Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Document-based Referral Request (DRR) • Robert Horn • Agfa Healthcare • IT Infrastructure – 2007/8 TI Profile

2. Clinical Referrals • DRR addresses the initial phase of a clinical referral • It is part of a multi-year roadmap that covers the full process from referral, through consultations, to the final report back. • It is adaptable to a variety of network infrastructure environments: • No network (using physical media) • Limited network (using email) • Partial automation • Full automation (a future roadmap item)

3. Clinical Reality • 20-30% of referrals require human judgment and intervention • Unlike most IHE profiles, this means that a significant percentage will diverge away from automation during this profile. • DRR will reduce administrative time • 70-80% of referrals can proceed using the information provided by the referring clinician.

4. Current Operational Uses • Media based referrals are common already, using PDI and XDM. • The NHS Book and Order system is similar to the DRR using a paper referral and XDS document transfer.

5. Sample Use Cases • Media-based Referral to Provider • Patient-selected Provider Referral • Direct Referral to Provider

6. Media-based Referral to Provider Portable Media Importer Content Consumer Content Creator Portable Media Creator Referral Requester Referral Dispatcher Media XDSFolder.uniqueID Referral Request Document Printed Referral

7. What is different from PDI or XDM? • There are additional rules defining how the XDSFolder is used to collect referral documents. • The Referral Request document is a CDA document as specified in the PCC XDS-MS profile. It is created by the Referal Requester. • The Referral Requester can create a printed referral request, containing instructions and the XDSFolder.uniqueID • The Referral Dispatcher can use the XDSFolder.uniqueID to find the proper XDSFolder, to retrieve the Referral Request document.

8. Patient Selected Provider Referral Document Consumer Content Consumer Content Creator Document Source Referral Requester Referral Dispatcher XDS XDSFolder.uniqueID ReferralRequestDocument Printed Referral

9. What is different from XDS or XDS-MS • There are additional rules defining how the XDSFolder is used to collect referral documents. • The Referral Request document is a CDA document as specified in the PCC XDS-MS profile. It is created by the Referal Requester. • The Referral Requester can create a printed referral request, containing instructions and the XDSFolder.uniqueID • The Referral Dispatcher can use the XDSFolder.uniqueID to find the proper XDSFolder, to retrieve the Referral Request document.

10. Referral Request Option Document Consumer Content Consumer Content Creator Document Source Referral Requester Referral Dispatcher XDS XDSFolder.uniqueID ReferralRequestDocument Referral Request Referral Request Response

11. What changes with this option • The • XDSFolder use is the same. • The Referral Request document is the same. • The ability to print is the same • The use of XDS to retrieve is the same. • The Referral Requester can send the HL7 request and receive the HL7 acknowledgement, using MLLP. • The Referral Dispatcher can receive the HL7 request and send the HL7 acknowledgement, using MLLP.

12. Referral Reqestor • Create and organize the XDSFolder • Create the Referral Request CDA document • Print the referral request • (Option) Use HL7 messaging to send the Referral Request, and to receive the acknowledgement

13. Referral Dispatcher • Receive and process the printed referral request. • Find and process the XDSFolder and it’s referral request CDA document. • Determine whether the request can be accepted, rejected, or deferred for human decision. • (Option) Use HL7 messaging to receive the Referral Request, and to send the acknowledgement