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-03: Referral to a Central Intake
Description
Requester Health Care Provider sends a referral request to a Central Intake, which forwards to most appropriate downstream Performer Health Care Provider
Scenario
Note: In this example, Dr. Jones' electronic medical record (EMR) solution could be integrated with an external Referral Management System (RMS) or his EMR solution could have the capability to directly manage eReferrals.
Mary Jane has a ski accident. Her primary care practitioner, Dr. Jones, strongly suspects that Mary Jane has torn her anterior cruciate ligament (ACL) in the right knee and would like to refer Mary Jane for further assessment.
Dr. Jones initiates an eReferral for “Orthopedics” and selects the appropriate service. The referral requirements are presented on his screen, with some information already completed based on information available in the EMR. Dr. Jones completes the rest of the information required for the referral.
Option 1 - Routing requests (Central Intake forwards request)
Note: In this scenario, the referral is received by Central Intake. A case assigner at Central Intake assigns the request to a specialist.
Dr. Jones submits the referral request to Central Intake. A notification is sent to Mary Jane to confirm that the referral has been requested.
The central intake system notifies the triage nurse about the incoming request. The triage nurse forwards the request to Dr. Treat, an orthopedic surgeon who is located a close distance to Mary Jane's home and has the shortest wait time. The referral request is forwarded to Dr. Treat. Dr. Jones also receives an update about the triage decision.
Dr. Treat’s office receives a notification about the referral request. The office staff contact Mary jane and schedule an appointment with her.
Updates are sent to Dr. Jones when the appointment is scheduled, any changes to the referral request, and when the appointment is complete.
Option 2 - Chaining requests
Note: In this scenario, the referral is received by Central Intake and an assessment is completed at a Rapid Access Clinic/ Rapid Assessment Centre. If the assessment outcome results in further services required, a new referral (that is linked to the initial referral) is created for the additional services.
Dr. Jones submits the referral request to Central Intake. A notification is sent to Mary Jane to confirm that the referral has been requested.
The central intake system notifies the triage nurse about the incoming referral request. The triage nurse assigns the referral to an available advanced practice provider at a Rapid Access Clinic / Rapid Assessment Centre / (RAC) that serves the geographic area where Mary Jane resides.
The administrative team at the RAC contacts Mary Jane and schedules an appointment. After completing the assessment, the advanced practice provider determines that Mary Jane is a candidate for surgery. The assessment outcome is sent to Central Intake and an update is also sent to Dr. Jones.
The triage nurse at Central Intake creates a new referral and sends the request to Dr. Treat, an orthopedic surgeon who is located a close distance to Mary Jane's home and has the shortest wait time. Dr. Jones also receives an update about the triage decision.
Dr. Treat’s office receives a notification about the referral request. The office staff contact Mary jane and schedule an appointment with her.
Updates are sent to Dr. Jones when the appointment is scheduled, any changes to the referral request, and when the appointment is complete.
Option 3 - Splitting requests
Note: In this scenario, the referral is received by Central Intake. Since more than one service is requested, the case assigner at Central Intake “splits” the request and assigns each service to a different service provider.
When completing the referral requirements, Dr. Jones sees that diagnostic imaging results need to be included with the eReferral request. Dr. Jones creates a request for an MRI and an ultrasound on the same eReferral request and sends the request to Central Intake.
The central intake system notifies the triage nurse about the incoming request. The triage nurse “splits” the request and sends the request for the services (MRI and ultrasound) to two different diagnostic imaging sites.
At the respective diagnostic imaging sites, the administrative staff are notified about the incoming request, contact Mary Jane and schedule an appointment with her.Updates are sent to Central Intake and Dr. Jones when the appointments are scheduled, as well as when the appointments have been completed.
Use Case Participants
People
- Requester HCP
- Performer HCP
- Downstream Service - Performer HCP (B)
- Rapid Assessment Centre - Performer HCP A
- Case Assigner
Systems
- Requester POS system
- Performer POS system
- Downstream Service
- Rapid Assessment Centre
- eReC Source
- eReC Target
- Downstream Service
- Rapid Assessment Centre
- Central Intake (eReC Target + eReC Source)
- Health Service Directory (HSD)
Please refer to Participants for definitions.
