Referral Request

1. Proposed Profile: Referral Request

• Proposal Editor: Robert Horn
• Profile Editor: TBD
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: IT Infrastructure

Summary

<Summarize in a few lines the existing problem . E.g. "It is difficult to monitor radiation dose for individual patients and almost impossible to assemble and compare such statistics for a site or a population.">

<Demonstrate in a line or two that the key integration features are available in existing standards. E.g. "DICOM has an SR format for radiation dose events and a protocol for exchanging them.">

<Summarize in a few lines how the problem could be solved. E.g. "A Radiation Dose profile could require compliant radiating devices to produce such reports and could define transactions to actors that collect, analyze and present such information.">

<Summarize in a line or two market interest & available resources. E.g. "Euratom and ACR have published guidelines requiring/encouraging dose tracking. Individuals from SFR are willing to participate in Profile development.">

<Summarize in a line or two why IHE would be a good venue to solve the problem. E.g. "The main challenges are dealing with the chicken-and-egg problem and avoiding inconsistent implementations.">

2. The Problem

There is not a way to convey the referral request in a form suitable for automatic processing. Internally within the organization various profiles deal with Scheduled Workflows and unscheduled workflows. These are not directly suitable for cross enterprise referrals. The various XDS alternatives already address conveying the patient records between enterprises, so a mechanism is needed to convey the dynamic workflow information.

The present system depends upon letters, faxes, telephone calls, and documents to convey the referral request. About 20% of referrals require conversations or other interactions between the various clinicians. The combination of simple request and patient medical record is insufficient. The goal is to significantly improve the 80% where the simple request is adequate without interfering with the 20% where more interactions are needed. The 20% can have some data entry and associated errors eliminated, but will continue to need the direct clinician interactions and will not fit into a well defined preset workflow.

3. Key Use Case

Referral

A doctor at chalet clinic sends a patient to larger hospital with a referral request for procedure X. Chalet clinic is only intermittently connected, so they use XDM to send the relevant medical records to larger hospital. They also use the Referral request to convey the procedure X request. Some time earlier, chalet clinic established a referral relationship with larger hospital. As part of this relationship they maintain the current referral procedure codes, and have established the other medical relationships regarding acceptance of referrals.

The request arrives at larger clinic and is processed to the referrals staff. They check the entry, work out scheduling, assignment of local doctor, etc. These internal tasks are not profiled by IHE. The incoming referral is used to automatically fill as much of the relevant information as is reasonable, e.g., patient name, and thus assist the other tasks such as assignment of doctor and scheduling. If this is one of the 20% that require further interactions, it is diverted into the more complex processing. This profile does not attempt to specify that processing. It only eliminates some of the need to perform data entry to re-enter patient information.

Significant variations in this use case are:

• Referring sites that use intermittent network connections. They presently use XDM or XDR for the transmitting their documents. More study is needed to decide whether a direct connection can be established for transmission of these small requests, or whether a intermittent connection approach must be supported.

• The backup documents and patient records may be sent directly to next healthcare site, or they might be sent to a repository. The referral request needs to have a means to accommodate all combinations.

Results

The results of a referral need to be returned to the referring physician. This relationships between requests and results can become quite complex. For example, if the referral is one of the 20% that required further conversations the results are not predictable from the referral information. There are also reporting complexities that arise during regular referrals. The proposal for a profile for Notification of Critical Results deals with one aspect of this. It manages the need to confirm that the patient has been informed of medically significant results, and the need to alert the referring physician when critical (abnormal) situations were detected. (In Radiology criticial results measurements have shown that emergent and urgent critical findings are handled well, but significant non-urgent unexpected findings are a problem. E.g., X-ray of broken bone detects a small cancer.)

The referring site might be on an intermittent connection. The results might be delivered to a repository (XDS), or they might be delivered by email (XDM).

New actors

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4. Standards & Systems

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5. Technical Approach

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<Outline how the standards could be used/refined to solve the problems in the Use Cases. The Technical Committee will be responsible for the full design and may choose to take a different approach, but a sample design is a good indication of feasibility.>

<If a phased approach would make sense indicate some logical phases. This may be because standards are evolving, because the problem is too big to solve at once, or because there are unknowns that won’t be resolved soon.>

Existing actors

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New actors

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Existing transactions

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New transactions (standards used)

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Impact on existing integration profiles

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New integration profiles needed

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Breakdown of tasks that need to be accomplished

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6. Support & Resources

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7. Risks

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8. Open Issues

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9. Tech Cmte Evaluation

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Effort Evaluation (as a % of Tech Cmte Bandwidth):

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA

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