L3: eReferral vs eConsult

The exchange paradigms outlined within this Implementation Guide can be applied to both eReferral and eConsult workflows but there are slight variations between workflow to be taken into consideration when using this specification.

eConsult is considered an L3 capability in the guide because it draws upon other L3 capabilities including Communications and, typically, separate Requester HCP, Case Assigner, and Performer HCP roles and corresponding flows.

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Case Assignment

The ON-eReferral-eConsult iGuide identifies eConsult specific business models that align closely but not identically with the Single Entry model examples in this IG, in a few ways:

• the Central System is used by both the Case Assigner (where applicable) and the Performer HCP;
• the Central System supports multiple Case Assignment models:
  • BASE Managed Service uses an algorith to perform case assignment taking into account location, availability, specialty, and sub-specialty, sometimes with human support.
  • Group Model allows the Requester HCP to choose a Group that performs Case Assignment to Performer HCPs within their group.
  • Direct allows the the Requester HCP to choose the Performer HCP to respond to the request

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Notes

Consult notes are text-based notes and attachments exchanged using the Communication resource (contentString and/or contentAttachment). Exchange of notes may coincide with changes to Task.status (or Task.businessStatus) or not.

Notes can be added to an eConsult request at various stages of the process. The referrer may add notes when the consult is in the following states:

• Case Submitted/Redirected
• Clarification Requested
• More Information Provided

The specialist may add notes during the following consult states:

• Consult Provided
• More Information Requested

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Case Redirect

Cases may be redirected to different specialists by the referrer and the case assigner. If a specific provider is not available, the assigner may redirect the case to another specialist. This scenario will not cancel or close the original request but direct it to another target.

A referrer has the ability to redirect a case when it is not assigned and before a consult is provided. In this scenario, the original request is terminated and a new one is generated.

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Requesting Clarification

After a consult has been provided, if further information is needed, the referrer has the ability to request clarification from the specialist. The consult state changes to Clarification Requested.

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Case Completion

After a consult has been provided by the specialist, if the referrer is satisfied with the response they will then mark the case complete. At this stage, the case state is Case Completed.

While the ON-eReferral-eConsult iGuide did have an additional step for completion of questionnaire by both the requester and the performer, the focus on collection is currently out-of-scope for the CA:eReC.

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Trigger Events & Interactions

Examples corresponding to the business events above

Party	Action / Trigger	Sending System	Focus of Message	State Change	Event Code	Receiving System	Expected action upon receipt of message
Performer HCP	Specialist provides consultation	Target System	Task (CA:eReC)	Response/Communication is added to Service Record with a status update	notify-update-process-request	Source System	Notify Requester HCP that response has been received
Requester HCP	Requester asks for clarification	Source System	Communication (CA:eReC)	n/a	send-communication-from-provider	Target System	Notify Performer HCP that a request has been received requiring a response
Performer HCP	Responds to RFI	Target System	Communication (CA:eReC)	Response/Communication is added to Task	notify-update-process-request	Source System	Notify Requester HCP that a request has been received requiring a response