DRAFT - The specification is currently in development and subject to significant change. It is not ready for limited roll-out or production level use.

UC-02: Consultation Request

Description

Requester Health Care Provider (HCP) would like to seek advice/opinion from a specialist.

Scenario

Note: In this example, the family doctor’s EMR solution could be integrated with an external Referral Management System (RMS) or his EMR solution could have the capability to directly manage eConsults.

Jane Doe visits her family doctor complaining about pain occurring in her back and lower abdomen for the past two days. During the assessment, the family physician notes right-sided flank pain radiating from the back to the lower abdomen with fluctuating intensity that has not resulted in fever, nausea or vomiting. The patient has not had any recent trauma, numbness or weakness in extremities, and no saddle anesthesia. Suspecting renal colic, Jane's doctor sends her for an ultrasound. The ultrasound confirms a non-obstructing 5mm stone in the right ureter but also find an incidental complex renal cyst. Jane's family physician decides to consult a urologist to ask if the cyst can be managed with serial imaging, or whether a referral and consideration of a biopsy is necessary.

Option 1 - Request sent to a Specific Provider

The family physician would like to submit the consult request to a urologist they know. The family physician creates the eConsult request and submits the request directly to the selected urologist.

Option 2 - Request sent to a specialty organization (e.g., specialist clinic/hospital)

Jane's family physician knows which organization to submit the consult request to but will leave it to the case assigner at the organization to select the specialist. The family physician searches for an organization, creates the eConsult request, and submits the case to the organization. The case is received by the Case Assigner at the organization who assigns the case to a Urologist.

Option 3 - Request sent to Central Intake / Specialty Service Group (e.g., managed specialty)

The family physician creates an eConsult request for “Urology” and then submits the request to centralized intake/pool of specialists. The case is received and assigned to a specific specialist by the case assigner.

After Case Assignment

The urologist receives a notification for the assigned case, reviews the case details, and sends a response back to Jane's family physician. The specialist indicates that based on the size of the cyst and characteristics reported on the ultrasound, it can be safely monitored without the need for immediate intervention. A repeat ultrasound is recommended within 6 months.

Jane's family physician receives the consult response, reviews the notes left by the urologist. The family physician is satisfied with the response. Since no further clarification is required, the family physician closes the case.

Use Case Participants

People

  • Requester HCP
  • Performer HCP
  • Case Assigner

Systems

  • Requester POS system
  • Performer POS system
  • eReC Source
  • eReC Target
  • Central Intake (eReC Target + eReC Source)
  • Health Service Directory (HSD)

Please refer to Participants for definitions.

Triggers

Patient visit with a Requester Health Care Provider (HCP) that results in a consultation request.

Pre-conditions

  • The POS system has the capability to directly manage the referral workflow or is integrated with an external eReC Source/eReC Target
  • The POS system or eReC Source is integrated with a valid and up-to-date Health Services Directory
  • Appropriate patient consent in accordance with jurisdictional requirements and legislation, whether implied or expressed, has been obtained to share their personal and health information during the referral process.
  • Patients have indicated their communication preferences and provided consent to receive notifications and information about their eReferral status and appointment via their selected method(s).
  • Patient information in Requester POS system is valid and up-to-date.

Post-conditions

  • The Requester HCP closes the consult request after receiving response from Performer HCP (e.g., Requester HCP has no further questions for the Performer HCP after reviewing the consultation notes and/or attachments from the Performer HCP). And/Or,
  • The Requester HCP initiates an eReferral because the Performer HCP wishes to see the patient for an in-person consultation. Or,
  • The Requester HCP cancels the consult request. Or,
  • The Requester HCP redirects the consult request to another specialist (e.g., individual, organization, or specialty service group). Or,
  • The Performer HCP declines the consult request.

Workflow Diagram - Specific Provider

The use case diagram represents the participants and their role in the end-to-end use case with a high-level view of the flow of information.

UC - 2 - Consultation Request (Specific Provider)

Use Case - Primary Flow (Specific Provider)

The following provides a textual description corresponding to the use case diagram.

  1. Requester HCP initiates a consult request.

  2. Requester HCP searches and selects a specific provider from the Service Directory.

    The Health Service Directory could be i) centrally managed, or ii) locally integrated with the POS system, or iii) part of an eReC Source that is integrated with POS system.

  3. Requester HCP writes consultation question, attaches images and notes.

  4. Requester HCP submits consult request. eReC Source transmits the request to the eReC Target.

    The eReC Source could be i) an EMR/HIS which has the capability to directly manage eConsults (the system is both a POS system and eReC Source) or ii) an external Referral Management System (RMS) (the eReC Source is integrated with the Requester HCP POS System).

