A: Primary Flow

The following sequence diagram shows the primary messaging flow starting from the Requester HCP (Referring Provider) sending a service request to the CAT until the Performer HCP completes the service.

See Participants for more information.

Element and Value

The following table includes elements for Communication, DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole resources. The elements for remaining resources are listed in appropriate steps below.

Step 1: Requester HCP sends service request to CAT

Step 2: CAT acknowledges service request from Requester HCP

Step 4: CAT notifies Requester HCP of creation of referral record

Step 6: CAT sends service request to Performer HCP

Step 7: CAT notifies Requester HCP of assignment of Performer HCP

Step 8: Performer HCP acknowledges service request from CAT

Step 10: Performer HCP notifies CAT of service request acceptance

Step 12: CAT notifies Requester HCP that performer accepts service request

Same as Step 10 above with changes as below:

Step 13: CAT notifies Requester HCP of update to referral record (accepted)

Same as Step 10 above with changes as below:

Step 15: Performer HCP notifies CAT of new appointment

Step 17: CAT notifies Requester HCP that appointment is booked

Step 18: CAT notifies Requester HCP of update to referral record (appointment booked)

Step 20: Performer HCP notifies CAT of appointment completion

Step 22: CAT notifies Requester HCP of appointment completion

Step 23: CAT notifies Requester HCP of update to referral record (appointment attended)

Step 25: Performer HCP notifies CAT of service request completion

Step 27: CAT notifies Requester HCP of service request completed

Same as Step 25 above with changes as below:

Step 28: CAT notifies Requester HCP of update to referral record

Same as Step 7 above with changes as below:

B: Requester HCP sends unsolicited update

The following sequence diagram shows the messaging flow when the Requester HCP sends unsolicited update on service request to the CAT.

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Business Rules

• Only Open Referrals May Be Updated: A referral with a closed status in the Central RMS (that is, equivalent to ServiceRequest.status "completed" or "revoked") cannot be updated and resubmitted. (If a referral with such a closed status is resubmitted, it will be rejected as an invalid submission.) Only a referral with an open status in the Central RMS (equivalent to ServiceRequest.status "active") can be updated and resubmitted.

• Send Patient AB ULI with Referral Update Request If the referral was originally submitted with an out-of-province PHN, an Alberta ULI for the patient will have been returned to the referring provider's EMR as part of the Service Record following the initial successful submission. The Alberta ULI shall be used in the referral update request.

• Non-Updateable Elements: Certain information on a previously submitted referral cannot be updated on a referral update request. Non-updateable elements:

  • Patient identifier and demographics that would change the subject of the referral The updated referral must still refer to the same patient (that is, the submitted patient identifier and demographics must resolve in the Provincial Client Registry to the same patient). However it is not mandatory to submit exactly the same patient identifier and demographics as the original submission. For example, if the referral was initially submitted with the wrong patient birthdate, which has since been corrected in the EMR, the updated referral can be submitted with the correct birthdate.If the referral should have been for a different person, the previously submitted referral will need to be cancelled and a new referral submitted
  • Performer (triage site), including related service zone The updated referral cannot change the referral's Triage Site. If the referral should have been directed to a different Triage Site, the desired change will need to be communicated to the CAT unit through other means (e.g., by phone). Additional methods for electronic communication are expected to become available in later phases of the project.

• Referral Identifier: The provincially-assigned referral identifier from the initial referral submission must be used in the updated version, so that the Central RMS can correctly identify the record to be updated.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Requester HCP sends unsolicited update to CAT

Step 3: CAT sends unsolicited update from Requester HCP to Performer HCP

Same as Step 1 above with changes as below:

C: CAT requests information

The following sequence diagram shows the messaging flow when the CAT requests additional information from the Requester HCP (Referring Provider) and the Requester HCP responds to the request.

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Element and Value

Refer to Primary Flow for Communication, DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: CAT requests Requester HCP for additional information

Step 2a: Requester HCP provides CAT additional information (through Communication)

Step 2b: Requester HCP provides CAT additional information (through updated ServiceRequest)

D: Performer HCP requests information

The following sequence diagram shows the messaging flow when the Performer HCP requests additional information from the Requester HCP (Referring Provider) and the Requester HCP (Referring Provider) responds to the request.