Triggers
Requester Health Care Provider (HCP) needs to send a referral request for a patient.
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
- Performer HCP completes the service and closes the eReferral request. The Requester HCP and Central Intake are updated about outcome of service.
This includes when:
- Performer HCP completes the initial consultation appointment with the patient.
- When a rapid assessment centre is used, Performer HCP A at the Rapid Assessment Centre completes assessment appointment with the patient and patient does not require further services. Or,
- Performer HCP converts the eReferral to an eConsult and provides advice to the Requester HCP instead of assessing the patient at an in-person appointment (UC-2: Consultation Request), Or,
- The service request was not fulfilled or was ended before completion because:
- The Requester HCP cancels the referral request. Or,
- The Case Assigner at Central Intake declines the referral request. Or,
- The Performer HCP A at Rapid Assessment Centre declines the referral request. Or,
- The Performer HCP (B) at Downstream Service declines the referral request. Or,
- The Patient declines the service.
Workflow Diagram - Routing/Splitting Requests
- Routing: The same referral request is forwarded to a new downstream service from Central Intake.
- Splitting: The referral request gets split into multiple parts/services that logically make up the original request at Central Intake, to be fulfilled by different downstream services. There could be further successive downstream services beyond the first downstream service shown in diagram below. A routed/split referral may be followed by successive chaining, routing or splitting operations at each successive downstream service in any combination needed to fulfil the original referral.
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.
Use Case - Primary Flow - Routing/Splitting Requests
The following provides a textual description corresponding to the use case diagram.
Requester HCP initiates a referral request.
Requester HCP searches and selects an appropriate central intake service from a 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.
Requester HCP is presented with, and completes the referral requirements, and/or provides a clinical narrative to support the reason for the referral. Patient information and some of the referral requirements may be automatically filled in based on information available in the POS system.
Requester HCP may optionally attach additional clinical notes and supporting documentation from the POS system to support the referral request.
Requester HCP submits the referral request (clinical documentation and/or completed referral requirements). eReC Source transmits the referral request to Central Intake (eReC Target + eReC Source) and an electronic notification is sent to the Patient that the referral request has been sent.
The eReC Source could be i) an EMR/HIS which has the capability to directly manage eReferrals (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).
Central Intake (eReC Target + eReC Source) receives the referral request and notifies Case Assigner.
Case Assigner processes the referral request (Processing includes analysis of referral request needs, urgency, downstream service wait times, location and may include consideration for patient preference for location, waiting period and health care provider.).
- If referral request contains multiple distinct services, it is split into its constituent parts to be forwarded to appropriate downstream services to fulfill different parts of the request.
- If referral request is just for a single service, it is routed to the appropriate downstream service as the same request.
Central Intake (eReC Target + eReC Source) transmits the referral request to the downstream service, and a notification to Requester eReC Source, which informs Requester HCP about the routed/split referral.
eReC Target (Downstream Service) receives the referral request and notifies Performer HCP.
The eReC Target could be i) an EMR/HIS which has the capability to directly manage eReferrals (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).
Performer HCP contacts the patient to arrange an appointment. After the appointment is scheduled, the eReC Target (Downstream Service) transmits an update to Central Intake (eReC Target + eReC Souce), which forwards to the Requester eReC Source. The Requester HCP receives a notification that the appointment has been booked.
Performer HCP completes the initial consultation appointment with the patient and closes the eReferral request. The eReC Target (Downstream Service) transmits an update to Central Intake (eReC Target + eReC Source) which forwards it to the Requester eReC Source. The Requester HCP receives a notification that the appointment has been completed.
Workflow Diagram - Chaining Requests
- Chaining: A new, distinct referral is created to a downstream service based on the original referral after a service is performed. There could be further successive downstream services beyond the first downstream service shown in diagram below. A chained referral may be followed by successive chaining, routing or splitting operation at each successive downstream service in any combination needed to fulfil the referral.
Use Case - Primary Flow - Chaining Requests
The following provides a textual description corresponding to the use case diagram.
Requester HCP initiates a referral request.
Requester HCP searches and selects an appropriate central intake service from a 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.
