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
    actor HospitalP as HospitalP (Placer)
    actor HospitalF as HospitalF (Fulfiller)
    
    rect rgb(191, 223, 255)
    HospitalP->>HospitalP: Create ServiceRequest SR-HospitalP001
    HospitalP->>HospitalF: Create Task (focus: SR-HospitalP001)
    activate HospitalF
    HospitalF-->>HospitalP: Notify Task T-UKB001 created
    deactivate HospitalF
    end
    
    rect rgb(191, 223, 255)
    HospitalF->>HospitalF: Update Task T-UKB001<br/>(status: accepted)
    HospitalF->>HospitalP: Request Resources (Diagnoses, Medications)
    activate HospitalP
    HospitalP->>HospitalF: Resources Response
    deactivate HospitalP
    end
    
    rect rgb(191, 223, 255)
    HospitalF->>HospitalF: Create Questionnaire (smoking status)
    HospitalF->>HospitalF: Update Task T-UKB001<br/>(owner: Placer, businessStatus: on-hold,<br/>output: Questionnaire)
    HospitalF-->>HospitalP: Notify Task update
    activate HospitalP
    HospitalP->>HospitalF: Fetch Task T-UKB001
    HospitalF->>HospitalP: Response (Task incl. Questionnaire)
    HospitalP->>HospitalP: Fill out Questionnaire
    HospitalP->>HospitalF: Post QuestionnaireResponse (smoking status)
    HospitalF->>HospitalF: Update Task T-UKB001<br/>(owner: Fulfiller, businessStatus: in-progress,<br/>input: QuestionnaireResponse)
    deactivate HospitalP
    end
    
    rect rgb(255, 230, 204)
    Note over HospitalF: Create Appointment A-UKB001 (initial consult)
    HospitalF->>HospitalF: Update Task T-UKB001<br/>(status: in-progress, output: A-UKB001)
    HospitalF-->>HospitalP: Notify Task update
    end

    rect rgb(255, 230, 204)
    Note over HospitalF: Create Appointment A-UKB002 (preop)
    HospitalF->>HospitalF: Update Task T-UKB001<br/>(status: in-progress, output: A-UKB002)
    HospitalF-->>HospitalP: Notify Task update
    end

    rect rgb(204, 255, 204)
    Note over HospitalF: Create Appointment A-UKB003 (surgery)
    HospitalF->>HospitalF: Update Task T-UKB001<br/>(status: in-progress, output: A-UKB003)
    HospitalF-->>HospitalP: Notify Task update
    end
    
    rect rgb(204, 255, 204)
    HospitalF->>HospitalF: Update Task T-UKB001<br/>(status: completed, output: R-UKB001)
    HospitalF-->>HospitalP: Notify Task update
    end

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 308461008 "Referral to radiology 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.
supportingInfo Referenced Secondary diagnosis: Heart Failure HFrEF; Medications: Entresto, Concor
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
output[0].type Hard-coded 273510007 (only when Questionnaire is created)
output[0].valueReference Referenced Reference to the Questionnaire to be completed (only when Questionnaire is created)
input[0].type Hard-coded 273510007 (only when QuestionnaireResponse is created)
input[0].valueReference Referenced Reference to the QuestionnaireResponse (only when QuestionnaireResponse is created)