Technical Specifications > Supporting Workflow

Supporting Workflow

The technical specifications in this IG provide building blocks that can be used to construct many different integration patterns, a few of which are illustrated on a previous page. This page illustrates how patterns can be applied to the three use cases in this IG. (The intent is to help implementers think through different integration approaches rather than to be prescriptive.)

Use Case 1: Referral to Service

Use Case #1 in this IG describes a scenario where Dr. Jones, a family doctor, uses a referral management system (RMS) integrated with a point of service system (POS) containing his patient's electronic medical record to select a service provider and initiate a referral to a housekeeping service.

Relevent Pattern #1: POS launches RMS Source

When configured as a SMART Server, a POS could launch an RMS SMART App with Direct Messaging in an iFrame or web browser to provide its users with access to the specialized functionality of an RMS to enable electronic referrals to a broad range of specialists and healthcare service providers accross the province.

Relevent Pattern 2: POS receives information via Direct Messaging

When configured to receive information via a Direct Messaging endpoint, a point of service system can receive notifications about referrals and/or appointments from an RMS for inclusion in a patient's chart, to initiate workflow or for other purposes.

Relating the integrations to the Use Case: The steps from the use case are included below.

Step	Description	Role of the integrations
1.	Patient visits Primary Care Physician (PCP) as a follow-up from an ER encounter.
2.	Upon consultation, the Patient and PCP agree that the Patient would benefit from in-home housekeeping services.
3.	PCP searches for and selects an appropriate service from a Services Catalogue, which is integrated with the EMR and the PCP’s Referral Management System (RMS).	A SMART Integration between a POS and RMS can enable the POS user to launch the RMS application (in an iFrame or web browser tab) with patient and user context from the POS. This uses: - the OAuth2 Authorization Framework to grant the newly launched RMS application access to the POS' FHIR endpoint to retrieve information about the user and patient; and - OpenID Connect with user identify data retrieved from the POS FHIR endpoint to sign the POS user into the RMS system. Benefit: The PCP is able to access the service catalogue and other specialized functionality provided by the RMS to search for providers and initate a request directly from the EMR without having to browse to or log in to a separate software application.
4.	PCP is presented with and completes the appropriate referral form for the Service Provider. Some of the data in the form has been automatically filled-in from the integrated EMR.	Using the SMART Integration with the POS, the RMS application can use the POS system's FHIR endpoint to retrieve patient demographic and clinical data needed to create a ServiceRequest. Benefit: The RMS is able to auto-populate referral forms on behalf of the PCP using information from the patient's record in the EMR, improving workflow.
5.	PCP submits the form to the Service Provider’s RMS. This also sends an email to patient, confirming the referral request.	Where the Service Provider and PCP use different RMS Systems, Direct Messaging can be used to transmit a referral request and supporting information from the RMS Source system used by the PCP to the RMS Target system used by the Service Provider. Benefit: The PCP can request services from a range of different service providers participating in different referral networks.
6.	The Service Provider is notified of the incoming referral by their Referral Management System and contacts the patient to arrange housekeeping services.
7.	PCP is notified in their RMS and EMR of the date of the first patient encounter when it is arranged by the Service Provider.	Using Direct Messaging RMS Target can send notifiations to the RMS Source as the request is performed and compleded, including inforation about appointments scheduled. Where the POS also has a Direct Messaging endpoint, an RMS Source system can provide notifications to the POS system when a request is created or updated to store alongside other information in the patient's chart. Benefit: The integrations maintain a current record of referrals and related information in the different systems the PCP uses for referral management and to maintain the patient's record.

Use Case 2: Referral to Service with Booked Appointment

Use Case #2, describes a scenario where a nurse practitioner uses a referral management system (RMS) integrated with a point of service system (POS) containing her patient's electronic medical record to select a service provider, initiate a referral, and book an appointment.

Relevent Pattern: RMS Source launches RMS Target

When configured as a SMART Server with Direct Messaging, an RMS SMART App can launch other RMS SMART Apps to provide its users with access to intake forms and other functionality offered by the RMS systems used by other service providers to assist in the creation of requests that are then managed locally.

