Referral/Transfer of Care Codeable Elements valuesets

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Introduction


The FHIR Referral Request resource draft content is available for review through the following link:

http://hl7-fhir.github.io/referralrequest.html


  • This draft resource identifies a number of codeabe data elements:
- Status
- Type
- Specialty
- Priority
- Reason
- Service requested


  • Valuesets need to be defined for each data elements.


Referral/Transfer of care Status values

This data element holds values to describe various workflow status pertinent to a referral or transfer of care request initiated by a requester.

  • The value set includes the following values:
- draft
- sent
- accepted
- active
- cancelled [or withdrawn]
- refused
- on referred (to another provider by the referral recipient)
- completed
- expired (without reaching completion state)


Statues codes

  • place holder for SNOMED CT or LOINC codes for the referral/transfer of care request "status" values


Referral/Transfer of care Type values

This data element holds the values that identifies the types of referral or transfer of care request

  • The value set includes the following values:
- specialist referral
- community services referral
- district nursing services referral
- aged care placement assessment referral
- allied health services referral (e.g. pharmacist medication review; physiotherapy; occupational therapy)
- skilled nursing facility transfer request
- aged care facility transfer request
- stroke rehabilitation service transfer request
- hospice care transfer request

[Note - the values included in this set extends beyond the above items - discussions required to determine whether just to provide examples or an exhaustive list]


Type codes

  • place holder for SNOMED CT or LOINC codes for the referral/transfer of care request "type" values


Referral/Transfer of care (clinical/service) Specialty values

This data element holds values that identifies the clinical/service specialty to which a referral or transfer of care is sent

  • The value set includes the following values:
- cardiology
- endocrinology
- haematology
- gynaecology/obstetrics
- orthopaedic
- haematology oncology
- radiation oncology
- surgical oncology
- urology

[Note - the values included in this set extends beyond the above items - discussions required to determine whether just to provide examples or an exhaustive list]


Specialty codes

  • place holder for SNOMED CT or LOINC codes for the referral/transfer of care request (clinical/service) "specialty" values


Referral/Transfer of care Priority values

This data element holds values to identify the priority/urgency of a referral/transfer of care request

  • This value set includes the following values:
- emergency
- urgent
- high priority
- medium priority
- normal priority


Note - different realms/jurisdictions may adopt different priority/categorisation systems. The following is a referral/elective surgery categorisation system used by Queensland Health in Australia:

- Category 1 – A condition that could get worse quickly to the point that it may become an emergency. Patient should have surgery within 30 days of being added to the waiting list.
- Category 2 – A condition causing some pain, dysfunction or disability, but is not likely to get worse quickly or become an emergency. patient should have surgery within 90 days of being added to the waiting list.
- Category 3 – A condition causing minimal or no pain, dysfunction or disability, which is unlikely to get worse quickly and which does not have the potential to become an emergency. Patient should have surgery within 365 days of being added to the waiting list.
Source:
- http://www.health.qld.gov.au/hospitalperformance/es-categories.aspx?hospital=99999


A similar categorisation system is used by other Australian jurisdictions, e.g. West Australia Health:
- Western Australia Health Referral/Elective Surgery Categories - 2014-08


Priority codes

  • place holder for SNOMED CT or LOINC codes for the referral/transfer of care request "priority" values


Referral/Transfer of care Reason values

This data element holds values to describe the reasons for a referral or transfer of care request.
The reason(s) for a referral/transfer of care provides clinical justification(s) for service(s) requested. In some referral/transfer of care requests, the reasons(s) data component may contain both the reasons and the services requested.

  • This value set includes the following example values:
- sudden/rapid onset of neurological symptoms
- unstable epilepsy
- neutropenia in association with lymphadenopathy and splenomegaly
- continuous gross haematuria
- acute urinary retention with catheter in situ
- abnormal tumour markers Ca125, CEA, Ca19.9 (gynae oncology referral)
- sinus node dysfunction
- AV node disease; persistent vomiting of unknown cause
- recent/recurrent upper GI bleeding

[Note - this is not an exhaustive list of reasons for referral or transfer of care request]


Reason codes

  • Medical Problem/Diagnosis Subset which may be used as "referral/transfer of care request reason code:


  • SNOMED CT Nursing Problem Subset which may be used as request reason code:
- SNOMED CT Nursing Diagnosis subset - Excel spreadsheet


Referral/Transfer of care Service(s) Requested values

This data element hold values to identify the type of services requested in a referral or transfer of care request.
In some referral/Transfer of Care requests, the services requested information may be part of the reasons for referral/transfer of care request data component.

  • The value set contains the following example values:
- neurological assessment and management of traumatic brain injury/brain tumour
- assessment and management of unstable epilepsy
- investigation of AV node disease and pacemaker implantation
- upper GI endoscopy

[Note - for discussion: an example list of values to be provided for the FHIR resource instead of an exhaustive list]


Service(s) Requested codes

  • place holder for SNOMED CT or LOINC codes for the referral/transfer of care request "Services(s) Requested" values


Condeable Concept Value Set: Relevant documents and external links

  • US National Library of Medicine: Nursing Problem List subset:
http://www.nlm.nih.gov/research/umls/Snomed/nursing_problemlist_subset.html


  • Referral Resource Codeable Concepts:
- Referral codeable concepts example codes - Excel spreadsheet