ReferralRequest: Implementation Guidance
Usage
Within the Clinical Decision Support API implementation, the ReferralRequest resource will be used to carry the triage outcome of recommendation to another service for a patient.
A reference to the relevant ReferralRequest will be carried in the action.resource element of the RequestGroup resource in the form of the logical id of the ReferralRequest.
The ReferralRequest MAY reference a ProcedureRequest, where there is a known requested procedure which the referring service is intended to perform.
RequestGroup.action.resource MAY also carry a reference to one or more CarePlans to carry accompanying care advice (not self-care) for the patient.
Detailed implementation guidance for a ReferralRequest resource in the CDS context is given below:
| Name | Cardinality | Type | FHIR Documentation | CDS Implementation Guidance |
|---|---|---|---|---|
identifier |
0..* |
Identifier | Business identifier | |
definition |
0..* |
Reference (ActivityDefinition | PlanDefinition) |
Instantiates protocol or definition | This MAY be populated with an ActivityDefinition, if a standard template for the ReferralRequest has been defined in the local implementation. |
basedOn |
0..* |
Reference (ReferralRequest | Careplan | ProcedureRequest) |
Request fulfilled by this request | This SHOULD be populated with a ProcedureRequest, where the ProcedureRequest contains the information on the next activity to be performed in order to identify the patient's health need. This ProcedureRequest will be a procedure that the current service is unable to perform, but that the recipient MUST be able to be perform. |
replaces |
0..* |
Reference (ReferralRequest) |
Request(s) replaced by this request | |
groupIdentifier |
0..* |
Identifier | Composite request this is part of | This MUST be populated with the logical id from the RequestGroup. |
status |
1..1 |
code | Code datatype with Required binding to RequestStatus | If the CDSS is recommending a draft (initial) triage recommendation, the status will be draft.If the CDSS is recommending triage to another service, the status will be active. This includes where the recommendation is an interim recommendation (that is, where the triage journey continues). |
intent |
1..1 |
code | Code datatype with Required binding to RequestIntent | In most cases, this will be populated with the code 'plan', as the patient will need to take the next step. |
type |
0..1 |
CodeableConcept | Referral/Transition of care request type | |
priority |
0..1 |
code | Urgency of referral/transfer of care request. This is a Code datatype with Required binding to RequestPriority | This SHOULD be populated by the CDSS. In most cases, this will be populated with the code 'routine', indicating that the request is of normal priority. |
serviceRequested |
0..* |
CodeableConcept | Actions requested as part of the referral | This SHOULD be populated with the recommended generic service type (e.g. GP or Emergency Department) |
subject |
1..1 |
Reference (Patient | Group) |
Patient referred to care or transfer | This MUST be populated with a reference to the Patient resource. |
context |
0..1 |
Reference (Encounter | EpisodeOfCare) |
Originating encounter | This MUST be populated with the logical id of the Encounter supplied in the ServiceDefinition.$evaluate operation. |
occurrence[x] |
0..1 |
dateTime | Period |
When the service(s) requested in the referral should occur | This MUST be populated by the CDSS with a timeframe in which the attendance at the next service must occur (e.g. within three days, within four hours etc.). This is represented as a start time (now) and end time (now+3 days, or now+four hours). |
authoredOn |
0..1 |
dateTime | Date of creation/activation | |
requester |
0..1 |
BackboneElement | Who/what is requesting service - onBehalfOf can only be specified if agent is practitioner or device | This element SHOULD NOT be populated. |
requester.agent |
1..1 |
Reference (Practitioner | Organization | Patient | RelatedPerson | Device) |
Individual making the request | |
requester.onBehalfOf |
0..1 |
Reference (Organization) |
Organization agent is acting for | |
specialty |
0..1 |
CodeableConcept | The clinical specialty (discipline) that the referral is requested for | This SHOULD be populated by the CDSS with the clinical specialty related to the patient's identified health need. |
recipient |
0..* |
Reference (Practitioner | Organization | HealthcareService) |
Receiver of referral/transfer of care request | This SHOULD NOT be populated by the CDSS. |
reasonCode |
0..* |
CodeableConcept | Reason for referral/transfer of care request | This SHOULD NOT be populated as the reasonReference element will carry the chief concern. |
reasonReference |
0..* |
Reference (Condition | Observation) |
Why is service needed? | This SHOULD be populated by the CDSS. The chief concern SHOULD be carried in this element. |
description |
0..1 |
string | A textual description of the referral | This SHOULD be populated by the CDSS. |
supportingInfo |
0..* |
Reference (Any) |
Additional information to support referral or transfer of care request | This SHOULD be populated by the CDSS. Secondary concerns SHOULD be be carried in this element. |
note |
0..* |
Annotation | Comments made about referral request | This SHOULD be populated by the CDSS. |
relevantHistory |
0..* |
Reference (Provenance) |
Key events in history of request | This SHOULD be populated by the CDSS. |
Procedure Request
The ProcedureRequest is referenced from ReferralRequest.basedOn.
This will be the diagnostic discriminator, or service requirement; diagnostic discriminator is a description of the next procedure which SHOULD be carried out in the referee service to validate or eliminate the chief concern.
ProcedureRequest elements of note
Status element of the ProcedureRequest
This shows the status of the ProcedureRequest and SHOULD carry the value ‘active’.
Intent element of the ProcedureRequest
The population of this element shows whether the request is a proposal, plan, an original order or a reflex order. It SHOULD carry the value ‘proposal’.
Code element of the ProcedureRequest
This element carries a code denoting the type of procedure being requested.
Subject element of the ProcedureRequest
This element SHOULD NOT be populated.
