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UC-01: Referral to a Service

Description

Requester Health Care Provider sends a referral request to a Performer Health Care Provider

Scenario

Note: In this example, Dr. Jones' electronic medical record (EMR) solution could be integrated with an external Referral Management System (RMS) or his EMR solution could have the capability to directly manage eReferrals.

Jane Doe is an active 72 year old who is managing type 2 diabetes, osteoarthritis (multiple joints), and chronic neck pain. Her neck pain had been well controlled with a combination of oral and topical medications, physiotherapy and massage therapy. However, in the last few months, Jane’s neck pain has worsened, exhibiting more concerning features.

Jane attends an appointment with her family doctor, Dr. Jones, who reviews past imaging results, including a fairly recent MRI. Dr. Jones determines that the underlying cause of the pain requires further assessment and refers Jane to a specialist.

Dr. Jones creates an eReferral from his EMR and selects a neurosurgical specialist that is located close to Jane’s home. After selecting the specialist, referral requirements are presented on his screen with some of the information already filled in (based on available data from his EMR). He completes the referral requirements and sends the referral request to the specialist. Jane also receives a notification that the referral has been sent.

The medical office assistant at the neurosurgical specialist’s office is notified of the incoming referral request and contacts Jane to schedule an appointment. Updates are sent to Dr. Jone's system when the appointment is scheduled and completed to keep him informed about the referral status.

Use Case Participants

People

• Requester HCP
• Performer HCP

Systems

• Requester POS system
• Performer POS system
• eReC Source
• eReC Target
• Health Service Directory (HSD)

Please refer to Participants for definitions.

Triggers

Requester Health Care Provider (HCP) needs to send a referral for a patient

Pre-conditions

• The POS system has the capability to directly manage the referral workflow or is integrated with an external eReC Source/eReC Target
• The POS system or eReC Source is integrated with a valid and up-to-date Health Services Directory
• Appropriate patient consent in accordance with jurisdictional requirements and legislation, whether implied or expressed, has been obtained to share their personal and health information during the referral process.
• Patients have indicated their communication preferences and provided consent to receive notifications and information about their eReferral status and appointment via their selected method(s).
• Patient information in Requester POS system is valid and up-to-date.

Post-conditions

• The Performer HCP completes the initial consultation appointment with the patient and closes the eReferral request. The Requester HCP is updated that the appointment is complete. Or,
• The Performer HCP converts the referral to a consultation and provides consultation advice to the Requester HCP instead of booking the patient in for an appointment (UC-2: Consultation Request). Or,
• The referral request was not fulfilled or was ended before completion because:
  • The Requester HCP cancels the referral request
  • The Performer HCP declines the referral request
  • The Patient declines the referral/request

Workflow diagram

This use case diagram represents the participants and their role in the use case with a high-level view of the flow of information.

Use Case - Primary Flow

The following provides a textual description corresponding to the use case diagram.

1. Requester HCP initiates the creation of an eReferral request.

2. Requester HCP searches for and selects the appropriate service based on results from the Health Service Directory.

   The Health Service Directory could be i) centrally managed, or ii) locally integrated with the POS system, or iii) part of an eReC Source that is integrated with POS system.

3. Requester HCP is presented with and completes the referral requirements and, if necessary, provides a clinical narrative to support the reason for the referral. Patient information and some of the referral requirements may be automatically filled in based on information available in the POS system.

4. Requester HCP may attach additional clinical notes and supporting documentation from the POS system to support the referral request.

5. Requester HCP submits the referral request with the required information and clinical documentation. The eReC Source transmits the referral request to the Performer HCP and an electronic notification is sent to the Patient that the referral request has been sent.

   The eReC Source could be i) an EMR/HIS which has the capability to directly manage eReferrals (the system is both a POS system and eReC Source) or ii) an external Referral Management System (RMS) (the eReC Source is integrated with the Requester HCP POS System).

6. The eReC Target receives the referral request. The Performer HCP receives a notification about the new referral request and reviews the request.

   The eReC Target could be i) an EMR/HIS which has the capability to directly manage eReferrals (the system is both a POS system and eReC Target) or ii) an external Referral Management System (RMS) (the eReC Target is integrated with the Performer HCP POS System).

7. Performer HCP contacts the patient to arrange an appointment. After the appointment is scheduled, the eReC Target transmits an update to the eReC Source. The Requester HCP receives a notification that the appointment has been booked.

8. Performer HCP completes the initial consultation appointment with the patient and closes the eReferral request. The eReC Target transmits an update to the eReC Source. The Requester HCP receives a notification that the appointment has been completed.

Use Case - Alternate Flows

The following list provides possible alternate flows that may occur within this use case.

1. Requester HCP may cancel/revoke the referral request. This status is noted in eReC Source and automatically forwarded to eReC Target. (Step 6 – 7)
2. Performer HCP may be unable to provide the service and decline the referral, this status is noted in their eReC Target and automatically forwarded to eReC Source. (Step 6 – 7)
3. Performer HCP and Requester HCP may update the referral request (e.g. send communications, update referral with new information, etc.). (Step 6 – 8)
4. Performer HCP may convert a referral to a consultation (providing advice to the Requester HCP instead of an appointment with the patient - See UC-02: Consultation Request). (Step 6)
5. Patient may decline the service and the status is notified in the eReC Source. (Step 6 – 8)
6. Patient may change the appointment date. (Step 7)