Clinical Order Workflows
1.0.0-ballot - STU 1 Ballot International flag

Clinical Order Workflows, published by HL7 International / Orders and Observations. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-cow-ig/ and changes regularly. See the Directory of published versions

Post-Discharge Assistance

Page standards status: Informative

Workflow Description

This example assumes that actors have already pre-coordinated business agreements, client registration, etc.

In this flow, a patient and their provider are attempting to determine how a patient should receive skilled nursing and other care post discharge. Once the patient knows what options are available, they may select a skilled nursing facility based on several criteria, not all of which need be healthcare related: the patient may decide they liked staff they spoke with, that a particular facility would be more convenient for their family to visit, etc.

Example

Example with Multiple Potential Fulfillers and BiddingExample with Multiple Potential Fulfillers and BiddingPatientProviderFacility AFacility BHome NursingPatientProviderFacility AFacility BHome NursingPre-coordinationRegister as clients, share service catalogues, share endpoints,and establish any administrative-subscriptionsIn WorkflowOrderingAgrees following discussion with theirprovider that skilled nursing would help with recoverycreate local order andServiceRequestfor Skilled NursingServiceRequest.id =12345.intent =Order... The provider may describe the patient'scare needs in supporting info. A provider may choose to create multipleServiceRequests, either for relatedservices or per fulfiller.From here, the provider may notify multiple potential fulfillers. In this examplemultiple methods are used, but generally there would be one mechanism definedfor the use-case. createBid Task Asend SubscriptionStatusNotification to Facility ABid Task A .id =97531.Status: requested.Owner: FacilityA.Focus: ServiceRequest 12345.Code: request-fulfillment.Intent: Bid...POSTBid Task BBid Task B .id =86420.Status: requested.Owner: FacilityB.Focus: ServiceRequest 12345.Code: request-fulfillment.Intent: Bid...query for ServiceRequest 12345POSTBid Task CBid Task C .id =54321.Status: requested.Owner: Home Care Provider.Focus: ServiceRequest 12345.Code: request-fulfillment.Intent: Bid...Evaluate request.Determine no availability.SubscriptionStatus Notification w/ Task updateBid Task C .id =54321.Status:rejected.Owner: Home Care Provider.Focus: ServiceRequest 12345.Code: request-fulfillment.Intent: Bid...Determine additionalinfo neededUpdate Task.input to indicate additional information neededSend SubscriptionStatus notification Bid Task B.status = Received.businessStatus = Awaiting Info.input = value or reference to information needed,such as a Communication or Questionnaire review requestCall to discussFacility_B Agrees they could accept the patient Bid Task B.status = Accepted...SubscriptionStatus Notification w/ Task updateReview request.Spawn Tasks in their ownsystem. Ultimately determinethey could acceptPOST Update toBid Task ABid Task A .Status:accepted...Provider now discusses with the patient. Facility A and Facility B have both indicated theywould take the patient. They decide on Facility B.discuss optionsdecide Facility B fits goals bestRecords decisionPOST (and Create)Coordination Task B (Separate from bidding Task)Coordination Task B.status = accepted.owner = Facility B.focus = ServiceRequest 12345.intent = order