Data Element
Submitted By: Adam Bazer, MPD / Integrating the Healthcare Enterprise USA (IHE USA)
Data Element Information
Use Case Description(s)
Use Case Description This use case pertains to the adoption of all of the defined data elements to be used as in the following use case.
a 28-year-old female, is going home from the hospital after having an infection due to systemic fibrosis. The doctors prescribed oxygen after treatment, and call a transport company to take her to a rehabilitation center. Alison is a paraplegic and is wheelchair bound. Due to the prescribed oxygen, there needs to be monitoring for her transport. The hospital creates a referral for her transport. The reasons for referral are heavily used to justify her transport for billing and payment. The referral requestor is used to identify who is requesting the service. The referral coverage includes the insurance information that may be needed to cover the event. The referral code indicates what type of service is being requested, in this case interfacility transport.
Estimate the breadth of applicability of the use case(s) for this data element This data class would utilized by emergency responders and ambulance systems that are used for interfacility transport. It will also be of interest for any provider engaged in continuity of care referrals.
Link to use case project page https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_RIPT.pdf
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) Routine Interfacility Patient Transport (RIPT) - https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_RIPT.pdf
https://hl7.org/fhir/R4/servicerequest.html
Additional Specifications Routine Interfacility Patient Transport (RIPT) - https://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_RIPT.pdf
https://hl7.org/fhir/R4/servicerequest.html
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts 360 Exchange Closed Loop Referral (360X) Connecathon testing in 2019
Used in multiple HIMSS Demos
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) none
Restrictions on Use (e.g. licensing, user fees) none
Privacy and Security Concerns none
Estimate of Overall Burden I anticipate that this may have a low burden for implementation since this data class and elements exist in FHIR and CDA for medical referrals, which has a large populations of stakeholders that already use this data class.
Other Implementation Challenges none

Comment

Submitted by rclark@carequest.org on

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.

Submitted by pwilson@ncpdp.org on

NCPDP Comments on USCDI draft v5

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

Submitted by pwilson@ncpdp.org on

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.

Submitted by pwilson@ncpdp.org on

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.

Submitted by Lantana Consul… on

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.

Submitted by nedragarrett_CDC on

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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