EHRS-FM IG

ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
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: CPS.4.6.1 Support for Referral Process (Function) - JSON Representation

Active as of 2024-08-12

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{
  "resourceType" : "Requirements",
  "id" : "EHRSFMR2.1-CPS.4.6.1",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/ehrs/StructureDefinition/FMFunction"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <span id=\"description\"><b>Statement <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b> <div><p>Evaluate referrals within the context of a patient's healthcare data.</p>\n</div></span>\n\n    \n    <span id=\"purpose\"><b>Description <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Informative Content\" class=\"informative-flag\">I</a>:</b> <div><p>The system assists with patient referrals, including compilation of relevant clinical and behavioral health results, demographic and insurance information (if available). Standardized or evidence based protocols for workup prior to referral may also be presented.</p>\n</div></span>\n    \n\n    \n\n    \n    <span id=\"requirements\"><b>Criteria <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b></span>\n    \n    <table id=\"statements\" class=\"grid dict\">\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#01</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHALL</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHALL provide the ability to capture and render clinical and administrative data (e.g., insurance information) as part of the referral process.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#02</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHOULD</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHOULD provide the ability to capture and render test and procedure results with a referral.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#03</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>MAY</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system MAY provide the ability to capture and render standardized or evidence based protocols (e.g., AHRQ evidence-based practice guidelines) with the referral.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#04</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHALL</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHALL provide the ability to render clinical and administrative data, as well as test and procedure results to the referred-to provider.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#05</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHALL</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHALL provide the ability to capture and render referral orders with detail adequate for correct routing to the referred-to provider.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#06</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHOULD</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHOULD provide the ability to transmit clinical and administrative data, as well as test and procedure results to the referred-to provider.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#07</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                <i>dependent</i>\n                \n                \n                \n                <span>SHALL</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHALL provide the ability to capture and render age appropriate data as part of the referral process according to scope of practice. (e.g., inclusion of growth chart in pediatric referral).</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#08</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHOULD</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHOULD provide the ability to capture a provider's schedule for receiving referrals.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#09</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                <i>conditional</i>\n                \n                \n                <span>SHOULD</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>IF the system provides the ability to capture provider schedules for receiving referrals, THEN the system SHOULD determine and render available provider appointments based on their schedules at the time of referral order entry.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>CPS.4.6.1#10</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>MAY</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system MAY provide the ability to transmit a referral to multiple providers.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n    </table>\n</div>"
  },
  "url" : "http://hl7.org/ehrs/Requirements/EHRSFMR2.1-CPS.4.6.1",
  "version" : "0.16.0",
  "name" : "CPS_4_6_1_Support_for_Referral_Process",
  "title" : "CPS.4.6.1 Support for Referral Process (Function)",
  "status" : "active",
  "date" : "2024-08-12T10:56:01+00:00",
  "publisher" : "EHR WG",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/ehr"
        }
      ]
    }
  ],
  "description" : "Evaluate referrals within the context of a patient's healthcare data.",
  "purpose" : "The system assists with patient referrals, including compilation of relevant clinical and behavioral health results, demographic and insurance information (if available). Standardized or evidence based protocols for workup prior to referral may also be presented.",
  "statement" : [
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-01",
      "label" : "CPS.4.6.1#01",
      "conformance" : [
        "SHALL"
      ],
      "conditionality" : false,
      "requirement" : "The system SHALL provide the ability to capture and render clinical and administrative data (e.g., insurance information) as part of the referral process.",
      "derivedFrom" : "EHR-S_FM_R1.1 DC.2.4.4.1#1"
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-02",
      "label" : "CPS.4.6.1#02",
      "conformance" : [
        "SHOULD"
      ],
      "conditionality" : false,
      "requirement" : "The system SHOULD provide the ability to capture and render test and procedure results with a referral.",
      "derivedFrom" : "EHR-S_FM_R1.1 DC.2.4.4.1#2"
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-03",
      "label" : "CPS.4.6.1#03",
      "conformance" : [
        "MAY"
      ],
      "conditionality" : false,
      "requirement" : "The system MAY provide the ability to capture and render standardized or evidence based protocols (e.g., AHRQ evidence-based practice guidelines) with the referral.",
      "derivedFrom" : "EHR-S_FM_R1.1 DC.2.4.4.1#3"
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-04",
      "label" : "CPS.4.6.1#04",
      "conformance" : [
        "SHALL"
      ],
      "conditionality" : false,
      "requirement" : "The system SHALL provide the ability to render clinical and administrative data, as well as test and procedure results to the referred-to provider."
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-05",
      "label" : "CPS.4.6.1#05",
      "conformance" : [
        "SHALL"
      ],
      "conditionality" : false,
      "requirement" : "The system SHALL provide the ability to capture and render referral orders with detail adequate for correct routing to the referred-to provider."
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-06",
      "label" : "CPS.4.6.1#06",
      "conformance" : [
        "SHOULD"
      ],
      "conditionality" : false,
      "requirement" : "The system SHOULD provide the ability to transmit clinical and administrative data, as well as test and procedure results to the referred-to provider.",
      "derivedFrom" : "EHR-S_FM_R1.1 DC.2.4.4.1#4"
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : true
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-07",
      "label" : "CPS.4.6.1#07",
      "conformance" : [
        "SHALL"
      ],
      "conditionality" : false,
      "requirement" : "The system SHALL provide the ability to capture and render age appropriate data as part of the referral process according to scope of practice. (e.g., inclusion of growth chart in pediatric referral).",
      "derivedFrom" : "PHFP DC.2.4.4.1#6"
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-08",
      "label" : "CPS.4.6.1#08",
      "conformance" : [
        "SHOULD"
      ],
      "conditionality" : false,
      "requirement" : "The system SHOULD provide the ability to capture a provider's schedule for receiving referrals."
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-09",
      "label" : "CPS.4.6.1#09",
      "conformance" : [
        "SHOULD"
      ],
      "conditionality" : true,
      "requirement" : "IF the system provides the ability to capture provider schedules for receiving referrals, THEN the system SHOULD determine and render available provider appointments based on their schedules at the time of referral order entry."
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
          "valueBoolean" : false
        }
      ],
      "key" : "EHRSFMR2.1-CPS.4.6.1-10",
      "label" : "CPS.4.6.1#10",
      "conformance" : [
        "MAY"
      ],
      "conditionality" : false,
      "requirement" : "The system MAY provide the ability to transmit a referral to multiple providers."
    }
  ]
}