See Participants for more information.

Element and Value

Refer to Primary Flow for *Communication, DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP requests Requester HCP for additional information

Step 3: CAT sends requests for additional information to Requester HCP

See Step 1 in CAT requests information message flow

Step 4a: Requester HCP provides additional information (through Communication)

See Step 2a in CAT requests information message flow

Step 4.b: Requester HCP provides additional information (through updated ServiceRequest)

See Step 2b in CAT requests information message flow

Step 6a: CAT sends Performer HCP additional information

See Step 2a in CAT requests information message flow with changes as below:

Step 6b: CAT sends Performer HCP additional information

See Step 2b in CAT requests information message flow with changes as below:

E: CAT rejects service request

The following sequence diagram shows the messaging flow when the CAT rejects the service request as invalid or inappropriate.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 2: CAT notifies Requester HCP that service request is rejected

Step 3: CAT notifies Requester HCP of update to referral record (rejected)

Same as Step 2 above with changes as below:

F: Performer HCP declines and CAT reassigns

The following sequence diagram shows the messaging flow when the Performer HCP (Service Provider) declines the service request and the CAT reassigns to another Performer HCP.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT of decline of service request

See Step 10 in Primary Flow message flow with changes as below:

Step 3: CAT sends service request to another Performer HCP

See Step 6 in Primary Flow message flow

Step 4: CAT notifies Requester HCP of assignment to another Performer HCP

See Step 7 in Primary Flow message flow with changes as below:

Step 5: Performer HCP acknowledges service request from CAT

See Step 8 in Primary Flow message flow

G: Performer HCP rejects service request

The following sequence diagram shows the messaging flow when the Performer HCP (Service Provider) rejects the service request as invalid or inappropriate. The service request is not reassigned.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT of rejection of service request

See Step 1 in Performer HCP declines and CAT reassigns message flow

Step 3: CAT notifies Requester HCP that service request is rejected

Same as Step 2 in CAT rejects service request message flow with changes as below:

Step 4: CAT notifies Requester HCP of update to referral record

See Step 3 in CAT rejects service request message flow with changes as below:

H: Requester HCP revokes service request

The following sequence diagram shows the messaging flow when the Requester HCP (Referring Provider) revokes the service request.

See Participants for more information.

Business Rules

• Only Open Referrals May Be Cancelled: A referral with a closed status in the Central RMS (that is, equivalent to ServiceRequest.status "completed" or "revoked") cannot be cancelled by the referring provider. (If an attempt is made to cancel a referral with such a closed status, it will be rejected as invalid.) Only a referral with an open status in the Central RMS (equivalent to ServiceRequest.status "active") can be cancelled.

• Non-Updateable Elements: The information on a previously submitted referral cannot be changed as part of a cancellation action. This includes the patient, the referring provider, the referral reason, or any other previously submitted information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Requester HCP revokes service request

Step 2.1: CAT notifies Requester HCP that service request was cancelled

See Step 10 in Primary Flow message flow with changes as below:

Step 3: CAT sends service request cancellation to Performer HCP

Same as Step 1 above with changes as below:

I: CAT cancels service request

The following sequence diagram shows the messaging flow when the CAT cancels the service request.

Note: The CAT only cancels the service request if it hasn't been sent to Performer HCP.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 2: CAT notifies Requester HCP of service request cancellation

Step 3: CAT notifies Requester HCP of update to referral record (cancelled)

J: Performer HCP cancels service request

The following sequence diagram shows the messaging flow when the Performer HCP cancels the service request.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT of service request cancellation

Step 3: CAT notifies Requester HCP of service request cancellation

Same as Step 2 in CAT cancels service request message flow with changes as below:

Step 4: CAT notifies Requester HCP of update to referral record (cancelled)

See Step 3 in CAT cancels service request

K: Performer HCP defers service request

DEPRECATED - Not to be used

The following sequence diagram shows the messaging flow when the Performer HCP defers the service request.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT that service request is deferred

Step 3: CAT notifies Requester HCP that service request is deferred

See Step 1 with changes as below:

