Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept
Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept
Care Coordination and 360 Referrals (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Patient Referral [I12] - the HL7 v2 patient care referral message REF_I12 and its
response RRI_I12, an alternative HL7 v2 carrier for
Referral Request [PCC-55], used by some systems.
OMG^O19 / OSU^O51. 360X uses the order
messages, which carry the whole referral lifecycle and match laboratory and radiology
order workflows. In FHIR there is one referral message whatever the HL7 v2 source:
Referral Order (O19) and
Referral Order Status (O51).
A REF_I12 is converted to the O19 FHIR Message and an RRI_I12 to O51.
| Message | HL7 v2 (I12) | HL7 v2 (360X, main route) | FHIR Message | Focus |
|---|---|---|---|---|
| Patient referral | REF^I12^REF_I12 |
OMG^O19^OMG_O19 (ORC-1 NW) |
Referral Order (O19) | Referral Request |
| Modify referral | REF^I13^REF_I12 |
OMG^O19 (ORC-1 XO) |
Referral Order (O19), updated ServiceRequest | Referral Request |
| Cancel referral | REF^I14^REF_I12 |
OSU^O51 (ORC-1 CA) [PCC-58] |
Referral Order Status (O51) | Referral Task |
| Status enquiry | REF^I15^REF_I12 |
- | FHIR REST read / search of the Task | Referral Task |
| Response (accept / decline) | RRI^I12^RRI_I12 (RF1-1 A / R) |
OSU^O51 (ORC-1 OK / UA) |
Referral Order Status (O51) | Referral Task |
| Interim note, outcome | Not defined | OSU^O51 (SC / A, SC / CM) + MDM^T02 |
Referral Order Status (O51) | Referral Task + document |
sequenceDiagram
participant RI as Referral Initiator<br/>GP system
participant RR as Referral Recipient<br/>EPR / PAS
RI ->> RR: REF^I12 / FHIR Message (O19, focus ServiceRequest)
RR -->> RI: ACK (MSA AA) / HTTP 200
RR -->> RR: Triage
RR ->> RI: RRI^I12 / FHIR Message (O51, focus Task)
Later steps (appointment, interim note, outcome, cancellation) use the same messages as the 360X route - see Exchange Options.
Indicative mapping of REF_I12 to FHIR:
| HL7 v2.5.1 | Meaning | FHIR | Note |
|---|---|---|---|
| MSH-4 / MSH-6 | Sending / receiving facility | MessageHeader.sender / destination.receiver (ODS code) |
|
| MSH-9 | REF^I12^REF_I12 |
MessageHeader.eventCoding v2-0003 I12 |
|
| RF1-1 Referral Status (0283) | P pending, A accepted, R rejected, E expired | Task status / businessStatus |
Pending in the request |
| RF1-2 Referral Priority (0280) | S stat, A ASAP, R routine | ServiceRequest.priority |
|
| RF1-3 Referral Type (0281) | e.g. Med medical, Lab, Rad | ServiceRequest.category |
Coarse; the service is in code |
| RF1-5 Referral Category (0284) | O outpatient, I inpatient, E emergency, A ambulatory | ServiceRequest.category / locationCode |
|
| RF1-6 Originating Referral Identifier | Referral ID (EI, namespace = ODS code) | ServiceRequest.identifier:referralId |
The Referral ID used in every later message |
| RF1-7 / RF1-8 | Effective / expiration date | occurrencePeriod; Task restriction.period |
Validity |
| RF1-10 Referral Reason (0336) | Administrative reason (e.g. O provider ordered) | - | The clinical reason is DG1 / OBX |
| RF1-11 External Referral Identifier | e.g. UBRN | ServiceRequest.identifier:ubrn |
To confirm NHS use |
| PRD (role RP) | Referring provider | ServiceRequest.requester (PractitionerRole) |
PRD-7 professional identifier |
| PRD (role RT) | Referred-to provider or service | ServiceRequest.performer (HealthcareService) |
|
| PID | Patient | Patient |
NHS Number and MRN in PID-3 |
| DG1 | Diagnosis / reason for referral | ServiceRequest.reasonCode / reasonReference (Condition) |
SNOMED CT |
| OBR / OBX | Clinical information, referral question | ServiceRequest.supportingInfo (Observation, QuestionnaireResponse), note |
Ask at order entry - see Referral Forms |
| NTE | Notes, referral question | ServiceRequest.note |
|
| PV1 | The encounter the referral was made in | ServiceRequest.encounter (Visit) |
Optional |
RRI_I12 adds MSA (acknowledging the referral message) and carries RF1-1 A (accepted)
or R (rejected), mapped to the Referral Task (accepted / rejected).
Dr Allen at HT PRACTICE (P89020) refers Hodor TAMESIDE to cardiology at MFT (R0A) - the same referral as the Referral Request example.
MSH|^~\&|GPSYSTEM|P89020|EPR|R0A|20260904101500+0100||REF^I12^REF_I12|MSG000123|P|2.5.1|||AL|NE|||||
RF1|P^Pending^HL70283|A^ASAP^HL70280|MED^Medical^HL70281||O^Outpatient^HL70284|REF-2026-000123^P89020|20260904|20261204||O^Provider Ordered^HL70336|000049637246^UBRN
PRD|RP^Referring Provider^HL70286|Allen^^^^Dr||||||G1234567^GMP
PRD|RT^Referred to Provider^HL70286|^General Cardiology Outpatients||^^^R0A^^^^^^^R0A|||1234567^ERS-SERVICE
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
DG1|1||267036007^Dyspnea^SCT||20260904|W
NTE|1||Determine the origin of Mr Tameside's shortness of breath. To be seen within a week.
NTE|2||BMI 30, non-smoker, no chest pain, family history of coronary artery disease.
FHIR Message equivalent: Bundle Message - Referral Order (O19) - the same message as the OMG^O19 on Referral Request [PCC-55].
Cardiology accepts the referral:
MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260905093000+0100||RRI^I12^RRI_I12|MFT-MSG-778899|P|2.5.1|||AL|NE|||||
MSA|AA|MSG000123
RF1|A^Accepted^HL70283|A^ASAP^HL70280|MED^Medical^HL70281||O^Outpatient^HL70284|REF-2026-000123^P89020|20260905|20261204
PRD|RT^Referred to Provider^HL70286|^General Cardiology Outpatients||^^^R0A^^^^^^^R0A|||1234567^ERS-SERVICE
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M
FHIR Message equivalent: Bundle Message - Referral Order Status (O51), accepted, whose focus is the accepted Referral Task.
REF_I12 / RRI_I12 |
360X OMG^O19 / OSU^O51 |
|
|---|---|---|
| Designed for | Patient care referrals between providers | Orders (laboratory, radiology), reused by 360X for referrals |
| Events | I12 referral, I13 modify, I14 cancel, I15 status enquiry; RRI_I12 response | One message type; ORC-1 order control says what is happening |
| Status after the first response | The receiver cannot push interim or completed status (I15 is an enquiry from the referrer) | Defined and pushed by the receiver: accept, decline, interim, outcome, cancel confirmed |
| Fits with | Referral systems | LTW and SWF.b order management in Trust Integration Engines |
| This guide | Accepted as an HL7 v2 alternative for the request, modify, cancel and first response; converted to the O19 / O51 FHIR Messages | Main route for the full closed loop; the FHIR Messages are O19 / O51 |
Either way, the Referral ID (RF1-6 or ORC-2) SHALL be carried in every later message.