Relevent Pattern 2: POS receives information via Direct Messaging

When configured to receive information via a Direct Messaging endpoint, a point of service system can receive notifications about referrals and/or appointments from an RMS (Source or Target) for inclusion in a patient's chart, to initiate workflow or for other purposes.

Relating the integrations to the Use Case: The steps from the use case are included below.

Step	Description	Role of the integrations
1.	Patient visits Nurse Practitioner (NP) as a follow-up from previous discussions.
2.	Upon consultation, the Patient and NP agree that the Patient would benefit from a structured exercise program.
3.	The NP searches for and selects an appropriate Exercise Program from a Services Catalogue, which is integrated with the EMR and with the NP’s Referral Management System (RMS).	A SMART Integration between the POS and RMS Source can provide the user of a POS system with access to a service catalogue and other specialized functionality provided by the RMS with a secure, RESTful data connection in the background. Benefit: The NP is able to access the service catalogue and other specialized functionality provided by the RMS to search for providers and initate a request directly from the EMR without having to browse to or log in to a separate software application.
4.	The RMS presents the NP with an appropriate two part form for the selected service, and the NP completes the first part. Part one of the form is based on the service details in the Services Catalogue, and some of the data in the form has been automatically filled-in from the integrated EMR.	A SMART Integration between the POS and RMS Source can enable the RMS Source to populate the referral forms behalf of the user using information from the POS. Benefit: The RMS is able to auto-populate referral forms on behalf of the NP using information from the patient's record in the EMR, improving workflow.
5.	The Service Provider’s RMS immediately provides the second part of the form for the Patient and NP to complete. Part 2 of the form includes real-time information from the service provider, such as available appointment slots, and other service-specific details such as clinical decision support information and additional data requirements that may not have been included in the more generic Service Catalogue information. In consultation with the Patient the NP selects an appointment date, completes Part 2 of the form and submits it.	A SMART Integration between two RMS systems can enable an RMS Source system to launch the RMS Target application (in an iFrame or web browser tab) to present appointment scheduling functionality to the POS user. Either Direct Messaging or the RESTful data connection between the two RMS systems could be used to associate the ServiceReqeust created in the RMS Source with the Appointment created in the RMS Target. Benefit: The functionality of multiple different RMS systems can be made available to the NP through multiple user interface integrations, secure data connections in the background allow information to move between the different systems and user interfaces.
6.	The NPs integrated RMS informs the Patient by email that the referral has been sent to the Exercise Program Service Provider, and the Service Provider’s RMS provides the Patient with the appropriate appointment information along with a link to change the date if needed.
7.	The Service Provider is notified of the incoming referral by their RMS, the appointment date, and that the Patient has already accepted to appointment date.
8.	The NP is automatically updated in both their EMR and their integrated RMS of status changes related to the referral to the Exercise Program.	Direct Messaging integrations between the two RMS systems and from the RMS to the EMR can keep the users of different systems up to date. Benefit: The integrations maintain a current record of referrals and related information in the different systems the NP uses for referral management and to maintain the patient's record.

Use Case 3: Referral to Home and Community Care through Care Cordinator

Use Case #3, describes a scenario where Dr. Jones, a family doctor, uses a referral management system (RMS) integrated with a point of service system (POS) containing his patient's electronic medical record to select a service provider and initiate a referral to personal support service option and the home safety assessment option. The request is directed to a care coordinator who receives the referral, contacts the patient, performs an assessment, creates a service plan, requests services from additional providers and sends the details back to Dr. Jones.

Relevent Patterns:

Relevent Pattern #1: POS launches RMS Source

A POS configured as a SMART Server could launch an RMS SMART App with Direct Messaging in an iFrame or web browser to initiate the referral process.

Relevent Pattern 2: Chained API integrations

A Chained API Integration could provide an RMS system used by a care coordinator in an assessment centre with the ability receive requests, create new requests for other service providers based on requests being performed, send requests on to other RMS systems, with notifications going back to the original requester.