Step 4: CAT notifies Requester HCP of update to referral record (deferred)

See Step 1 with changes as below:

L: Performer HCP cancels appointment

The following sequence diagram shows the messaging flow when the Performer HCP cancels an appointment.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT of appointment cancellation

See Step 15 in Primary Flow message flow with changes as below:

Step 3: CAT notifies Requester HCP of appointment cancellation

See Step 17 in Primary Flow message flow with changes as below:

Step 4: CAT notifies Requester HCP of update to referral record (appointment cancelled)

See Step 18 of Primary Flow message flow with changes as below:

M: Performer HCP updates appointment

The following sequence diagram shows the messaging flow when the Performer HCP updates an appointment.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT of appointment update

See Step 15 in Primary Flow message flow with changes as below:

Step 3: CAT notifies Requester HCP of appointment update

See Step 17 in Primary Flow message flow with changes as below:

Step 4: CAT notifies Requester HCP of update to referral record

See Step 18 of Primary Flow message flow with changes as below:

N: Peformer HCP places service request on waitlist

The following sequence diagram shows the messaging flow when the Performer HCP places the service request on a waitlist for an appointment.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT that service request was placed on waitlist

Step 3: CAT notifies Requester HCP that service request was placed on waitlist

Same as Step 1 above with changes as below:

Step 4: CAT notifies Requester HCP of update to referral record (waitlisted)

Same as Step 1 above with changes as below:

O: CAT creates service request on behalf of Requester HCP

The message flow starting from Step 3 in Primary Flow shows the messaging flow when the CAT creates a follow-on service request (based on a preceding service request) on behalf of Requester HCP.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 4: CAT notifies Requester HCP of creation of referral record

P: CAT assigns service request to another CAT

The following sequence diagram shows the messaging flow when the CAT assigns the service request to another CAT.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 2: CAT notifies Requester HCP of updated to referral record

See Step 7 in Primary Flow message flow with changes as below:

Q: Performer HCP notifies missed appointment

The following sequence diagram shows the messaging flow when Performer HCP notifies CAT of missed appointment.

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Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 1: Performer HCP notifies CAT of missed appointment

See Step 15 in Primary Flow message flow with changes as below:

Step 3: CAT notifies Requester HCP of missed appointment

See Step 17 in Primary Flow message flow with changes as below:

Step 4: CAT notifies Requester HCP of update to referral record (appointment missed)

See Step 18 of Primary flow message flow with changes as below:

R: CAT completes service request with advice

The following sequence diagram shows the messaging flow when CAT completes the service request with advice.

Note: This workflow takes place during clerical triage in the CAT.

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Element and Value

Refer to Primary Flow for Communication,DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 2: CAT notifies Requester HCP of service completion and advice

Same as Step 27 in Primary Flow message flow with changes as below:

Step 3: CAT notifies Requester HCP of update to referral record

See Step 28 in Primary Flow message flow with changes as below:

S: CAT sends unsolicited update

The following sequence diagram shows the messaging flow when CAT sends unsolicited update to the service request.

See Participants for more information.

Element and Value

Refer to Primary Flow for DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 2: CAT notifies Requester HCP of update to service request

See Step 17 in Primary Flow message flow with changes as below:

Step 3: CAT notifies Requester HCP of update to referral record

Step 4: CAT sends unsolicited update from Requester HCP to Performer HCP

Same as Step 3 above with changes as below:

T: Performer HCP completes service request with advice

The following sequence diagram shows the messaging flow when Performer HCP completes the service request with advice. This is an alternate flow from the Primary Flow where a service request can be completed without scheduling and completing an appointment.

See Participants for more information.

Element and Value

Refer to Primary Flow for Communication,DocumentReference, HealthcareService, Location, Patient, Practitioner, and PractitionerRole elements.

Step 2: Performer HCP notifies CAT of service completion and advice

Same as Step 25 in Primary Flow message flow with changes as below:

Step 4: CAT notifies Requester HCP of service completion and advice

Same as Step 27 in Primary Flow message flow with changes as below:

Step 5: CAT notifies Requester HCP of update to referral record

See Step 28 in Primary Flow message flow with changes as below: