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
Document Sharing (IHE MHD) - publishing clinical documents (referral letters, consultation notes, discharge reports) so they can be found and read later, instead of sending a copy to every party. In the EU Health Data API these are the Document Publisher, Document Access Provider and Document Consumer.
sequenceDiagram
participant SRC as Document Source<br/>Document Publisher<br/>(Referral Recipient)
participant DAP as Document Recipient / Responder<br/>Document Access Provider
participant CON as Document Consumer<br/>(Referral Initiator)
SRC ->> DAP: Provide Document Bundle [ITI-65]<br/>or Simplified Publish [ITI-105]
SRC ->> CON: Referral Outcome [PCC-57] status<br/>(Task completed, output = DocumentReference)
CON ->> DAP: Find Document References [ITI-67]
DAP -->> CON: DocumentReference(s)
CON ->> DAP: Retrieve Document [ITI-68]
DAP -->> CON: Document (FHIR Document, PDF)
| Transaction | From - To | Use in the closed loop |
|---|---|---|
| Provide Document Bundle [ITI-65] | Document Source - Document Recipient | Publish a document with full metadata (FHIR transaction with DocumentReference, Binary, List) |
| Simplified Publish [ITI-105] | Document Source - Document Recipient | Publish by POSTing a DocumentReference with the document as its attachment; the recipient completes the metadata. The usual route from a Trust Integration Engine converting HL7 v2 MDM^T02 |
| Find Document References [ITI-67] | Document Consumer - Document Responder | Find a patient's letters and reports, e.g. the outcome of a referral or earlier correspondence when triaging |
| Retrieve Document [ITI-68] | Document Consumer - Document Responder | Get the document itself |
| Find Lists [ITI-66] | Document Consumer - Document Responder | Folders and submission sets - not needed for this guide |
The Health Data API Document Publisher creates a DocumentReference (Simplified
Publish style); its Document Access Provider supports search and read of
DocumentReference and read of Binary, with an optional submission (create) option.
Metadata for referral documents:
DocumentReference |
Value | Note |
|---|---|---|
subject |
The patient (NHS Number) | Same patient identifier as the referral |
type |
Referral Document Type, e.g. LOINC 11488-4 Consult Note, 34105-7 Hospital Discharge Summary | Health Data API discharge type is 18842-5 - see Reports Open |
category |
Document class | To confirm NHS class codes (PRSB Document Naming) |
date, author, custodian |
When, who, which organisation | |
context.encounter |
The encounter or stay | |
context.practiceSetting |
Specialty | |
context.related |
The referral (ServiceRequest, with the Referral ID as identifier) |
Links the document to the referral it answers |
content.attachment |
FHIR Document (application/fhir+json) or PDF |
url to the Binary |
content.format |
Format code (e.g. HDR, PDF) |
Finding documents by the referral (related) is a core FHIR R4 search parameter but is
not in the Health Data API Document Access Provider's list (which has patient,
type, category, date, status, identifier, period, format, setting,
facility and others) - Open. Until it is, the referrer finds the outcome through
the Task (Task.output references the DocumentReference) or by patient, type and date.
| 360X | Document Sharing |
|---|---|
| Referral Request [PCC-55] | The referral letter or form may be published; ServiceRequest.supportingInfo references the DocumentReference |
| Interim Consultation Note [PCC-59] | Publish the note; the status message (OSU^O51 or Task) references it |
| Referral Outcome [PCC-57] | Publish the outcome; the status message references it; the referrer retrieves it |
| HL7 v2 | MDM^T02 to the Trust Integration Engine, which publishes by [ITI-105] |
360X's MHD Option groups the Referral Initiator and Recipient with MHD Document Source and Recipient so the transport itself is MHD. This guide uses MHD for sharing and keeps the workflow in the status messages - the referrer must still be told the outcome exists (Exchange Options).