Requester HCP is presented with, and completes the referral requirements, and/or provides a clinical narrative to support the reason for the referral. Patient information and some of the referral requirements may be automatically filled in based on information available in the POS system.
Requester HCP may optionally attach additional clinical notes and supporting documentation from the POS system to support the referral request.
Requester HCP submits the referral request (clinical documentation and/or completed referral requirements). eReC Source transmits the referral to Central Intake (eReC Target + eReC Source) and an electronic notification is sent to the Patient that the referral request has been sent.
The eReC Source could be i) an EMR/HIS which has the capability to directly manage eReferrals (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).
Central Intake (eReC Target + eReC Source) receives the referral request and notifies Case Assigner.
Case Assigner processes the referral and routes to an assessment centre (i.e. a Rapid Assessment Centre). (Processing includes analysis of referral request needs, urgency, downstream service wait times, location and may include consideration for patient preference for location, waiting period and health care provider.).
Central Intake (eReC Target + eReC Source) transmits the referral request to the assessment centre, and a notification to Requester eReC Source, which informs Requester HCP about the routed referral for assessment.
eReC Target (Rapid Assessment Centre) receives the routed request and notifies Performer HCP A.
The eReC Target could be i) an EMR/HIS which has the capability to directly manage eReferrals (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).
Performer HCP A confirms referral request acceptance and contacts patient for assessment.
eReC Target (Rapid Assessment Centre) transmits the acceptance message along with any optional note to the Central Intake (eReC Target + eReC Source) which forwards it to Requester eReC Source, so that Requester HCP has access to the update that the patient is accepted for assessment.
Performer HCP A assesses patient is eligible for downstream service.
eReC Target (Rapid Assessment Centre) sends the assessment outcome to Central Intake (eReC Target + eReC Source) which forwards it to Requester eReC Source, so that Requester HCP has access to the assessment outcome.
Case Assigner processes the updated referral and creates a new distinct referral request to a downstream service, eReC Target (Downstream Service).
Central Intake (eReC Target + eReC Source) transmits the referral request to the downstream service, and a notification to Requester eReC Source, so that Requester HCP has access to the update about the new downstream referral.
eReC Target (Downstream Service) receives the referral request and notifies Performer HCP B.
The eReC Target could be i) an EMR/HIS which has the capability to directly manage eReferrals (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).
Performer HCP B contacts the patient to arrange an appointment. After the appointment is scheduled, the eReC Target (Downstream Service) transmits an update to Central Intake (eReC Target + eReC Souce), which forwards to the Requester eReC Source. The Requester HCP receives a notification that the appointment has been booked.
Performer HCP B completes the initial consultation appointment with the patient and closes the eReferral request. The eReC Target (Downstream Service) transmits an update to Central Intake (eReC Target + eReC Source) which forwards it to the Requester eReC Source. The Requester HCP receives a notification that the appointment has been completed.
Use Case - Alternate Flows - Routing/Splitting/Chaining Requests
The following list provides possible alternate flows that may occur within this use case.
- Request for Information from Central Intake:
- Case Assigner requests more information from Requester HCP and sends a request for information from Central Intake (eReC Target + eReC Source).
- Requester HCP views the Request for Information and updates the referral with the requested information.
- Case Assigner receives the referral update in Central Intake (eReC Target + eReC Source) and processes the referral using the remaining steps in the flow
- Request for Information from Assessment Centre:
- Performer HCP A at Rapid Assessment Centre requests more information from Requester HCP and sends a request for information to Central Intake (eReC Target + eReC Source) from their eReC Target (Rapid Assessment Centre).
- The request for information is forwarded from Central Intake (eReC Target + eReC Source) to Requester eReC Source.
- Requester HCP views the Request for Information and updates the referral with the requested information. Referral update is received in Central Intake (eReC Target + eReC Source) and forwarded by Central Intake (eReC Target + eReC Source) to eReC Target (Rapid Assessment Centre)
- Performer HCP A receives the referral update in eReC Target (Rapid Assessment Centre) and processes the referral using the remaining steps in the flow
- Request for Information from Downstream Service:
- Performer HCP (B) at Downstream Service requests more information from Requester HCP and sends a request for information to Central Intake (eReC Target + eReC Source) from their eReC Target (Downstream Service).
