CH UMZH Connect IG (R4)
1.0.0-cibuild - ci-build Switzerland flag

CH UMZH Connect IG (R4), published by UMZH. This guide is not an authorized publication; it is the continuous build for version 1.0.0-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/umzhconnect/umzhconnect-ig/ and changes regularly. See the Directory of published versions

Referral - Orthopedic Surgery

Referral - Orthopedic Surgery

The patient PetraMeier visits the emergency department of HospitalP(lacer) with knee pain after falling on icy street. The treating practitioner suspects a rupture of the left ACL and suggests treatment at HospitalF(ulfiller). Comorbidities: The patient is already being treated for heart problems in cardiology at HospitalP.

Example ServiceRequest

Example Task (Initial - Referral Orthopedic Surgery)

Example Task (Updated - with Questionnaire)

Example Questionnaire (Smoking Status)

Example QuestionnaireResponse (Smoking Status)

Overview

sequenceDiagram
    title Referral - Orthopedic Surgery

    participant HospitalP as HospitalP(lacer)
    participant HospitalF as HospitalF(ulfiller)
    activate HospitalP
    HospitalP->>HospitalP: POST ServiceRequest-ReferralOrthopedicSurgery
    HospitalP->>HospitalF: POST Task (basedOn/focus: ServiceRequest-ReferralOrthopedicSurgery)
    activate HospitalF
    HospitalF-->>HospitalP: created
    deactivate HospitalP
    deactivate HospitalF
    
    HospitalF->>HospitalP: GET Resources (Diagnoses, Medications, Reports)
    activate HospitalF
    activate HospitalP
    HospitalP-->>HospitalF: return search results (Bundle)
    deactivate HospitalF
    deactivate HospitalP

    Note over HospitalF: Request additional information<br/>(smoking status) via Questionnaire
    HospitalF->>HospitalF: Update Task<br/>(owner: HospitalP, businessStatus: on-hold,<br/>output: QuestionnaireSmokingStatus)
    activate HospitalF
    HospitalF-->>HospitalP: Notify Task updated
    activate HospitalP
    HospitalP->>HospitalF: GET Task
    HospitalF-->>HospitalP: Return Task
    HospitalP->>HospitalF: GET Questionnaire by canonical
    HospitalF-->>HospitalP: Return QuestionnaireSmokingStatus
    HospitalP-->>HospitalP: Practitioner fills out Questionnaire
    HospitalP->>HospitalF: POST QuestionnaireResponse
    HospitalF-->>HospitalP: created
    HospitalP->>HospitalF: PATCH Task (owner: HospitalF, input: QuestionnaireResponseSmokingStatus)
    HospitalF-->>HospitalP: updated
    deactivate HospitalP
    deactivate HospitalF

    HospitalF->>HospitalF: Update Task<br/>(businessStatus: completed, output: Report)
    activate HospitalF
    HospitalF-->>HospitalP: Notify Task updated
    activate HospitalP
    HospitalP->> HospitalF: GET Task?_id=...&_include=Task:ch-umzhconnectig-task-outputreference
    HospitalF-->>HospitalP: return result (Bundle)
    deactivate HospitalP
    deactivate HospitalF

Field Sources

The following table indicates the source of each field in the ServiceRequest:

Field Source Description
identifier[placerOrderIdentifier].system Hard-coded TODO?
identifier[placerOrderIdentifier].value Generated Unique referral order number (e.g., REF-2025-001)
status Hard-coded Fixed value active
intent Hard-coded Fixed value order
category VS CH UMZH Connect ServiceRequest Category SNOMED CT code 183545006 "Referral to orthopedic service (procedure)"
subject Referenced the patient being referred
requester Referenced the referring physician with their organizational context
authoredOn Current date Date when the referral was created
reasonReference Referenced Primary diagnosis: Suspected ACL Rupture. If the primary diagnosis is unknown, all diagnoses go to supportingInfo as Condition. The title of the diagnosis is captured in Condition.code.text whereas any additional description in Condition.note.text.
supportingInfo Referenced Secondary diagnosis: Heart Failure HFrEF; Medications: Entresto, Concor; Documents: Report Cardiology
note.text Manual entry Free-text clinical note entered ad-hoc for the referral

Task Field Sources

The following table indicates the source of each field in the Task:

Field Source Description
status Dynamic Initial Task: ready (created by Placer). Updated Task: in-progress (after Fulfiller accepts and updates)
intent Hard-coded Fixed value order
priority Hard-coded Fixed value routine
basedOn Referenced The ServiceRequest this Task is based on
for Referenced The patient being referred: PetraMeier
requester Referenced The referring physician with their organizational context: HansMusterRole
owner Dynamic Initial Task: HospitalF (Fulfiller). When Fulfiller creates Questionnaire: changed to HospitalP (Placer). When QuestionnaireResponse is created: changed back to HospitalF (Fulfiller). The organization responsible for fulfilling the task
businessStatus Dynamic Initial Task: ready. When Fulfiller creates Questionnaire: changed to on-hold. When QuestionnaireResponse is created: changed to in-progress
authoredOn Current date Date when the Task was created by the Placer
lastModified Current date Date when the Task was last updated (only in updated Task)
focus Referenced The ServiceRequest this Task focuses on
input[0].type Hard-coded 273510007 (only when Questionnaire is created)
input[0].valueCanonical Referenced Reference to the canonical Questionnaire to be completed (only when Questionnaire is created)
output[0].type Hard-coded 273510007 (only when QuestionnaireResponse is created)
output[0].valueReference Referenced Reference to the QuestionnaireResponse (only when QuestionnaireResponse is created)