Use Case 2 - Patient Referral

This use case has been created by the HIMSS Interoperability Maturity Model (IMM) Task Force as a sample of basic technical capabilities necessary for achieving interoperability and improved care processes through health information technology.

If you would like to see other use cases added, please submit a request to interop@himss.org.

This use case describes the situation where a patient is referred to another care provider.  The health information systems of the two provider organizations should be able to successfully transfer a notification of the patient referral.  The notification may include important patient data elements that facilitate the effective transfer of the patient's care from the first provider organization to the second.

  • Communicate a patient referral to an external organization
  • Similar to a transition of care
  • Includes provider to provider referral using DIRECT

Goals:

To be able to electronically send a referral for a patient from care provider A to care provider B with the appropriate patient demographic, administrative and clinical data to ensure a smooth transition of care.

Primary actors:

  • Senders
  • Receivers

Preconditions/triggers:

  • Specific patient requirement
  • Consult is necessary

List or describe the basic flow of the use case from beginning to end, without error states.

  • Patient status changes which requires additional care
  • Provider organization creates referral to XYZ organization
  • Documentation and payor authorizations required for the case are transferred to the provider organizations
  • Acknowledgement from the receiving provider organization is received
  • Receiving provider organization responds to accept or decline the referral

Looking for a printer-friendly copy of this basic workflow?  Download the workflow diagram here!

List or describe alternate flows, including those that involve error conditions.

  • Receiver does not acknowledge referral – manual process
  • Receiver declines referral

Are there post conditions that will be true about the system after the use case has been accomplished?

  • Referring entity is informed
  • Demographic update to the patient record
  • Both provider organizations have updated records

Set of resources that must be made available and/or configured to execute the use case. Data, services, systems, etc.

  • Secure method of bi-directional communication between provider organizations
  • Policy and procedure for method of transmission and data content
  • Formal provider agreement in place

Looking for a printer-friendly copy of this use case?  Download the printable PDF here!

 

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Keywords: 
use cases, interoperability, Referral, care provider