Relevent Pattern 3: POS receives information via Direct Messaging

When configured to receive information via a Direct Messaging endpoint, a point of service system can receive notifications about referrals and/or appointments from an RMS (Source or Target) for inclusion in a patient's chart, to initiate workflow or for other purposes.

Relating the integrations to the Use Case: The steps from the use case are included below.

Step	Description	Role of the integrations
1.	Patient visits Primary Care Physician (PCP) as a follow-up from an ER encounter
2.	Upon consultation, the Patient and PCP agree that the Patient would benefit from home care services.
3.	PCP searches for and selects an appropriate service from a Services Catalogue, which is integrated with the EMR and the PCP’s Referral Management System (RMS).	A SMART Integration between the POS and RMS Source can provide the user of a POS system with access to a service catalogue and other specialized functionality provided by the RMS with a secure, RESTful data connection in the background. Benefit: The PCP is able to access the service catalogue and other specialized functionality provided by the RMS to search for providers and initate a request directly from the EMR without having to browse to or log in to a separate software application.
4.	PCP is presented with and completes the appropriate referral form for the Service Provider. Some of the data in the form has been automatically filled-in from the integrated EMR.	As in the prior cases, a SMART Integration between the POS and RMS Source can enable the RMS Source to populate referral forms behalf of the user using information from the POS. Benefit: The RMS is able to auto-populate referral forms on behalf of the PCP using information from the patient's record in the EMR, improving workflow.
5.	PCP submits the form to the Service Provider’s RMS. This also sends an email to patient, confirming the referral request.	A Direct Messaging integration between the RMS systems can be used to transmit information from the RMS Source to the RMS Target. Benefit: The PCP can request services from a range of different service providers participating in different referral networks.
6.	The Care Coordinator (the recipient) is notified of the incoming referral by RMS Target and reviews the referral details.
7.	The Care Coordinator confirms the referral acceptance in RMS Target and the message along with any optional note is conveyed to the PCP by the RMS Source.	Direct Messaging integrations between the two RMS systems can be used to keep information about the request current. Benefit: The PCP is kept in the loop as the request is performed.
8.	Upon assessing the patient for home care services the Care Coordinator creates the service plan and orders services from an SPO.	Chained API integration allow an RMS system used in an assessment centre to perform both as both an RMS Target and RMS Source. Benefit: The Care Coordinator can receive referrals and send referrals from the same system, creating associations between them.
9.	The Care Coordinator updates the referral status to Completed in the RMS Target and includes the ordered service details in the communication as a service summary, identifying that ACME will start delivering the requested services on a certain date.
10.	The RMS Target sends the referral status update including the service summary and any additional details specified by the Care Coordinator to RMS Source system.	The Direct Messaging integrations between the two RMS systems can be used to provide the RMS Source system about service outcomes, associating information from the service provider and new requests with the original. Benefit: The PCP is has access to information about the services performed and ordered.
11.	The RMS Source notifies the PCP in their EMR of the referral update and at the same time notifies the Patient by email of the referral outcome.	A Direct Messaging integration from the RMS to the POS can be used to keep the patient record up to date and/or trigger workflow. Benefit: The integrations maintain a current record of referrals and related information in the different systems the PCP uses for referral management and to maintain the patient's record.

Use Case #4: Consultation Request

Use Case #4 describes a scenario where a family physician uses a referral management system (RMS) to search for healthcare services and/or specific providers to whom an eConsult request is to be directed towards.

