EHRS-FM IG

ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
0.16.0 - CI Build

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Requirements: CP.4.6 Manage Orders for Referral (Function)

Active as of 2024-08-12
Statement N:

Enable the origination, documentation and tracking of referrals between care providers or healthcare organizations, including clinical and administrative details of the referral, and consents and authorizations for disclosures as required.

 Description I:

Documentation and tracking of a referral from one care provider to another is supported, whether the referred to or referring providers are internal or external to the healthcare organization. Guidelines for whether a particular referral for a particular patient is appropriate in a clinical context and with regard to administrative factors such as insurance may be provided to the care provider at the time the referral is created. The EHR-S provides the ability to receive and act upon referral responses from providers. The EHR-S may provide the ability to capture completion of the referral appointment. Referrals may be received electronically (i.e. e-Referrals); or may be received non-electronically. If non-electronic, the system needs to allow the user to capture the referral information and manage referral request. If the system supports e-Referrals, then the system will also need to support additional functionality to manage the receipt of the referral request.

 Criteria N:
CP.4.6#01 SHALL

The system SHALL provide the ability to manage outbound referral(s), whether internal or external to the organization.
CP.4.6#02 dependent SHALL

The system SHALL provide the ability to capture clinical details necessary for the referral according to scope of practice of the referral recipient.
CP.4.6#03 dependent SHALL

The system SHALL provide the ability to link (e.g., link to image stored in PACS) clinical details as necessary for the referral according to scope of practice of the referral recipient.
CP.4.6#04 dependent SHALL

The system SHALL provide the ability to render clinical details as appropriate for the referral according to scope of practice of the referral recipient (e.g., clinical details required for dermatologist differ from those required by oncologist).
CP.4.6#05 SHOULD

The system SHOULD provide the ability to capture administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral.
CP.4.6#06 SHOULD

The system SHOULD provide the ability to link to administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral.
CP.4.6#07 SHOULD

The system SHOULD provide the ability to render administrative details (e.g., insurance information, consents and authorizations for disclosure) as necessary for the referral.
CP.4.6#08 SHALL

The system SHALL provide the ability to capture, store, and render an inbound referral response (e.g., referral accepted, referral denied, or more information needed).
CP.4.6#09 SHALL

The system SHALL provide the ability to determine and render recommended actions based on an inbound referral response (e.g., referral accepted, referral denied, or more information needed).
CP.4.6#10 MAY

The system MAY provide the ability to capture a notification that the patient fulfilled a referred appointment.
CP.4.6#11 SHOULD

The system SHOULD provide the ability to determine and render diagnosis-based clinical guidelines for making a referral.
CP.4.6#12 SHOULD

The system SHOULD provide the ability to determine the contents of a referral order by rendering order sets for review by the provider.