UKCore Hackathon Supporting Guide

Referral

Asking a provider to request a procedure or diagnostic or other service.

UK Core Profiles

• UKCore-ServiceRequest
• UKCore-Task

Frameworks and Implementation Guides

• FHIR Workflow is alternative to traditional messaging which is built on top of a shared patient records Query Patient Care Data

Specifications

• Booking and Referral - FHIR API
• e-Referral Service - FHIR API
• Electronic Prescription Service - FHIR API

Referrals and Test Orders

In FHIR these are collectively known as ServiceRequest. It is the method where service is requested for a patient. This is typically between different health or social care sercices. When a ServiceRequest is performed this normally results in a Procedure or DiagnosticReport being returned to the requester. However it is common for a letter or document to be returned back. For example in NHS England systems, both electronic Referral Service (eRS) and Transfer Of Care (TOC) are often used together as one process:

1. A referral is made together with supporting documentation and this is recorded on eRS
2. eRS acts as a brokering service and helps get the referral actioned. The tasks are known as worklist items.
3. An Outpatient or Discharge letter (TOC), is sent back to the requester.

This is different to HL7 v2 workflow where in pathology:

1. The ServiceRequest or Test Order is sent using OML_O21 - Laboratory Order
2. The DiagnosticReport is sent back using ORU_R01 - Unsolicited transmission of an observation message

The main difference betwween HL7 FHIR and v2 is:

1. The request is ideally shared by the system creating the request and is not sent.
2. The ask which is sent, is a fulfilment Task. This allows communication between the requester and the intended performer. This communication normally starts with a fulfilment Task being requested and the performer will respond with either a accepted response if they are going to perform the request or a rejected response with reasons why they are not performing the request.

In FHIR this is represented as:

1. The referral is represented as a ServiceRequest when shared from a EPR system.
2. The Task resource is sent to the intended performer of the referral, this contains a link to the shared ServiceRequest. (This is quite different from the letter based approaches in previous standards.)
3. The referral is actioned according to local procedures and when completed a Task indicating the referral is complete is sent back. Ideally the results of the referral would be shared as a DiagnosticReport but this may take other formats potentially PDF.

ServiceRequest is part of FHIR Workflow and is classed as a request resource. The returned response to the ServiceRequest is classed as an event resource.