Care Coordination and 360 Referrals (Proof of Concept)
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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

Interim Consultation Note [PCC-59]

Interim Consultation Note [PCC-59] - the Referral Recipient sends results before the end of care, for example the clinic letter after a first appointment. It does not end the referral, and may be sent more than once.

References

Interaction

sequenceDiagram
    participant RI as Referral Initiator
    participant RR as Referral Recipient
    RR -->> RR: Consultation
    RR ->> RI: Interim Consultation Note<br/>OSU^O51 SC/A + document<br/>Task businessStatus interim-report + document
    RI -->> RI: Show results; referral still open
Actor Optionality
Referral Initiator R (receive)
Referral Recipient O (send)

Content

Status Update

Data item 360X HL7 v2 FHIR (Referral Task)
Order control ORC-1 SC status in-progress
Referral ID ORC-2 basedOn.identifier, focus
Order status ORC-5 A (some, but not all, results available) businessStatus interim-report
Ordering provider and facility ORC-12 and ORC-21 - the referrer, required in this guide (360X leaves ORC-12 empty) Task.requester (unchanged)
Document In the package; OBX ED / RP or MDM^T02 output - added to any earlier outputs

Clinical Document

A clinic letter as a FHIR Document: Composition (LOINC 11488-4 Consult Note) with the HL7 Europe HDR section codes, with sections as needed. It is linked to the referral by the status update (Task.output, or TXA-14 in HL7 v2), not inside the document. HDR itself is for inpatient stays - see Referral Outcome Reports:

Section LOINC Content
Reason for referral 29299-5 The referral reason and question as understood
History of present illness 10164-2  
Assessment 51848-0 Findings and answer to the referral question
Plan of care 18776-5 Planned tests, treatment, follow up, onward referrals
Problems 11450-4 Diagnoses
Results 30954-2 Relevant results

LOINC 42349-1 (Reason for referral), used by C-CDA, could not be checked on tx.fhir.org; 29299-5 (Reason for visit) is used instead - To confirm.

Example: Clinic Letter - Interim.

Example

The status update and the clinic letter. 360X sends the document with the status update; in HL7 v2 it travels as an MDM^T02 carrying the Referral ID in ORC-2 and TXA-14 (placer order number), so the referrer can match it to the referral.

MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260907160000+0100||OSU^O51^OSU_O51|MFT-MSG-779001|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|||A||||20260907160000+0100|||G1234567^Allen^^^^Dr^^^GMP|||||||||HT PRACTICE^^P89020^^^ODS

MSH|^~\&|EPR|R0A|GPSYSTEM|P89020|20260907160000+0100||MDM^T02^MDM_T02|MFT-MSG-779002|P|2.5.1|||AL|NE
EVN|T02|20260907160000+0100
PID|1||9737383397^^^NHS^NH~B6789012^^^R0A^MR||TAMESIDE^Hodor||19600727|M|||Stockport Road^^Tameside^^OL7 0NS
PV1|1|O|^^^R0A||||||||||||||||OP2026090701^^^R0A^VN
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|20260907160000+0100|7654321^Brown^^^^Dr^^^GMC|||||||DOC-55501^R0A||REF-2026-000123^P89020|||AU||AV
OBX|1|ED|11488-4^Consult note^LN||^application^pdf^Base64^JVBERi0xLjQK...||||||F

The attendance is identified by its Visit Number in PV1-19 (type VN) - see Patient Administration. FHIR equivalent: a Referral Order Status (O51) message whose Task output is the interim consultation note.

Expected Actions

  • The Referral Initiator SHALL extract the document and present the results to the appropriate users. Particular attention is needed when the note reports a serious condition.
  • Each interim note and the final outcome are separate documents. Relationships between them (e.g. a note replacing an earlier one) use Composition.relatesTo.