Profile: ServiceRequest

AB:eReC Simplifier Project Page: ServiceRequest (AB:eReC)

Derived from CA:eReC ServiceRequest

Views of Profile Content

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RoutingOptionsC0..*Extension(CodeableConcept)
CopiedParticipantsC0..*Extension(Reference(PractitionerRole))
ServiceProviderPreferenceC0..*Extension(Complex)
referralTimestampS C0..*Extension(Complex)
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reasonReferenceΣ C0..*Reference(Condition | DiagnosticReport | DocumentReference | Observation)
insuranceC0..*Reference(ClaimResponse | Coverage)
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systemS Σ1..1uri
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displayΣ0..1string
timeS Σ1..1dateTime
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patientInstructionΣ0..1string
relevantHistoryC0..*Reference(Provenance)

Restrictions

Alberta eReferral and eConsult (AB:eReC) employs a set of constraints on the Bundle (AB:eReC) Profile that prevents referrals and consults created in Alberta to include certain elements from ServiceRequest.

ServiceRequest records sent in an AB:eReC Bundle SHALL NOT contain any of the following ServiceRequest details:

  • .contained
  • .encounter
  • .reasonReference
  • .insurance
  • .specimen
  • .relevantHistory

These elements are restricted based on current privacy requirements that require data that is collected, used or disclosed be limited to only the amount of health information that is essential to enable the custodian or the recipient of the information to carry out the intended purpose.

Usage

Information about a healthcare provider's request for a service to be performed for a patient.

The ServiceRequest resource contains the key information about a service being requested (such as eReferral or eConsult), who requested it, which patient it's for, who is assigned to perform, and the nature of the service being requested.

Notes

.id

  • TESTED element
  • an identifier for the ServiceRequest resource, unique within the submitted bundle
  • SHALL have an .id that is unique for the point-in-time submission. This allows cross-referencing between related resources when sent together in a Bundle; and is used by systems to track the information being sent or received
  • if a persistent identity for the resource is not available to use when constructing a Bundle for transmission, a UUID SHOULD be used in this element (with a corresponding value in Bundle.entry.fullUrl)

.meta

  • TESTED element
  • metadata about the ServiceRequest resource, relevant to the submission or data exchange.
  • .lastUpdated
    • TESTED element
    • the date and time when the service request` was last updated, spanning all contained resources and data elements
    • contains the create-date for a new request, or the date when it was most recently updated by the referring provider or by any workflow participant authorized to create or change the request

.identifier

  • TESTED element
  • one or more version-independent identifiers for the ServiceRequest resource
  • different participants may each assign their own identifier (e.g., referring provider or service provider)
  • SHALL always be populated
  • Submitting EMR (Source System)
    • SHALL assign its own identifier prior to submission to facilitate matching the provincially-assigned identifier to its own records
    • SHALL use UUID for .value and SHALL use "urn:ietf:rfc:3986" for .system
  • Central RMS
    • when the Central RMS receives a submitted referral, it will assign the eReferral provincial identifier that will be sent back to the submitting EMR (along with the initially submitted identifier)
    • Submitting EMRs SHALL use only the eReferral provincial identifier from that point forward - as that ensures traceability to/from the receiving EMR as well
  • Receiving EMR (Target System)
    • SHALL use only the eReferral provincial identifier received from the Central RMS
  • .use
    • TESTED element
    • the purpose of the identifier
    • SHALL always be populated with "official" for Central RMS assigned/eReferral provincial identifier
  • .system
    • TESTED element
    • the namespace / naming system used for this service request identifier
    • SHALL always be populated
    • SHALL use URI from Service Identifier Naming System for Central RMS assigned/eReferral provincial identifier
  • .value
    • TESTED element
    • the value of the assigned service request identifier
    • SHALL always be populated

.basedOn

  • CONDITIONALLY TESTED element
  • links this particular ServiceRequest to another existing ServiceRequest, when both are explicitly linked
  • .reference
    • CONDITIONALLY TESTED element
    • a reference to the associated ServiceRequest resource within the Bundle
  • .type
    • CONDITIONALLY TESTED element
    • identifies the type of FHIR resource used to convey the request's information
  • .identifier
    • CONDITIONALLY TESTED element
    • .type
      • the type of request identifier, to ensure correct interpretation and usage of the identifier value
    • .system
      • CONDITIONALLY TESTED element
      • the namespace / naming system used for this request identifier
    • .value
      • CONDITIONALLY TESTED element
      • the value of the assigned request identifier

.replaces

  • CONDITIONALLY TESTED element
  • the service request that this request is a replacement for
  • the Central RMS SHALL populate this with the ServiceRequest.identifier assigned by the Submitting EMR specifically when notifying the Submitting EMR that the service request has been added to the Central RMS
  • when valued, the following SHALL populated:
    • .identifier
      • CONDITIONALLY TESTED element
      • .value
        • the value of the assigned request identifier
        • CONDITIONALLY TESTED element
      • .system
        • the namespace / naming system used for this request identifier
        • CONDITIONALLY TESTED element

