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
Referral Request [PCC-55] - the Referral Initiator sends a referral to the Referral Recipient, which replies with an accept or a decline.
sequenceDiagram
participant RI as Referral Initiator
participant RR as Referral Recipient
RI ->> RR: Referral Request<br/>OMG^O19 + document / ServiceRequest
RR -->> RI: Acknowledgement (ACK / HTTP)
RR -->> RR: Triage
alt accepted
RR ->> RI: Referral Accept<br/>OSU^O51 OK/IP / Task accepted
else declined
RR ->> RI: Referral Decline<br/>OSU^O51 UA/CA / Task rejected
end
| Message | Trigger | HL7 v2 | FHIR |
|---|---|---|---|
| Referral Request | The clinician decides to refer | OMG^O19^OMG_O19 (ORC-1 NW) and a clinical document |
Referral Request and a FHIR Document; a Referral Task with businessStatus requested |
| Referral Accept | The Referral Recipient accepts responsibility for providing the service | OSU^O51^OSU_O51 (ORC-1 OK, ORC-5 IP) |
Task status accepted, businessStatus accepted |
| Referral Decline | The Referral Recipient cannot provide the service | OSU^O51^OSU_O51 (ORC-1 UA, ORC-5 CA, ORC-16 reason) |
Task status rejected, businessStatus declined, statusReason |
| Data item | 360X HL7 v2 | Required | FHIR (Referral Request) | Notes |
|---|---|---|---|---|
| Order control | ORC-1 NW |
R | status active, intent order |
|
| Referral ID | ORC-2 and OBR-2 | R | identifier:referralId (Referral Identifier) |
<referral ID>^^<assigning authority>; in the NHS the assigning authority is the ODS code |
| UBRN | Not in 360X | if eRS | identifier:ubrn |
eRS referrals only |
| Patient | PID-3, PID-5, PID-7, PID-8, PID-11 | R | subject (Patient) |
NHS Number (traced) and local identifier |
| Ordering provider | ORC-12 and OBR-16 | R | requester (PractitionerRole - practitioner) |
GMP / GMC or other professional number; 360X uses NPI |
| Ordering facility | ORC-21 | R (this guide) | requester (PractitionerRole - organization) |
ODS code (XON.3, assigning authority ODS); not required by 360X |
| Service referred to | OBR-4 | R | code |
360X default LOINC 57133-1 Referral note; in the NHS, the specialty / service - SNOMED CT referral procedure (e.g. 183519002 Referral to cardiology service) |
| Referred-to service | MSH-5 / MSH-6 | - | performer |
HealthcareService (eRS service ID, Directory of Services ID) or Organization |
| Reason for referral | OBR-31 (repeats) | R | reasonCode, reasonReference |
SNOMED CT preferred, else text in OBR-31.2 |
| Referral question | OBX-5 (OBX-11 O, OBX-29 QST) |
O | note |
The clinical question to answer |
| Validity | TQ1-6 service duration | O | occurrencePeriod; Task restriction.period |
Must not delay the accept / decline response |
| Expected by | TQ1-8 | R2 | occurrenceDateTime |
360X converts urgency into a date. Also send priority |
| Total occurrences | TQ1-14 | O | quantityQuantity |
|
| Priority | TQ1-9 | - | priority |
see Priority |
| Clinical information | CDA document in the package | R | supportingInfo - FHIR Document, DocumentReference (referral letter PDF), QuestionnaireResponse |
|
| Date of referral | ORC-9 | - | authoredOn |
Example: Referral Request - GP to Cardiology.
Where the record can be queried (EU Health Data API: QEDm, MHD), the referral SHOULD carry only what the Recipient cannot read for itself - the reason, the question, the referral form - and reference the rest. Querying is highly recommended over copying the record into the referral.
360X sends a CDA document (XDS-MS Referral Summary or C-CDA Referral Note) with the order. This guide allows, in order of preference:
DocumentReference with a PDF attachment (as eRS
referral letters are today)QuestionnaireResponse for the service's referral form (e.g. exercise
pre-participation screening, virtual ward eligibility), with the answers needed as
data also sent as Observations - see Referral FormsWhere the Referral Initiator is a GP practice, the Referral Recipient may instead pull the record when triaging, with GP Connect Access Record (HTML or Structured) and Access Document, or a supplier IM1 interface. The referral SHALL still carry the reason for referral and the referral question.
The clinical information is subject to the same access controls as the record, and the reason for referral in the order message is clinical information too (PCC TF-2 3.55.5.2).
| NHS | FHIR priority |
Expected by (TQ1-8) |
|---|---|---|
| Routine | routine |
Service standard |
| Urgent | urgent |
Date set by the referrer or service |
| Urgent suspected cancer (formerly two week wait) | urgent - To confirm a code for the cancer pathway |
Within the Faster Diagnosis Standard timescale |
| Same day / emergency (e.g. virtual ward step-up) | asap or stat |
Today |
360X notes that "Urgent", "ASAP" and similar mean different things in different settings, which is why it asks the Referral Initiator to convert urgency into a date.
The Referral Recipient SHALL respond with an accept or a decline. It SHALL use the patient identifier and Referral ID from the request in every later message.
| Data item | 360X HL7 v2 | FHIR (Referral Task) |
|---|---|---|
| Order control | ORC-1 OK |
status accepted (or in-progress once care starts) |
| Referral ID | ORC-2 | basedOn.identifier, focus |
| Order status | ORC-5 IP |
businessStatus accepted |
| Ordering provider and facility | ORC-12 (ordering provider) and ORC-21 (ordering facility, ODS code) - the referrer, required in this guide (360X leaves ORC-12 empty) | Task.requester (unchanged) |
| Responsible service | MSH-3 / MSH-4 | owner |
Example: Referral Task - Accepted.