- The request for information is forwarded from Central Intake (eReC Target + eReC Source) to Requester eReC Source.
- Requester HCP views the Request for Information and updates the referral with the requested information.
- Referral update is received in Central Intake (eReC Target + eReC Source) and forwarded by Central Intake (eReC Target + eReC Source) to eReC Target (Downstream Service)
- Performer HCP (B) receives the referral update in eReC Target (Downstream Service) and processes the referral using the remaining steps in the flow
- Decline from Central Intake:
- Case Assigner at Central Intake declines the referral request, the decline notification is sent to Requester from Central Intake (eReC Target + eReC Source).
- Requester HCP receives the decline status in their eReC Source.
- Decline from Assessment Centre:
- Performer HCP A at Rapid Assessment Centre declines the referral request, the decline notification is sent to Central Intake (eReC Target + eReC Source) from their eReC Target (Rapid Assessment Centre).
- Case Assigner at Central Intake receives the decline, sends a referral request to another Rapid Assessment Centre, and an update to Requester HCP about the new referral to another Rapid Assessment Centre
- Requester HCP receives the update in their eReC Source.
- Decline from Downstream Service:
- Performer HCP (B) at Downstream Service declines the referral request, the decline notification is sent to Central Intake (eReC Target + eReC Source) from their eReC Target (Downstream Service).
- Case Assigner at Central Intake receives the decline, sends a referral request to another Downstream Service, and an update to Requester HCP about the new referral to another Downstream Service
- Requester HCP receives the update in their eReC Source.
- Decline from Patient
- Patient declines the referral at the Requester, Central Intake, Rapid Assessment Centre and Downstream Service settings.
- Notifications about the referral decline are sent upstream to Central Intake/Requester or downstream to Rapid Assessment Centre / Downstream Service depending on in which setting the patient declined the referral, and if a referral is already sent to the Rapid Assessment Centre or Downstream Service.
- Requester HCP / Case Assigner at Central Intake / Performer HCP A at Rapid Assessment Centre / Performer HCP (B) at Downstream Service receives the update in their POS/eReC Source or integrated eReC Source.
- Patient not Eligible for Downstream Service
- Performer HCP A assesses patient at Central Intake and determines that a referral to downstream service is not needed
- Central Intake (eReC Target + eReC Source) sends the referral outcome to Requester HCP.
- Requester HCP receives the update in their eReC Source.
- Cancellation:
- Requester HCP cancels the service request in their eReC Source, which sends the cancellation message to the Central Intake (eReC Target + eReC Source) and notifies Patient by their communication preference that the initial referral has been cancelled.
- Case Assigner receives the referral cancellation notification in the Central Intake (eReC Target + eReC Source). If a referral request has been sent/forwarded to a Rapid Assessment Centre or Downstream Service, Central Intake (eReC Target + eReC Source) sends the cancellation message to the eReC Target (Rapid Assessment Centre) / eReC Target (Downstream Service).
- eReC Target (Rapid Assessment Centre) / eReC Target (Downstream Service) receives the cancellation notifications and any appointments/tasks created in response to the referral request are cancelled.
- Referral Updates
- Requester HCP updates the initial referral to add additional service(s) and commits the update in their eReC Source.
- Case Assigner receives the updated service request including the new service from the Central Intake (eReC Target + eReC Source) and processes the modified referral to completion using the remaining steps in the basic flow.
- Appointment Date Changed by Patient
- Patient changes the appointment date with Rapid Assessment Centre or Downstream Service
- Performer HCP A at Rapid Assessment Centre / Performer HCP (B) at Downstream Service updates the referral with the new appointment date and the update notification is sent upstream to Requester HCP
- Requester HCP receives the update in their eReC Source.
- Convert Referral to a Consultation
- Performer HCP A at Rapid Assessment Centre / Performer HCP (B) at Downstream Service may convert a referral to a consultation (providing advice to the Requester HCP instead of an appointment with the patient - See UC-02: Consultation Request).
- Requester HCP receives the consultation notes in their eReC Source.