.status

  • TESTED element
  • the workflow state of the service request
  • SHALL always be populated
  • a nationally-defined set of standard workflow status values cannot be modified or extended with additonal values. More granular workflow states are captured in Task.businessStatus
  • is used primarily to indicate whether the request is active or not
  • for referrals and eConsult requests, will be set to "active" when submitted and will remain in that state until "completed" or "revoked"

.intent

  • TESTED element
  • the intention and authorization underlying the service request, indicating how it should be received and acted upon
  • SHALL always be populated with fixed value of "proposal"
  • a nationally-defined set of standard values cannot be modified or extended. The value of "proposal" is standard for referral and eConsult requests

.category

  • TESTED element
  • A coded value that represents the specialty being requested for the referral or eConsult
  • same value as the HealthcareService.specialty
  • SHALL always be populated
  • value SHALL match a code in the associated value set, otherwise, the service request will be rejected

.priority

  • TESTED element
  • the priority with which the service request should be addressed with respect to other requests
  • SHOULD default to "routine" in source / submitting systems
  • "urgent" is accepted if the source system has some mechanism to prompt or instruct parallel use of urgent referral pathways (e.g. RAAPID, etc.)
  • "asap" and "stat" SHALL NOT be used for electronic referrals or eConsults
  • extension.subPriority
    • TESTED element
    • used for "semi-urgent" priority; otherwise this SHALL NOT be valued
    • when extension.subPriority is valued with "semi-urgent", .priority SHALL be valued as "urgent"

.code

  • TESTED element
  • a code or text description identifying the type of service being requested
  • expected to be populated from the provincially published list of referral reason codes that are eligible for electronic submissions
  • NOTE: The source code system is proprietary to Alberta and the codes listed are only a few examples. Contact HISCA at hisca@gov.ab.ca for information on how to obtain the complete list
  • SHALL always be populated
    • .coding
      • TESTED element
      • .code
        • TESTED element
        • a codified value that represents the type of service being requested
        • SHALL always be populated
      • .system
        • TESTED element
        • the terminology system used by the code
        • SHALL always be populated
    • .text
      • TESTED element
      • the name or textual description of the type of service being requested
      • SHOULD be populated with the published text from Alberta Health to EMRs accompanying the allowed codes

.subject

  • TESTED element
  • a reference to the Patient resource of the submitted service request, specifying that the patient is the subject of the requested service
  • SHALL always be populated
  • .reference
    • TESTED element
    • a reference to the associated subject (patient) resource within the submission bundle
  • .type
    • TESTED element
    • identifies the type of FHIR resource used to convey the subject's information
  • .identifier
    • TESTED element
    • .system
      • TESTED element
      • if .identifier is populated, this SHALL always be populated
    • .value
      • TESTED element
      • if .identifier is populated, this SHALL always be populated

.authoredOn

  • TESTED element
  • the date and time when the service request was created from the source system's information and submitted for action
  • once this date is assigned, it SHALL NOT be updated

.requester

  • TESTED element
  • a reference to the PractitionerRole resource for the provider requesting the service, specifying the requesting healthcare provider's role, services, and location for the purpose of this service request
  • SHALL always be populated
  • .reference
    • TESTED element
    • a reference to the associated healthcare provider role resource within the submission Bundle
  • .type
    • TESTED element
    • identifies the type of FHIR resource used to convey the requester's information

.performer

  • TESTED element

  • a reference to the resource of the performer requested to fulfill the service

  • Submitting EMR (Source System)

    • SHALL use HealthcareService to represent CAT as performer
  • Central RMS (Source System)

    • SHALL use PractitionerRole to assign to a specific provider or SHALL use HealthcareService to assign to service location
  • SHALL always be populated

  • .reference

    • TESTED element
    • a reference to the associated resource within the submission bundle
  • type

    • TESTED element
    • identifies the type of FHIR resource used to convey the requested performer's information
  • .identifier

    • TESTED element
    • .system
      • TESTED element
      • the namespace / naming system used for this service request identifier
      • if .identifier is populated, this SHALL always be populated
    • .value
      • TESTED element
      • the value of the assigned service request identifier
      • if .identifier is populated, this SHALL always be populated
  • when performer is a CAT or a service location, a valid HealthcareService.identifier SHALL be provided, otherwise the service request will be rejected

  • .extension.role

    • TESTED element
    • indicates the role that the performer takes (e.g. central intake) and distinguishes the CAT from a service location
  • additional guidance when the CAT sends an update on the service record to the referring provider (i.e. when CAT sends the eReCm-11 message to Requester HCP)