Expected actions. The Referral Initiator's system SHALL show that the Referral Recipient has taken responsibility for the requested service.
| Data item | 360X HL7 v2 | FHIR (Referral Task) |
|---|---|---|
| Order control | ORC-1 UA |
status rejected |
| Referral ID | ORC-2 | basedOn.identifier, focus |
| Order status | ORC-5 CA |
businessStatus declined |
| Ordering provider and facility | ORC-12 (ordering provider) and ORC-21 (ordering facility, ODS code) - the referrer, required in this guide (360X leaves ORC-12 empty) | Task.requester (unchanged) |
| Reason | ORC-16 (required; at least text in ORC-16.2) | statusReason (Referral Status Reason, example) |
Example: Referral Task - Declined. The referral
ServiceRequest.status becomes revoked.
Expected actions. The Referral Initiator's system SHALL show the decline and its
reason. A new referral needs a new Referral ID (ServiceRequest.replaces may point to
the declined one). The Referral Recipient handles the patient information it received
according to its policy for patients it will not treat.
The Tameside cardiology referral, on the main HL7 v2 route (360X OMG^O19 / OSU^O51)
and as FHIR Messages (Referral Order (O19),
Referral Order Status (O51)). The
REF_I12 alternative is on Patient Referral [I12].
In every ORC in this guide, ORC-12 (ordering provider - the referring clinician,
with professional identifier) and ORC-21 (ordering facility - the referring
organisation's ODS code) are mandatory, including in the status updates the Referral
Recipient sends back. 360X leaves ORC-12 empty in status updates; filling both means
every message identifies the referrer without a look-up, as in the NW GMSA ORC.
When the Task is exchanged by messaging (Referral Order Status (O51)), both sides
already know the patient from the referral, so the FHIR Message does not include a
Patient resource: Task.for carries the NHS Number as identifier with the
reference, and Task.requester and Task.owner carry the referrer's professional code
and the recipient's service identifier. (The HL7 v2 OSU^O51 still has its PID
segment, which the message structure requires.)
The Referral ID is in ORC-2 and OBR-2 (namespace = the referrer's ODS code); the reason in
OBR-31; the referral question in an OBX with OBX-11 O and OBX-29 QST; the expected date
in TQ1-8.
MSH|^~\&|GPSYSTEM|P89020|EPR|R0A|20260904101500+0100||OMG^O19^OMG_O19|MSG000124|P|2.5.1|||AL|NE
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
ORC|NW|REF-2026-000123^P89020|||||||20260904101500+0100|||G1234567^Allen^^^^Dr^^^GMP|||||||||HT PRACTICE^^P89020^^^ODS
TQ1|1|||||||20260911|A^ASAP^HL70485
OBR|1|REF-2026-000123^P89020||57133-1^Referral note^LN||||||||||||G1234567^Allen^^^^Dr^^^GMP|||||||||||||||267036007^Dyspnea^SCT
OBX|1|TX|QUESTION^Referral question^L||Determine the origin of Mr Tameside's shortness of breath. To be seen within a week.||||||O||||||||||||||||||QST
NTE|1||BMI 30, non-smoker, no chest pain, family history of coronary artery disease.
FHIR Message: Bundle Message - Referral Order (O19) (focus Referral Request).
ORC-1 OK, ORC-5 IP; ORC-12 and ORC-21 repeat the referrer.
MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260905093000+0100||OSU^O51^OSU_O51|MFT-MSG-778900|P|2.5.1|||AL|NE
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
ORC|OK|REF-2026-000123^P89020|||IP||||20260905093000+0100|||G1234567^Allen^^^^Dr^^^GMP|||||||||HT PRACTICE^^P89020^^^ODS
FHIR Message: Bundle Message - Referral Order Status (O51), accepted (focus Referral Task - Accepted).
ORC-1 UA, ORC-5 CA, reason in ORC-16 (at least the text in ORC-16.2). The same
message is used for a later decline [PCC-56].
MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260905093000+0100||OSU^O51^OSU_O51|MFT-MSG-778901|P|2.5.1|||AL|NE
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
ORC|UA|REF-2026-000123^P89020|||CA||||20260905093000+0100|||G1234567^Allen^^^^Dr^^^GMP||||SERVICE-NOT-PROVIDED^Please refer to the rapid access chest pain clinic instead.^L|||||HT PRACTICE^^P89020^^^ODS
FHIR Message: Bundle Message - Referral Order Status (O51), declined
(focus Referral Task - Declined, with
statusReason for ORC-16).
eRS allows a provider to return a referral to the referrer for more information, and
the HL7 Physical Activity IG puts Tasks on-hold; a service may also need a form
completed by the patient (Referral Forms). 360X has no such step. This guide uses businessStatus
information-requested with Task status on-hold, and the question in Task.note
or a Communication; the Referral Initiator updates ServiceRequest.supportingInfo and
the Task returns to requested. HL7 v2 equivalent - Open.
| eRS | BaRS | HL7 v2 (trust / region) | |
|---|---|---|---|
| Referral | eRS referral with attachments (UBRN) | ServiceRequest in a FHIR Message |
OMG^O19 (360X) or REF_I12 |
| Accept / decline | eRS triage outcome: accept, return to referrer, reject | Interim validation response (Application 4) - see BaRS | OSU^O51 or RRI_I12 |
| Message | OMG^O19 (360X) or REF_I12 - see Patient Referral [I12] |
||
| Mapping to this guide | UBRN in identifier:ubrn; eRS service as performer |
Map to Referral Request and Referral Task - see BaRS | As above |