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.
See Participants for more information.
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 toServiceRequest.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
- Specialty or Performer (Triage Site), including related service zone
The updated referral cannot change the referral's Specialty (
ServiceRequest.categoryandHealthcareSerivce.typeor Performer (Triage Site). If the referral should have been directed to a different Specialty or 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 timestamps, such as the submitted date (ServiceRequest.authoredOn) or received date The submitted date cannot be updated. The Central RMS assigns and maintains other referral timestamps.
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
| Element | Value |
|---|---|
| Bundle.meta.extension.submissionMetadata | metadata for: Submitting Site; EMR Vendor Name; EMR Product Name; Submission Implementation Guide (IG) Type; Submission Implementation Guide (IG) Version; Service Delivery Site; Authoring Provider ID |
| Bundle.id | UUID |
| Bundle.meta.lastUpdated | date/time |
| Bundle.meta.security | "R" |
| Bundle.identifier.value | UUID |
| Bundle.identifier.system | "urn:ietf:rfc:3986" |
| Bundle.type | "message" |
| Bundle.timestamp | current date/time |
| Bundle.entry:MessageHeader | MessageHeader |
| Bundle.entry:Focus | ServiceRequest |
| MessageHeader.id | UUID |
| MessageHeader.meta.lastUpdated | date/time |
| MessageHeader.eventCoding | "notify-update-service-request" |
| MessageHeader.destination.endpoint | CAT RMS endpoint |
| MessageHeader.author.reference | Requester HCP UUID |
| MessageHeader.author.type | "PractitionerRole" |
| MessageHeader.source.endpoint | Requester HCP endpoint |
| MessageHeader.reason | as appropriate |
| MessageHeader.focus | ServiceRequest |
| ServiceRequest.identifier.value | provincial identifier |
| ServiceRequest.identifier.system | "https://fhir.alberta.ca/NamingSystem/ca-ab-eref-id" |
| ServiceRequest.identifier.use | "official" |
| ServiceRequest.status | "active" |
| ServiceRequest.intent | "proposal" |
| ServiceRequest.category | as previously valued or updated |
| ServiceRequest.priority | as previously valued or updated |
| ServiceRequest.priority.extension.subPriority | as previously valued or updated |
| ServiceRequest.code | as previously valued or updated |
| ServiceRequest.subject.identifier.value | Patient identifier |
| ServiceRequest.subject.identifier.system | as appropriate |
| ServiceRequest.authoredOn | as previously valued |
| ServiceRequest.requester.reference | Requester HCP UUID |
| ServiceRequest.requester.type | "PractitionerRole" |
| ServiceRequest.performer.identifier.value | 1) CAT identifier (HealthcareService) |
| ServiceRequest.performer.identifier.system | "https://fhir.alberta.ca/NamingSystem/ca-ab-eref-healthcare-service-id" |
| ServiceRequest.performer.extension.role | "central-intake" |
| ServiceRequest.performer.reference | 2) Performer HCP UUID |
| ServiceRequest.performer.type | "PractitionerRole" or "HealthcareService" |
| ServiceRequest.performer.extension.role | "receiving-provider" or "service-location" |
| ServiceRequest.reasonCode.text | as previously valued or updated |
| ServiceRequest.supportingInfo | as previously valued or updated |
| ServiceRequest.note.text | as previously valued or updated |
| ServiceRequest.extension.referralTimestamp.extension.timestamp | as previously valued |
| ServiceRequest.extension.referralTimestamp.extension.timestampType | as previously valued |
| ServiceRequest.extension.patientPreference.extension.preferenceType | "preferred" |
| ServiceRequest.extension.patientPreference.extension.preferenceValueType | as previously valued or updated |
| ServiceRequest.extension.patientPreference.extension.preferenceValue | as previously valued or updated |
| ServiceRequest.extension.patientPreference.extension.rationale | as previously valued or updated |
Step 3: CAT sends unsolicited update from Requester HCP to Performer HCP
Same as Step 1 above with changes as below:
| Element | Value |
|---|---|
| MessageHeader.destination.endpoint | Performer HCP EMR endpoint |
| MessageHeader.source.endpoint | CAT RMS endpoint |