Most ambulatory practices treat diagnostic imaging as a fax-based afterthought — the order goes out on paper, the report comes back days later as a scanned PDF, and nobody tracks whether the patient actually got the scan. REV.health treats diagnostic imaging as a structured clinical fact. Imaging orders specify modality, body part, and clinical indication; reports arrive as signed radiology narratives via HL7 v2 or DICOMweb; and key findings auto-surface in the problem list.
The platform uses DICOMweb for study exchange, HL7 v2 for report ingestion, and FHIR ImagingStudy for API projection. The signed radiology report is the authoritative clinical document (trust tier 3), and every imaging order is tracked from indication through finding reconciliation.
Orders placed with OrderType="Imaging", specifying modality (CT / MRI / X-ray / Ultrasound / PET), body part, and clinical indication. CPT codes are auto-suggested by CDS based on the indication and modality — the 70000-series radiology codes are mapped to clinical scenarios so the clinician selects the study and the system suggests the code.
Ambra Health, Nuance PowerShare, and Life Image integrations for viewing and sharing studies. StudyInstanceUID and AccessionNumber are tracked on every imaging entity, enabling cross-reference between the order, the study, and the report. WADO-RS retrieval allows the clinician to launch a DICOMweb viewer directly from the imaging record without leaving the encounter context.
Reports auto-parsed into Imaging entities, linked to the originating Order by SourceInboundID. The signed report is trust tier 3 (authoritative) — the radiologist's narrative is the system of record. HL7 v2 ORU messages carry the report text, and the parser extracts structured fields (modality, body part, findings, impressions) alongside the free-text narrative.
Key findings auto-extracted from the report narrative and surfaced in problem list reconciliation. When a chest CT report mentions "2.4 cm pulmonary nodule, right lower lobe," the extracted finding appears as a candidate problem list entry for the clinician to confirm or dismiss. This closes the loop between ordering a study and acting on its results.
CDS checks whether an imaging order requires prior authorization based on payer and modality. When prior auth is required, the system auto-generates an ePA request populated with the clinical indication, supporting documentation, and CPT code. The request is routed to the payer's FHIR Prior Authorization API (CMS-0057-F compliant) or to the payer's portal when FHIR is not yet available.
USCDI v3 bundles for specialist referrals include imaging studies with report text. When a primary care provider refers a patient to a pulmonologist for a pulmonary nodule, the referral bundle carries the CT report and finding alongside the clinical summary. The specialist receives the full imaging context without a separate records request.
Patients can view imaging reports and request study copies. A DICOMweb viewer allows image review directly in the portal — the patient sees their own X-ray or MRI alongside the radiologist's report. Study copies on CD or USB are requestable through the portal for second opinions.
Imaging orders and reports are modeled as two primary noun-apps on the IC platform: Order (with OrderType="Imaging") and Imaging. Every entity carries the full four-field audit trail and is global (cross-org), keyed by SourceOrganizationID in the audit trail. The patient referenced by an Imaging entity is a global entity; the imaging row carries the performing facility and study identifiers from the authoritative source.
Study exchange uses WADO-RS for retrieval and STOW-RS for upload. StudyInstanceUID and AccessionNumber are tracked on every Imaging entity. Ambra Health, Nuance PowerShare, and Life Image provide image-sharing networks. The DICOMweb viewer launches from the imaging record using the StudyInstanceUID as the retrieve key.
HL7 v2 ORU messages carry the signed radiology report. The parser extracts the report text, modality, body part, and structured findings. Trust tier 3: the signed report is authoritative — the radiologist's narrative is the system of record, not the order or the CPT code.
Imaging maps to FHIR R4 ImagingStudy (study-level metadata, series, and instance references) and DiagnosticReport (report narrative and findings). Both resources conform to US Core 7.0.0+ profiles. The FHIR API supports query by patient, date range, modality, and body part.