  5. The eReC Target receives the request and automatically assigns the request to the Performer HCP.

    The eReC Target could be i) an EMR/HIS which has the capability to directly manage eConsults (the system is both a POS system and eReC Target) or ii) an external Referral Management System (RMS) (the eReC Target is integrated with the Performer HCP POS System).

  6. Performer HCP receives a notification on the arrival of the new consult request.

  7. Performer HCP reviews the consult request through their eReC Target and responds to the consult request by entering in notes and/or attachments.

  8. Performer HCP sends the consultation notes back to the Requester HCP.

  9. Requester HCP receives a notification indicating that a consult has been provided.

  10. Requester HCP reviews the consultation response in eReC Source

  11. Requester HCP is satisfied with the information, and closes the request.

Use Case - Alternate Flows (Specific Provider)

The following list provides possible alternate flows that may occur within this use case.

  1. Clarification Requested (Step 10): After a consult has been provided, if further information is needed, the Requester HCP has the ability to request clarification from the Performer HCP.
  2. Request for Information (Step 7): Performer HCP requests for more information from the Requester HCP and Requester HCP provides the information.
  3. Case Cancelled (Step 5 - 7): The Requester HCP can decide to cancel the consult request if the consult is no longer needed.
  4. Case Redirect by Requester (Step 5 - 7): The Requester can redirect the consult request to another another specialist, organization or central intake/specialty service group. This closes the original consult request and creates a new request for the recipient.
  5. Return Case and convert to eReferral (Step 7): The Performer HCP provides the consult and indicates they wish to see the patient. The Requester HCP completes the consult and initiates an eReferral. (UC-01: Referral to a Service)
  6. Case Rejected by Performer (Step 7): The Performer HCP rejects the consult because it is not appropriate or is missing information. This closes the consult request.
  7. Performer HCP completes Performance KPI Survey (Step 7): Performer HCP may answer questions related to billing and time spent on case after providing the consult.
  8. Requester HCP completes Performance KPI Survey (Step 11): Requester HCP may answer questions related to service utilization and feedback for Performer HCP.

Workflow Diagram - Specialty Organization

The use case diagram represents the participants and their role in the end-to-end use case with a high-level view of the flow of information.

UC - 2 - Consultation Request (Provider Group)

Use Case - Primary Flow (Specialty Organization)

The following provides a textual description corresponding to the use case diagram.

  1. Requester HCP initiates a consult request.

  2. Requester HCP searches and selects an organization from the Service Directory

    The Health Service Directory could be i) centrally managed, or ii) locally integrated with the POS system, or iii) part of an eReC Source that is integrated with POS system.

  3. Requester HCP writes consultation question, attaches images and notes.

  4. Requester HCP submits consult request, and eReC Source sends the request.

    The eReC Source could be i) an EMR/HIS which has the capability to directly manage eConsults (the system is both a POS system and eReC Source) or ii) an external Referral Management System (RMS) (the eReC Source is integrated with the Requester HCP POS System).

  5. Case Assigner at the specialty group receives the consult request through eReC Target and assigns to a Performer HCP.

    The eReC Target could be i) an EMR/HIS which has the capability to directly manage eConsults (the system is both a POS system and eReC Target) or ii) an external Referral Management System (RMS) (the eReC Target is integrated with the Performer HCP POS System).

  6. Performer HCP receives a notification on the arrival of the new consult request.

  7. Performer HCP accesses the consult request through their eReC Target and responds to the consult request by entering in notes and/or attachments.

  8. Performer HCP sends the consultation notes back to the Requester HCP.

  9. Requester HCP receives a notification indicating that a consult has been provided.

  10. Requester HCP reviews the consultation response using their eReC Source.

  11. Requester HCP is satisfied with the information, and closes the request.

Use Case - Alternate Flows (Specialty Organization)

The following list provides possible alternate flows that may occur within this use case.

  1. Clarification Requested (Step 10): After a consult has been provided, if further information is needed, the Requester HCP has the ability to request clarification from the Performer HCP.
  2. Request for Information (Step 7): Performer HCP requests for more information from the Requester HCP and Requester HCP provides the information.
  3. Case Cancelled (Step 5 - 7): The Requester HCP can decide to cancel the consult request if the consult is no longer needed.
  4. Case Redirect by Requester (Step 5 - 7): The Requester can redirect the consult request to another another specialist, organization or central intake/specialty service group. This closes the original consult request and creates a new request for the recipient.
  5. Case Redirect by Assigner (Step 6): The Case Assigner at the specialty can redirect the consult request to another Performer HCP, which does not close the original consult request, but simply redirects it to another target.
  6. Return Case (Step 6): The case is returned by the Performer HCP to the Case Assigner to be assigned to another specialist.
  7. Return Case and convert to eReferral (Step 7): The Performer HCP provides the consult and indicates they wish to see the patient. The Requester HCP completes the consult and initiates an eReferral. (UC-01: Referral to a Service)
  8. Case Rejected by Performer (Step 7): The Performer HCP rejects the consult because it is not appropriate or is missing information. This closes the consult request.
  9. Case Self-assigned by Performer (Step 5): The Performer HCP may assign themselves to the case from a queue of incoming consult requests at the specialty group, essentially acting as the Case Assigner.
  10. Performer HCP completes Performance KPI Survey (Step 7): Performer HCP may answer questions related to billing and time spent on case after providing the consult.
  11. Requester HCP completes Performance KPI Survey (Step 11): Requester HCP may answer questions related to service utilization and feedback for Performer HCP.

