Referral Splitting

With some referral pathways, Patients may be referred to a listing and with more than one Health Service Category requested e.g. CT and MRI. In these cases, depending on the receiving site’s workflow, the referral could be split into 2 or more referrals – depending on the number of HSCs selected. Depending on the site’s configuration, the referrals can be split automatically or manually. More information on referral splitting can be found in this [article](https://welllifestyles.sharepoint.com/sites/OceanMDDocumentManagement/Shared Documents/04_Product & Interoperability/Integrations/Playbook/- https:/support.cognisantmd.com/hc/en-us/articles/360056059111-What-happens-when-an-eReferral-is-sent-with-more-than-one-Health-Service-Offering-requested-eReferral-Splitting).

Ocean FHIR APIs also support the referral splitting workflows and it is reflected in the payloads which are sent to the receiving system. Typically, 2+ sets of payloads are generated upon the eReferral splitting creation which is described below.

Automatic Splitting

• Source referral will have all the Patient's requested HSC’s i.e. CT, US
  • Payload is not sent for source referral only child referrals
  • Adding a note on the source referral doesn't get sent in any payloads in Ocean
  • Demographic updates made on the source referral gets sent for each child referral
• Child referral will have the Patient's HSC’s broken down e.g. 2 child referrals: 1 CT, 1 US
  • Payload is sent for each child referrals
  • Payload will only include service request of child referral it's sent for AND service request for source referral. Therefore, you wouldn't be able to find the service request for other child referrals in another child referral's payload.
  • The service request of the child referral will be ‘basedOn’ the service request of the source referral
  • When a note is added on the child referral, previous notes added on the source referral and/or other child referrals don't get sent upstream
  • Demographic updates added on child referrals gets reflected in other child referrals and sent in the payloads

Manual Splitting

• Source referral
  • Payload is sent for source referral
  • Adding a note on source referral prior to the split gets sent in the source referral payloads
  • Following split, previous source referral note gets removed from the payload
  • Subsequent behaviour mimics Automatic splitting

Figures are obtained from the same eReferral payload. Figure a (left) shows a child referral’s ServiceRequest resource with a “basedOn” element referring to the parent referral’s ServiceRequest in addition to highlighting the HSC for the child referral. Figure b (right) shows the parent referral’s ServiceRequest resource, highlighting the two child referrals HSC’s which were generated.