Patient Care Workflow

1. Proposed Profile: <initial working name for profile>

• 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.
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.
4. Primary care provider writes an order, or creates a referal letter to give to the specialist.
5. Patient contacts the specialist for an appointment.
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.
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 recieves treament 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.