Cross-enterprise Basic eReferral Workflow Definition

This supplement is written according to the specific template defined for Workflow Definition profiles. The structure of this document differs from a PCC Content Profile. In particular the XBeR-WD profile establishes a common set of rules to share between participants involved in an eReferral workflow. The eReferral process, and workflow related to it, is applicable to many different sharing infrastructures. In this profile we present a specific XDS based use-case.

Summary

A common workflow pathway that illustrates the simplest process enabled by XBeR-WD profile is the use-case where the patient consults his GP for a health problem. As part of the consultation the patient is examined and some prior information is looked up by the GP. As a result of the visit the GP refers the patient to a specialist for further examination. The workflow connected to these organizational and clinical actions is composed of four steps:

1) a physician refers a patient to another healthcare provider for a specialist’s consultation;
2) the Health Care Provider (HCP), from the Hospital Information System, schedules the visit;
3) the HIS admits the patient in hospital and the specialist can start the consultation which may span one or more visits;
4) the specialist completes the consultation and produces a report;

These steps can be modeled in 3 different tasks of the eReferral workflow, (figure X.2-1):

1) Request Referral: that tracks step A, performed by the Requester of the referral
2) Schedule Referral: that tracks step B, performed by the Scheduler of the visit (This task is optional and doesn’t need to be tracked if the option “Process without scheduling phase” is selected)
3) Perform Referral: that tracks steps C and D, performed by the HCP and the specialist.

Benefits

Cross-enterprise management of the workflow related to clinical processes is a fundamental topic with the increasing use by different sectors of document sharing related IHE profiles with their different types of document and information. This profile is built upon the ITI XDW Profile to manage the Cross Enterprise Basic eReferral Workflow. The management of the workflow related to the eReferral is involved in many clinical and organizational processes for its important role in the process of digitalization. The lack of a workflow management, at the moment, blocks the use of the eReferral in an extended way. The eReferral, without an instrument to manage its workflow, is only an order without any information about the status of the order itself. The definition of a workflow with fixed rules and tasks is needed in a cross-enterprise scenario in which many actors are involved in the same process. The creation of an eReferral by a GP, or Primary Care Provider (PCP) opens a clinical process that involves many actors and that is a cross-enterprise workflow. The purpose of the XBeR-WD profile is to precisely define the workflow associated with an eReferral Document, the actors involved and the digital documents related with this process (produced in this or in other processes, but related to the eReferral workflow).

Details

A. A physician refers a patient to another healthcare provider for a specialist’s consultation. In this task the GP examines the patient and reviews the patient’s most recent laboratory reports. The GP refers the patient to a specialist, creating an eReferral Document and referencing the laboratory reports. The GP’s software, as a Referral Requester, produces the eReferral Document and one Workflow Document to track the clinical workflow of the eReferral. As shown in column A of Figure below, at this moment the Workflow Document created has only one task (“Request Referral”) characterized by:

- a task status “COMPLETED”
- the references to the laboratory report analyzed by the GP as inputs of the task
- the reference to the eReferral document produced as outputs of the task.

In order to share documents that are produced during the task, the Referral Requester submits the eReferral Document and the Workflow Document to the XDS Document Repository. From this moment the eReferral is available to a wide range of care providers.

B. The HCP, from the Hospital Information System, schedules the visit The patient can call or go to healthcare provider of his choice (or suggested by the GP) to schedule the exam. During this step the HCP, as a Referral Scheduler, checks in which step the eReferral is and he schedules the visit. Once the visit has been scheduled, the Referral Scheduler updates the Workflow Document to track that the visit has been scheduled. As shown in column B of figure below, at this step of the workflow, the Workflow Document is updated with a new version in which a new task “Schedule Referral” is added to the content of the previous version of the Workflow Document. The task “Schedule Referral” is characterized by:

a task status “COMPLETED”
the references to the eReferral document produced by the GP as inputs of the task.

The Referral Scheduler provides the updated version of Workflow Document to the XDS Document Repository/Registry through a Replace of the previous version of the Workflow Document. From this moment no other HCP can claim this referral.

C. The patient is admitted by the HCP the day of the visit and the specialist can start the visit. The patient is admitted by the HCP on the scheduled day and time. During this task, the HCP, as a Referral Performer, consults the eReferral and the Workflow Document related to understand the task that needs to be performed and the process of the visit can start. The Referral Performer accesses the document by using his software, and an XDS Document Consumer, to query and retrieve the Workflow Document and the eReferral document, to check the reservation. As shown in column C of figure below, at this step of the workflow, the Workflow Document is updated with a new version in which a new task “Perform Referral” is added to the content of the previous version of the Workflow Document. The task “Perform Referral” is characterized by:

a task status “IN_PROGRESS”
the references to the eReferral document produced by the GP as inputs of the task.

The Referral Performer provides the updated version of Workflow Document to the XDS Document Repository/Registry through a Replace of the previous version of the Workflow Document. From now the Workflow Document and the eReferral document are available for the specialist.

D. The specialist completes the consultation and produces a report. The specialist performs the visit and, at the end of the consultation the specialist’s software, as a Referral Performer, produces a report of the consultation itself and he terminates the visit process. In this task, the Referral Performer updates the Workflow Document changing the status of the “Perform Referral” task. As shown in column D of the figure X.3.1.1-1 the Workflow Document, the “Perform Referral” task is characterized by:

a task status “COMPLETED”
the references to the eReferral document produced by the GP (the laboratory report was not used by the specialist) as inputs of the task
the references to the report of the consultation as output of the task

The history of the changes of status of the task is tracked inside the task as a list called taskEventHistory. The Referral Performer provides the updated version of Workflow Document to the Document Repository through a replace of the previous version of the Workflow Document. At any time the Referral Requester may review the Workflow Document and the new documents produced related to this workflow. This is accomplished through a query and retrieve by the GP’s software of the active Workflow Document from the XDS Document Registry and the XDS Document Repository. Although not shown in this use case, it would also be possible to manage a system of subscription and notification to communicate the progress between the different steps through the use of the Document Metadata Subscription (DSUB) profile or the Notification of Document Availability (NAV) profile.