Relevant Pattern #1: RMS Receives Information via RESTful Interactions and Direct Messaging

RMS Source queries

Step	Description	Role of the integrations
1.	Patient visits Primary Care Physician (PCP) with a complaint about pain.
2.	After reviewing imaging in patient chart, the PCP seeks input from urologist.
	Variation 1
3.a)	Using a Services Catalogue which is integrated with the EMR and the PCP’s Referral Management System (RMS), the PCP selects the BASE Managed Specialty model to search for the recipient of the case.	A RESTful Integration between RMS Systems can enable querying of service directories between systems. Benefit: The PCP can access the service catalogue and other specialized functionality provided by the RMS to search for services and initiate a request directly from the RMS without having to browse to or log in to a separate software application.
	The PCP selects Urology and Urology - General as the specialty and sub-specialty for the service.
	The solution auto selects a default Base Managed Specialty based on location. (The PCP has the option to override the default selection.)
	The PCP writes the question for the specialist, attaches an image and other notes to support the request.
	The PCP submits the consultation request.	A Direct Messaging integration between the RMS systems can be used to transmit information from the RMS Source to the RMS Target. Benefit: The PCP can request services from a range of different service providers participating in different referral networks.
	The PCP receives a notification in the EMR that the request was successfully submitted.	Once Direct Messaging is established, an RMS Source system can provide notifications to the POS system when a request is created or updated to store alongside other information in the patient's chart. Benefit: The PCP has a current record of consults and related information in the various systems they use.
	Case Assigner assigns case to Urologist, or the case gets automatically assigned by the system.
	Variation 2
3.b)	The PCP searches for and selects a specific Uroglogist.	A RESTful Integration between RMS Systems can enable querying of providers. Benefit: The PCP can access the service catalogue and other specialized functionality provided by the RMS to search for specialists (like a Urologist) and initiate a request.
	The PCP writes the question for the specialist, attaches an image and other notes to support the request.
	The PCP submits the consultation request.	Direct Messaging Integration can be used to transmit a consult request and supporting information from the RMS Source system used by the PCP to the RMS Target system used by the Service Provider. Benefit: The PCP can request services from a range of different service providers participating in different referral networks.
	The PCP receives a notification in the EMR that the request was successfully submitted.	Through Direct Messaging Integration, RMS Target can send notifications to the RMS Source as the request is performed and completed. Benefit: The integrations maintain a current record of consult requests and related information in the different systems the PCP uses for request management.
	After Case Assignment
4.	The Assigner of the Specialty group receives an email notification for the new case, logs into the OTN web application. The Assigner view the case alongside others pending assignment. The Assigner assigns the case to a Specialist.	A Direct Messaging Integration allows the RMS Target to send notifications to the RMS Source to view pending assignment requests. Benefit: The assigner can see an up-to-date record of cases and related information for case assignment and management.
5.	The Specialist receives an email notification on the arrival of the new case.	A Direct Messaging Integration can allow the Service Provider to receive notifications about the referral in their RMS Target system. Benefit: The specialist can receive the updates of case arrivals real-time through the system.
6.	The Specialist responds to the consult by entering in notes and/or attachments into the RMS system.	A Direct Messaging Integration can allow the specialist to enter notes regarding the referral in their RMS Target system. Benefit: The specialist can enter or update their notes and/or attachments (i.e. images) of the patient as needed through the system using direct messaging.
7.	The Specialist is prompted to enter in time spent on the case and answer other survey questions.	A Direct Messaging Integration can allow the specialist to enter their responses to surveys within RMS Target system. Benefit: The specialist can enter or update the time they spent on cases within the system.
8.	The PCP receives an email notification indicating that a consult has been provided.	A Direct Messaging Integration can allow the Service Provider to receive notifications about the referral in their RMS Target system. Benefit: The PCP can receive the services referral updates and provide those to the patient as needed through the system using direct messaging.
9.	Using the EMR and the Referral Management System (RMS), the PCP reviews the response, is satisfied with the information, and completes the case.	A Direct Messaging integrations between the two RMS systems can be used to provide the RMS Source system information about service outcomes, associating information from the service provider and new requests with the original. Benefit: The PCP is has access to information about the services performed and ordered.
10.	Upon case completion, the PCP is prompted to fill out a survey which helps to measure the performance of the eConsult application. The PCP also provides feedback to the Specialist.	A Direct Messaging integration from the RMS to the POS can be used to keep the patient record up to date and/or trigger workflow. Benefit: The integrations maintain a current record of referrals and related information in the different systems the PCP uses for referral management and to maintain the patient's record.