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.

Description of the use case:

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.

Identify the actor(s) involved:

Primary actors:

Senders
Receivers

Use case preconditions:

Preconditions/triggers:

Specific patient requirement
Consult is necessary

What is the basic flow?

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!