Patient Care Workflow

1. Proposed Profile: Patient Care Workflow

• Proposal Editor: Kboone
• Profile Editor: TBD
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: PCC

2. The Problem

Presently, there is no established and uniform mechanism for the interchange of orders for consultations or referals across organizational boundaries. As part of this problem, information about where the patient's medical home also needs to be communicated, to facilitate communication between the consulting provider with the patient's primary care team. Along the way, various communications need to occur between specialists, treating physicians, and the patient's primary care team. These communications are often relatively simple requests, which should be able to be automated via modest workflow.

3. Key Use Case

1. Patient visits their primary healthcare provider for a health issue. (Note: It is conceivable that patient comes in for a preventive visit and a reason for consultation is discovered; this would be important to consider if “visit type” is a filter for the use case.)
2. Primary Care provider evaluates the health issue, and makes a determination that the patient needs to be referred to a specialist.
3. Patient locates a specialist based upon their preferences. (Note: In some situations, the patient will do this, however, in most, the primary healthcare provider will provide guidance, perhaps a specific name of a physician or practices; in other cases, the referral coordinator in the referring physicians’ office will need to check the patient’s insurance network, etc.)
4. Primary care provider writes an order, or creates a referral letter to give to the specialist. (Note: There may be standardized referral forms from the payer or state (i.e., Maryland has a Universal Referral Form); in some cases, the referral is given to the patient, in others faxed to the specialist; if the patient schedules the visit, then he/she would need the referral)
5. Patient contacts the specialist for an appointment. (Note: Again, could be patient, office, physician (especially for an urgent/emergent referral))
6. Patient visits specialist, fills out form indicating problems, meds, allergies, reason for visit, insurance information, et cetera.
7. Front desk enters information into Specialist EHR.
8. Specialist reviews patient details, and interviews patient.
9. Specialist contacts primary care provider for more detail.
10. Primary care faxes copy of details to specialist. (Note: Some of this information can be transmitted verbally; other information might come from lab or hospital…)
11. Specialist orders followup treatment with other healthcare provider.
12. Patient contacts the followup provider for an appointment.
13. Patient visits followup provider, fills out form indicating problems, meds, allergies, reason for visit, insurance information, et cetera.
14. Front desk enters information into followup provider EHR.
15. Patient receives treatment from followup provider.
16. At next visit to primary care provider, PCP asks patient for an update on referall.

4. Standards & Systems

Systems

• EHR Systems
• Practice Management Systems
• HIS Systems
• ADT Systems

Standards

• HL7 Version 2.X
• HL7 Version 3.X
• HL7 CDA Release 2.0
• ASTM/HL7 Continuity of Care Document
• Web Services
• SOAP
• HTTP
• DNS
• SMTP
• MIME
• S/MIME

5. Discussion

The workflow for exchange of information between providers needs to address:

• Ordering
• Scheduling
• Communications between Providers
• Task Lists
• Reporting

IHE would be a good venue to solve this problem because it reflects a need to support the integration of several standards together.