CH UMZH Connect IG (R4)
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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 Placer with knee pain after falling on icy street. The treating practitioner suspects a rupture of the left ACL and suggests treatment at Fulfiller. Comorbidities: The patient is already being treated for heart problems in cardiology at Placer.

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 Placer as Placer
    participant Fulfiller as Fulfiller
    activate Placer
    Placer->>Placer: POST ServiceRequest-ReferralOrthopedicSurgery
    Placer->>Fulfiller: POST Task (basedOn/focus: ServiceRequest-ReferralOrthopedicSurgery)
    activate Fulfiller
    Fulfiller-->>Placer: created
    deactivate Placer
    deactivate Fulfiller

    Fulfiller->>Placer: GET Resources (Diagnoses, Medications, Reports)
    activate Fulfiller
    activate Placer
    Placer-->>Fulfiller: return search results (Bundle)
    deactivate Fulfiller
    deactivate Placer

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

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

Field Sources

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

Field Source Description
identifier[placerOrderIdentifier].system Generated or 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: Fulfiller. When Fulfiller creates Questionnaire: changed to Placer. When QuestionnaireResponse is created: changed back to Fulfiller. The organization responsible for fulfilling the task
businessStatus Dynamic Initial Task: ready. When Fulfiller creates Questionnaire: changed to awaiting-information. 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)