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eReferral Detailed Specification

Referral Workflows

The interfaces and FHIR Profiles described in this document are intended to satisfy eReferral workflows. What follows is a description of common workflows, indicating as well, the various status changes the FHIR Resources transition through. The events may be combined in other ways to create workflows not defined in this guide.

The workflow step can be derived, by the Requester, Performer or Intermediary, by examining the MessageHeader.eventCoding and focus and various status codes.

This guide does not specify how Requester, Performer or Intermediary systems react to message received beyond sending the acknowledgment or notifications. For example, a Performer system that received a referral request should contact the healthcare worker and present them with a user interface to review the referral, look up additional information (say documents or clinical history of patients) and either accept or reject the referral.

Referral Created, Accepted and Completed Workflow

Event	Business Event	ServiceRequest Status	Task Status	Appointment Status
create-referral	Initial submission by Requester	active	requested	booked
notify-referral	The Intermediary notifies the Performer that there is a referral assigned to them.	active	requested	booked
accept-referral	Performer accepts the referral.	active	accepted	booked
notify-referral	The Intermediary notifies the Requester that there is a significant referral status change.	active	requested	booked
complete-referral	Performer has completed	completed	completed	fulfilled
notify-referral	The Intermediary notifies the Requester that there is a significant referral status change.	completed	completed	fulfilled

Consideration 🔎 Notifications (notify-referral) in some cases may be omitted. I.e. if there is no requirement to inform the Requester that the Performer has accepted, that message may be omitted.

Consideration 🔎 The events may be extended by adding more granular events such as appointment-complete or appointment-booked (if the Requester doesn't book the appointment but it is booked by the Patient or Performer), or appointment-noshow (if the Patient does not show up for the appointment).

Rejected Scenario With No Appointment Workflow

Event	Business Event	ServiceRequest Status	Task Status	Appointment Status
create-referral	Initial submission by Requester	active	requested	n/a
notify-referral	The Intermediary notifies the Performer that there is a referral assigned to them.	active	requested	n/a
rejected-referral	Performer rejects the referral.	active	rejected	n/a
notify-referral	The Intermediary notifies the Requester that there is a significant referral status change.	active	rejected	n/a

Cancelled Scenario With No Appointment Workflow

Event	Business Event	ServiceRequest Status	Task Status	Appointment Status
create-referral	Initial submission by Requester	active	requested	n/a
notify-referral	The Intermediary notifies the Performer that there is a referral assigned to them.	active	requested	n/a
accept-referral	Performer accepts the referral.	active	accepted	n/a
notify-referral	The Intermediary notifies the Requester that there is a significant referral status change.	active	accepted	n/a
cancel-referral	Requester cancels the referral.	revoked or entered-in-error	cancelled	n/a
notify-referral	The Intermediary notifies the Performer that there is a significant referral status change.	revoked or entered-in-error	cancelled	n/a

Referral Is Updated With Documentation Workflow

Event	Business Event	ServiceRequest Status	Task Status	Appointment Status
create-referral	Initial submission by Requester.	active	requested	booked
notify-referral	The Intermediary notifies the Performer that there is a referral assigned to them.	active	requested	booked
accept-referral	Performer accepts the referral.	active	accepted	booked
notify-referral	The Intermediary notifies the Requester that there is a significant referral status change.	active	accepted	booked
update-referral	Requester adds a DocumentReference to the referral.	active	accepted	booked
notify-referral	The Intermediary notifies the Performer that there is a significant referral change.	active	accepted	booked
complete-referral	Performer has completed.	completed	completed	fulfilled
notify-referral	The Intermediary notifies the Requester that there is a significant referral status change.	completed	completed	fulfilled

Search For Referrals

This is not a workflow and therefore has no steps, like above, defined. The FHIR search and read interactions are suitable. For instance, to find all referrals based on Patient, that are active, one could use the following:

GET [base]/ServiceRequest?subject=Patient/324&status=active&_revinclude=Appointment:based-on&_revinclude=Task:based-on

Besides returning the ServiceRequest the Appointment and Task are also returned.

Accessing Resources Independent of Workflow Messages

The Intermediary is expected to store Resources recieved in the FHIR Repository, updating them as necessary. The Requestor or Performer is permitted (in general, subject to security configurations) access to these Resource instances through standard FHIR search and read interactions. This is permitted as the Performer or Requestor may not have their own FHIR repositories to store FHIR Resources, instead only storing References or elements normalized to suite their custom data models. Updates outside of the FHIR Message workflows defined in this guide SHALL not be permitted.

Recipient Notifications

This guide describes the FHIR Resources and their structure to transport messages regarding the referral but how the systems contacts the recipients (the recipients being the administrative staff or other healthcare workers responsible to fulfill the service) is not in scope. This could be an email or SMS, and the recipient's system will need to implement this functionality. E.g. when the Intermediary receives a create-referral Message it notifies the Performer's system with a notify-referral Message indicating there is a eReferral submitted for the Performer to accept or reject. How the Performer's system communicates to the Performer is not defined in this guide.