Activity performed for or on a patient as part of the provision of care.

Data Element

Reason for Referral

Explanation or justification for a referral or consultation.


CareQuest Comments on Referral Data Element for USCDI Version 5

CareQuest Institute for Oral Health recommends creating a separate data class for Referral with its own data elements including Reason for Referral. A referral can also be an intervention as part of a patient’s treatment plan to address a health problem or diagnosis. When a CCD document is generated and shared externally, a referral should display as part of the patient’s treatment plan or order to request additional care and is not always a procedure that was completed as part of the provision of care from that visit. 

Health records are also sent to HIEs or are exchanged with other entities such as QHINS, QIOs to be made available to the patient’s care team when requested. It would be helpful to have additional information included about the referral to provide more context to the care team member reviewing the summary of care document. This will also better support coordination of care for both the Primary Care providers as well as other specialties such as Oral Health providers.

In most cases, this may be the only record to which a provider would have access. Therefore, data elements in the USCDI should also furnish the provider with enough information to administer the appropriate service that is needed, thereby closing the loop on the referral.

For broader sharing of electronic health information and to be inclusive of all specialties such as Oral Health, the USCDI is critical toward establishing the basic standards to support both patient care and care coordination for all providers in a community.

NCPDP Comments on USCDI draft v5

NCPDP applauds the addition of SNOMED CT codes to the applicable vocabulary standards.

NCPDP Comment

NCPDP recommends the use of SNOMED CT codes. Pharmacists document “Reason for Referral" in the NCPDP/HL7 Pharmacist eCare Plan using SNOMED CT codes. For example, used within the NCPDP/HL7 Pharmacist eCare Plan, the SNOMED CT codes are in two value sets the NLM VSAC “PharmacyReferralsTo” OID 2.16.840.1.113762.1.4.1096.203 and “PharmacyReferralsFrom” OID 2.16.840.1.113762.1.4.1096.216.

NCPDP Comments

NCPDP recommends the use of SNOMED CT. Pharmacists document “Reason for Referral" in the NCPDP/HL7 Pharmacist eCare Plan using SNOMED CT.  These SNOMED CT codes are in 2 value sets the NLM VSAC “PharmacyReferralsTo” OID 2.16.840.1.113762.1.4.1096.203 and “PharmacyReferralsFrom” OID 2.16.840.1.113762.1.4.1096.216.

Lantana Consulting Group Comment

The data element Reason for Referral is listed under Procedures; however, referrals are not limited to the completion of a procedure. Orders often include referrals but can be considered as a Plan of Treatment. We note that in C-CDA, referrals are listed as part of the plan of treatment. Lantana recommends placing this data element under Care and Treatment Plans category.

Unified Comment from CDC

  • Referral data elements, such as reason, requestor, and coverage, are important to support CDC’s efforts in streamlining the efficient exchange of health information between healthcare providers and principally extra-clinical program service systems that reside in community services, lifestyle change, public health, and other organizations. These data elements play a major role in identifying appropriate services based on the patient’s health needs and aid in ensuring appropriate parties involved in the overall health and wellbeing of the patient are receiving information regarding the patient intake outcome, referral service provisioning, and final referral outcome. The referral data elements are also useful to understand how often patients are referred to specialist for occupational illnesses.
  • Support for healthcare aims:  Also supports Improving health of populations and Reducing cost of care, Improving provider experience of care.
  • Additional Technical Specification: Bidirectional Services eReferrals (BSeR) FHIR Implementation Guide

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