Appropriate FHIR Resource for 'Referrals'

#1

FHIR release 3 had a specialized resource for Referral Request: https://hl7.org/fhir/STU3/referralrequest.html

What’s the equivalent in release 4 or the upcoming release 5 to represent the same?
Conceptually, referring a patient to another specialist doesn’t seem to qualify as a “service” to be represented as part of a ServiceRequest, does it?

#2

ServiceRequest covers the functionality of ReferralRequest. The determination was that the data collected was largely the same and there wasn’t consistency in when systems would use ProcedureRequest vs. ReferralRequest - so they got collapsed together.

#3

Ok. Thank you for clarifying.

#4

For the following scenario which representation is correct, rather better. Couldn’t find much of a guideline or an example around this:
“To refer a patient to another specialist (for example a cardiologist) for xyz reason”:

Representation 1:
ServiceRequest.category = 3457005 - Patient referral (procedure)
ServiceRequest.code = 308471005 - Referral to cardiologist (procedure)
ServiceRequest.performerType = 17561000 - Cardiologist (occupation)

Representation 2:
ServiceRequest.category = 3457005 - Patient referral (procedure)
ServiceRequest.code = 3457005 - Patient referral (procedure)
ServiceRequest.performerType = 17561000 - Cardiologist (occupation)

Representation 3:
ServiceRequest.category = 3457005 - Patient referral (procedure)
ServiceRequest.performerType = 17561000 - Cardiologist (occupation)

While representation 1 & 2 seems to be making the best use of the ServiceRequest model, they introduce some level of redundancy. The 3rd way seems precise but doesn’t contain the ServiceRequest code, which is as per definition “What is being requested”. This introduces a dilemma when we don’t know the best practice for this scenario wrt FHIR. What do you think is the best approach?

#5

Procedure.code should indicate what is to be done. So my leaning would be #3 with the code being set to what it is you want the cardiologist to do.

#6

I think I was not very clear with the scenario.

For an OPD consultation, patient visits a General Physician and the GP thinks the patient should see a cardiologist. They cannot pin point a coded “reason” for the same, if it’s a good day, they might just add a free text “note” for the reason for referring the patient to see a cardiologist.

Now, regardless of the above three representations, we’d capture this aspect with the ServiceRequest.note.
With that, I think we could have a generic ServiceRequest.code as “3457005 - Patient referral (procedure)”, because we’re anyway capturing ServiceRequest.performerType = 17561000 - Cardiologist (occupation). But if we do this, then we miss out on capturing the specialized code “308471005 - Referral to cardiologist (procedure)”. You see where the issue is, right?

#7

There’s sort of an implicit action in that case - one of “please assess” - dunno what the appropriate SNOMED code would be though.

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#8

Patient Care discussed this last week. Option 1 seems best to Patient Care, but none of the options are wrong per se (from a base specification perspective). Profiles will often have additional constraints (cardinality, must support) that may be a factor to consider.

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