy, then add complementary patterns as needed.

Customization

These combinations are starting points. Adapt them based on your specific requirements, existing infrastructure, and organizational constraints.