Workflow Diagram - Specialty Service Group / Central Intake

The use case diagram represents the participants and their role in the end-to-end use case with a high-level view of the flow of information.

UC - 2 - Consultation Request (Managed Specialty)

Use Case - Primary Flow (Specialty Service Group / Central Intake)

The following provides a textual description corresponding to the use case diagram.

  1. Requester HCP indicates the need for a consult.

  2. Requester HCP searches and selects a Specialty/sub-specialty from the Service Directory. A default selection is provided based on location which can be overridden by Requester HCP.

    The Health Service Directory could be i) centrally managed, or ii) locally integrated with the POS system, or iii) part of an eReC Source that is integrated with POS system.

  3. Requester HCP writes consultation question, attaches images and notes.

  4. Requester HCP submits consult request, which is transmitted by eReC Source.

    The eReC Source could be i) an EMR/HIS which has the capability to directly manage eConsults (the system is both a POS system and eReC Source) or ii) an external Referral Management System (RMS) (the eReC Source is integrated with the Requester HCP POS System).

  5. Case Assigner at the Specialty Service Group receives the consult request through Central Intake (eReC Target + eReC Source) system and assigns to an available Performer HCP.

    The Central Intake System receives consult request from Requester HCP and routes it to a downstream Performer HCP. It can act as both the eReC Target (for Case Assigner to receive consult requests) and an eReC Source (for Case Assigner to assign a request to the Performer HCP)

  6. Central Intake (eReC Target + eReC Source) routes the consult request which is received by eReC Target (Performer)

    The eReC Target could be i) an EMR/HIS which has the capability to directly manage eConsults (the system is both a POS system and eReC Target) or ii) an external Referral Management System (RMS) (the eReC Target is integrated with the Performer HCP POS System).

  7. Performer HCP receives a notification on the arrival of the new consult request.

  8. Performer HCP accesses the consult request through their eReC Target, and responds to the consult request by entering in notes and/or attachments.

  9. Performer HCP sends the consultation notes back to the Requester HCP via Central Intake (eReC Target + eReC Source).

  10. Requester HCP receives a notification indicating that a consult has been provided.

  11. Requester HCP reviews the consultation response using their eReC Source.

  12. Requester HCP is satisfied with the information, and closes the request.

Use Case - Alternate Flows (Specialty Service Group / Central Intake)

The following list provides possible alternate flows that may occur within this use case.

  1. Clarification Requested (Step 11): After a consult has been provided, if further information is needed, the Requester HCP has the ability to request clarification from the Performer HCP.
  2. Request for Information (Step 8): Performer HCP requests for more information from the Requester HCP and Requester HCP provides the information.
  3. Case Cancelled (Step 5 - 8): The Requester HCP can decide to cancel the consult request if the consult is no longer needed.
  4. Case Redirect by Requester (Step 5 - 8): The Requester can redirect the consult request to another another specialist, organization or central intake/specialty service group. This closes the original consult request and creates a new request for the recipient.
  5. Case Redirect by Assigner (Step 7): The Case Assigner at the specialty can redirect the consult request to another Performer HCP, which does not close the original consult request, but simply redirects it to another target.
  6. Return Case (Step 7): The case is returned by the Performer HCP to the Case Assigner to be assigned to another specialist.
  7. Return Case and convert to eReferral (Step 8): The Performer HCP provides the consult and indicates they wish to see the patient. The Requester HCP completes the consult and initiates an eReferral. (UC-01: Referral to a Service)
  8. Case Rejected by Performer (Step 8): The Performer HCP rejects the consult because it is not appropriate or is missing information. This closes the consult request.
  9. Case Self-assigned by Performer (Step 5): The Performer HCP may assign themselves to the case from a queue of incoming consult requests at the specialty group, essentially acting as the Case Assigner.
  10. Performer HCP completes Performance KPI Survey (Step 8): Performer HCP may answer questions related to billing and time spent on case after providing the consult.
  11. Requester HCP completes Performance KPI Survey (Step 12): Requester HCP may answer questions related to service utilization and feedback for Performer HCP.