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Hey all
Thanks for the rapid feedback. @Pierre I think it may be a different work flow but would like to hear from others and or to review the work flows against referral etc? Maybe it's a function of a registry like this or a separate business function.
@Carl L: that would be fantastic. Anything g you can share here or point us towards? I'm very interested in understanding the work flows and business logic with reminders etc.
In discussing here a very high level set of functions would see a Referral Registery (RR) needing to have an option of registering a referral from a known institution including patients, reason, where referred to and date. As well as receiving a referral complete notification. Reminder to patient and reports to managers. (very high level as working on tiny keys ;-))
Sound similar and or are there other points in here that I'm missing?
Carl Fourie | Senior Program Manager | Jembi Health Systems NPC | +27715404477 | Skype: carl.fourie17
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We have several referral Use Cases we implement in Indonesia, in 6 provinces and 40 districts in a “Referral Exchange”. This is not specifically based on OHIE as Indonesia is very decentralized and the MoH sets more standards around what data it needs and does not specify what HIS the district needs to support – each one doing their own thing for HMIS currently. This also includes in some districts call centres connected into the Exchange, where providers can call in with emergency questions and ask for assistance, along with automated routing.
This is also used as the Emergency Response system in 10 of these districts also (think 911 for those of you in the US). This handles emergency maternal and neonatal referrals. What is critical here is the governance and clinical work and then the technology follows – the MoU at the district level between the DHO and the providers, facilities to agree to referral pathways and standards has been very key – and these MoUs (called PKs) then convert into decrees which is a long process. The clinical side set some of the patient stabilization guidelines ahead of referral to reduce morbidity and mortality, for the leading causes of mortality. This created a collective sense of district ownership for health services rather than leaving this to specific providers, facilities, etc. This included public and private facilities also which is key in a referral network.
Am very interested in this question, and as we worked on eHealth Strategy in Tanzania we included a ‘Referral Exchange’ as a key component under the ‘EMR’ and management area.
Niamh
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Hi Carl,
As Scott mentioned, we discussed this in some more detail on the FR community call today. He will be following up I believe – please correct me if I am wrong her Scott?
I think we need to separate out the prioritization also, as we discussed that handling of referral emergencies is different than routine referrals which tie into appointment scheduling also. Also CMM models for referral.
I will defer to Scott here.
Thanks! Niamh
- Scott
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Carl FourieSenior Program Manager | Digital Health Division
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Sorry to slow responding to this very interesting thread; I’ve been traveling the last few days.
There are a number of referral message specs and patterns that have been balloted as standards-based processes. Some or all of them may be of use to us; we can tap into whatever “serves us” from the pre-existing body of work in this space.
· Carl F has already identified the CSD (Care Services Discovery) profile. This profile, as the name implies, may be leveraged to answer questions germane to referral workflows such as: “at which facility/facilities is service X provided?”; “what are all the services provided at facility Y?”; “who are the health workers who provide service X… and at what facilities?”; “what are the services provided by organization Z… and at which facilities are these services provided?”. The first section of this profile describes a set of use cases that the profile is intended to satisfy; a number of these use cases are referral workflows. The CSD spec can be found here: http://www.ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_Suppl_CSD.pdf.
· When a subject of care is referred to a specific health worker (a specialist) or to a specific facility, summary information about the patient is also (typically) conveyed. There are IHE profiles regarding referral content; specifically, the XDS-MS (medical summary) CDA document is used to fulfill this use case. IHE’s patient care coordination (PCC) technical framework describes the content modules and the rules around exchanging such CDA documents (vol 1: http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_TF_Vol1.pdf; vol 2: http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_TF_Vol2.pdf; supplementary content modules: http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_Suppl_CDA_Content_Modules.pdf). OpenHIE’s workflows for saving clinical information and querying for clinical information may be leveraged to save and query for these referral documents. [NOTE: the XDS-MS content profile is very flexible, but the minimum required content elements are relatively few.]
· There are a number of IHE profiles that have been specifically developed to support patient referrals. These are generally managed by the PCC technical committee. A list of IHE’s PCC profiles, including a number of supplements which are in trial implementation, is found here: http://wiki.ihe.net/index.php/Profiles#IHE_Patient_Care_Coordination_Profiles. Any CDA-based profile is supportable, today, by OpenHIE’s existing clinical information save & query workflows. Some of the newer PCC profiles leverage FHIR – and this is slated to be supported in a future version of OpenHIE (maybe v2?).
Also, as discussed on our FR call today, there are different referral “archetypes” and we are well-served to separate these out so that their unique characteristics can be understood and supported.
Point-to-point referral vs. refer-to-queue…
· Refer a subject of care to a specific health worker. This referral is very precisely articulated and may well lead to an appointment being set up with the target care-giver.
· Refer a subject of care to a specific service queue. This kind of referral is more generic; it may refer a patient for specialized testing or surgery… but not to a specific health worker. The premise is that the queued patient will be serviced by the next available provider. In the case of a specialist referral, this “becomes” an instance of case #1 once the provider-referral connection is made. However, in urgent or even emergent cases where a patient is referred to a facility that offers the necessary service, the queue the patient joins is the physical queue in the facility waiting room.
Referral triggered by care path…
· Sometime referrals are care pathway-based escalations triggered by a lab result or by a clinical observation (e.g. blood pressure, temperature, etc.). An HIV patient whose CD4 count drops below the MOH-set threshold is automatically referred into the ARV treatment programme, for example. A pregnant mum with a high blood pressure reading at her ANC visit may be routinely referred from the health outpost to the district clinic. [This latter pattern is also reflective of geographic catchment areas that share a common referral facility.]
One of the things I’d strongly advocate for is idea that we would try to construct our referral workflow out of the “primitives” that we already have in OpenHIE; that this would be a “composite” workflow in the same way our “save clinical information” workflow is. I hope there is support for this line of thinking. It is how we get “paid back” for the effort we’ve put into implementing generic, re-usable, standards-conformant capabilities in our infrastructure.
Warmest regards,
Derek.
Derek Ritz, P.Eng., CPHIMS-CA
ecGroup Inc.
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From: ohie-imp...@googlegroups.com [mailto:ohie-imp...@googlegroups.com] On Behalf Of Carl Fourie
Sent: Thursday, August 11, 2016 4:43 AM
To: OpenHIE Implementers Network (OHIN)
Hey Scott
Carl
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Carl Fourie
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Carl FourieSenior Program Manager | Digital Health Division
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Carl FourieSenior Program Manager | Digital Health Division
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- Scott
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Thank you for sharing this Carl. I'm copying Oretu as well. Please keep us in the loop - this is one of the challenges for the Ministry of Health in Namibia and even though it is not currently in the funding cycle, there is potential to get some funding from the private sector.
RegardsRosaline
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From: Carl LeitnerSent: Saturday, 13 August 2016 10:36To: Scott TeesdaleCc: Darcy, Niamh; Carl Fourie; OpenHIE Implementers Network (OHIN); Rosaline Hendricks
Cheers,-carl
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