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 Outcome [PCC-57]

Referral Outcome [PCC-57] - the Referral Recipient sends the result of the referral at the end of care. It closes the loop.

References

• IHE PCC 360X PCC TF-2 3.57
• HL7 Europe Hospital Discharge Report (1.0.0 STU 1)
• Transfer of Care
• Referral Outcome Reports

Interaction

sequenceDiagram
    participant RI as Referral Initiator
    participant RR as Referral Recipient
    RR -->> RR: End of care / discharge
    RR ->> RI: Referral Outcome<br/>OSU^O51 SC/CM + document<br/>Task completed + document
    RI -->> RR: Acknowledgement
    RI -->> RI: Import document, close referral
    opt Document Sharing
        RR ->> RR: Publish document (Health Data API / MHD)
    end

Content

The outcome is a status update and a clinical document.

Status Update

The referral ServiceRequest.status becomes completed.

Clinical Document

360X used the XPHR or C-CDA documents. Whatever the type, the document SHALL:

• be linked to the referral by the workflow that carries it (Task.output, MDM^T02 TXA-14, DocumentReference.context.related) - see Referral Outcome Reports;
• identify the patient with the same identifier as the referral;
• include the answer to the referral question and the plan of care, including any onward (secondary) referral the Referral Recipient has made;
• state medication changes, and who will action them - a prescription already sent by EPS, or a request to the GP;
• name the Referral Initiator as a recipient (extension[informationRecipient] in HDR), and the patient's GP if different.

Examples:

• Cardiology (after the catheterisation admission): Hospital Discharge Report - Referral Outcome, Referral Task - Completed
• Virtual ward: Hospital Discharge Report, Referral Task - Virtual ward completed

Example

The outcome status update and the discharge letter (MDM^T02, Referral ID in ORC-2 and TXA-14). The letter follows the day case admission, so PV1-19 carries the Account / Spell Number (type AN).

MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260924110000+0100||OSU^O51^OSU_O51|MFT-MSG-779950|P|2.5.1|||AL|NE
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
ORC|SC|REF-2026-000123^P89020|||CM||||20260924110000+0100|||G1234567^Allen^^^^Dr^^^GMP|||||||||HT PRACTICE^^P89020^^^ODS

MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260924110000+0100||MDM^T02^MDM_T02|MFT-MSG-779951|P|2.5.1|||AL|NE
EVN|T02|20260924110000+0100
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
PV1|1|I|^^^R0A||||||||||||||||1001166717^^^R0A^AN
ORC|SC|REF-2026-000123^P89020||||||||||G1234567^Allen^^^^Dr^^^GMP|||||||||HT PRACTICE^^P89020^^^ODS
OBR|1|REF-2026-000123^P89020||57133-1^Referral note^LN
TXA|1|11488-4^Consult note^LN|AP|20260924110000+0100|7654321^Brown^^^^Dr^^^GMC|||||||DOC-55777^R0A||REF-2026-000123^P89020|||AU||AV
OBX|1|ED|11488-4^Consult note^LN||^application^pdf^Base64^JVBERi0xLjQK...||||||F

FHIR Message: Bundle Message - Referral Order Status (O51), referral outcome (the completed Task and the outcome consultation note).

Expected Actions

• The Referral Initiator SHALL store the document, make it available to users with access to the patient record, and show that the referral has ended.
• It SHALL import the document (360X Document Import Option) and MAY import sections or discrete data (problems, medications, care plan).
• A Referral Outcome may arrive instead of a Cancel Confirmation if the Referral Recipient could not cancel (PCC-58).

NHS Implementations