Scenario Content of ServiceRequest.performer
CAT assigned the service request to a receiving provider The CAT designated by referring provider and the receiving provider SHALL be included
CAT assigned the service request to a service location The CAT designated by referring provider and the service location SHALL be included
CAT assigned the service request to another CAT Only the new CAT SHALL be included
CAT reassigned to another receiving provider or service location The CAT designated by referring provider and only the newly assigned receiving provider or service location SHALL be included

.reasonCode

  • TESTED element
  • the clinical question on which the requesting provider is requesting consultation; in more general terms, the requesting provider's rationale for requesting the service
  • SHALL always be populated
  • .text
    • TESTED element
    • a text description of the requesting provider's rationale for requesting the service; or additional information about why advice is being sought for an eConsult
    • SHALL always be populated

.supportingInfo

  • TESTED element

  • DocumentReference resource

    • SHALL be used when information is one or more attached files ("Documents") containing the referral letter and any supporting investigations (e.g. lab/DI results) that supports the service request
    • depending on source system capabilities, all information MAY be bundled into a single attached file vs separate attachments for each (letter, test result, etc.)
    • attachment file size SHALL be limited to 30 MB maximum per file for a referral submission with a maximum 150 MB total
    • every referral SHOULD have at least one attached document for the referral letter - as not all required information can be captured through discrete elements in electronic referrals
  • Communication resource

      1. SHALL be used when the information is captured only as "notes" content rather than a file attachment
      1. SHALL also be used for special considerations relevant to the referral (e.g., patient's physical, psychological, social and/or economic situation) that the requesting provider chooses to include
        • Communication.category SHALL be valued with "sc" when supporting information is for special consideration
        • Note: this information will appear in Netcare as part of the referral record
        • Note: this information was captured in ServiceRequest.note in previous version of this specification
  • .reference

    • TESTED element
    • a reference to the associated document or other allowed resource within the submission bundle
  • .type

    • TESTED element
    • identifies the type of FHIR resource used to convey the supporting information
  • .identifier

    • TESTED element
    • .system
      • TESTED element
      • the namespace / naming system used for supporting information identifier
      • if .identifier is populated, this SHALL always be populated
    • .value
      • TESTED element
      • the value of the assigned supporting information identifier
      • if .identifier is populated, this SHALL always be populated

.note

  • TESTED element
  • explanatory note provided by referring provider or other workflow participant (e.g. explanation when service request is revoked or reason referral is updated)
  • Note: This element was used in previous version of this specification to capture the special consideration that referring provider includes. See .supportingInfo for where this element is now captured
  • when populated:
    • .text
      • TESTED element
      • SHALL always be populated
    • .time
      • TESTED element
      • SHALL always be populated
    • .authorString
      • TESTED element
      • SHALL be populated when CAT is the author of the note
    • .authorReference
      • TESTED element
      • SHALL be populated when referring provider and/or service provider is the author of the note

Extensions

.RequestStatusReason

  • TESTED element
  • used to provide a reason for the status and/or status change (e.g. to revoked) to be documented

.referralTimestamp

  • CONDITIONALLY TESTED element
  • zero or more timestamps of interest during the referral workflow
  • approppriate timestamp SHALL be populated when the corresponding event has taken place (e.g. when CAT has received the referral)
  • the CAT SHALL be the only one that would assign these timestamps
  • if populated,
    • extension.timestamp
      • CONDITIONALLY TESTED element
      • the date and time of the referral activity
      • SHALL always be populated
    • extension.timestampType
      • CONDITIONALLY TESTED element
      • identifies the type of referral activity associated with the date and time (e.g., referral received)
      • SHALL always be populated

.patientPreference

  • CONDITIONALLY TESTED element
  • zero or more patient preferences; if the patient has multiple preferences of the same preferenceType and preferenceValueType, such as multiple preferred locations, list them in the same preferenceValue element
  • SHALL only be populated if patient prefers a provider or location other than "next available"
  • if populated,
    • extension.preferenceType
      • CONDITIONALLY TESTED element
      • identifies the type of preference being expressed (e.g., preferred, excluded, etc.)
      • SHALL always be populated
    • extension.preferenceValueType
      • CONDITIONALLY TESTED element
      • Identifies what is being preferred (e.g., provider, location, etc.)
      • SHALL always be populated
    • extension.preferenceValue
      • CONDITIONALLY TESTED element
      • the patient's expressed preference
      • SHALL always be populated
    • extension.rationale
      • CONDITIONALLY TESTED element
      • the patient's expressed reason for the preference
      • SHOULD be provided

Unused if submitted

  • .requisition
  • .doNotPerform
  • .orderDetail
  • .quantity
  • .subject.display
  • .occurence
  • .asNeeded
  • .performerType
  • .locationCode
  • .locationReference
  • .bodySite