Data Element
Referral Category
Description
The classification of the referral, or the service being requested. For example a procedure, an intervention such as counseling or education, or a service.
Submitted By: Grace Glennon, on behalf of NCQA / NCQA
Data Element Information
Rationale for Separate Consideration This referral category data element is intended to support other referral data elements/information including the referral code and reason for referral.
Use Case Description(s)
Use Case Description Referral information, including the referral category, are important for the efficient exchange of health information to support care coordination. Referrals are routinely captured and exchanged to support patient care, for example when a PCP refers a patient to a surgical center, or to a diabetes education program. Moreover a referral category helps appropriate distinguish types of services being requested, which can be broad and include referrals to 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 the required information.

Inclusion of specific referral information in the USCDI should also facilitate the ability to close the loop on referrals to ensure services requested are carried out, and care is provided, which is the critical step for high-quality, equitable care.
Estimate the breadth of applicability of the use case(s) for this data element (Level 2) – Use cases apply to most care settings or specialties.
Use Case Description In addition to being collected for routine care coordination activities, referrals and referral categories are used in quality measurement, including NCQA HEDIS, to support assessing appropriate follow-up planning based on care needs.

Moreover, tracking referral information and the outcome of referrals is critical to understanding and improving the quality of care provided and health equity concerns.
Estimate the breadth of applicability of the use case(s) for this data element This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders; Majority of care settings are sending and receiving referral information.
ONC Priority
  • Address behavioral health integration with primary care and other physical care
  • Mitigate health and health care inequities and disparities
  • Address the needs of underserved communities
  • Address public health interoperability needs of reporting, investigation, and emergency response
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) HL7 FHIR US Core ServiceRequest Category Codes
HL7 Service Request Category

http://hl7.org/fhir/us/core/ValueSet-us-core-servicerequest-category.html ; http://hl7.org/fhir/R4/valueset-servicerequest-category.html
Additional Specifications ServiceRequest profile is included in HL7 FHIR US Core IG (6.0.0 and 6.1.0).
Category is a must support element

Bidirectional Services e-Referrals (BSeR) IG supports bidirectional exchange of referral and service completion information

360 Exchange Closed Loop Referral (360X)
Current Use (Level 2) Captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer
Extent of exchange (Level 2) Between more than two production EHRs or other HIT modules using available interoperability standards
Supporting Artifacts USCDI already includes reason for referral element in Procedure Data Class. HIT are routinely capturing referral information. This element is exchanged via the US Core ServiceRequest profile, which includes the other referral elements recommended by NCQA (code, category).
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) No restrictions.
Restrictions on Use (e.g. licensing, user fees) None.
Privacy and Security Concerns Exchange of patient health information should follow HIPPA Privacy Rules.
Estimate of Overall Burden This element, combined with other referral information should be low burden to collect and exchange. Referral category is a ‘must support’ element in the US Core Service Request profile, already being used to support exchange of the ‘reason for referral’ USCDI element.

The element should not require significant developer time to implement in EHR systems.
Other Implementation Challenges No other known implementation challenges .
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment Data represented by this element is needed in a very narrow set of use cases.

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