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FHIR Infrastructure Work Group

Maturity Level: 2

Standards Status: Trial Use

• Overview
• Communication Patterns
• Ad-hoc Workflow Patterns
• Workflow Management Patterns
• Examples

12.13 Usage Examples for Workflow Patterns

12.13.1 Option F Scenario - Creation of Task on placer's system

Lab order to known performer

A provider orders a serum glucose test for a patient to the local/regional lab.

The local/regional lab has an established relationship with the medical clinic where the lab has a subscription that monitors for assigned lab orders. Prior to a patient's annual visit, their GP creates a lab requisition for a new serum glucose test to ensure they have current results to discuss at the patient's visit. Their nurse assigns fulfillment of the requisition to the local lab, which receives a notification and accepts the lab order. The patient visits a collection site and their blood is processed. Upon completion, the Task is updated by the lab with a link to the DiagnosticReport and is marked as 'completed'. The EHR retrieves the DiagnosticReport and associated Observations and presents them to the clinician for review prior to the patient's arrival for their visit.

12.13.2 Option G Scenario - POST of Task to fulfiller's system

Outpatient prescription

A patient is suffering from a poison ivy rash and is prescribed a steroid medication to manage the reaction. The provider asks the patient for his preferred pharmacy and creates the Task at the specified pharmacy's system pointing to the MedicationRequest on the provider's system. The patient is running late and by the time he arrives at the pharmacy, it is closed. He calls the clinic where the provider practices and requests that the pharmacy where the order is to be fulfilled is changed to one that is open around the clock. The staff at the clinic cancels the Task at the original pharmacy and creates a new Task at the requested new one. The new pharmacy updates the Task to accepted and prepares the dispense. By the time the patient arrives at the new pharmacy, the medication is ready for pickup. Once the medication is picked up is fulfilled, the clinic receives the notification that the Task is complete with a link to the MedicationDispense confirming the details of the dispensed medication and quantity. At some later point, when it is believed the patient has likely completed the use of the medication, the MedicationRequest is also marked as complete.

12.13.3 Option H Scenario - POST of Task to a workflow broker

12.13.4 Option I Scenario - POST of Task to fulfiller's system, followed by POST of sub-Task on placer's system

Outpatient referral

A patient is seen by her Primary Care Provider (PCP) for shortness of breath and the provider decides to refer her to a cardiologist. Because of the referral, the provider's system creates ServiceRequest resource and POSTs a Task resource to a cardiologist's practice system, requesting a referral. This places the referral request on a referral coordinator's work list to review. Upon accepting the referral, the Task is updated as accepted and a new sub-Task, referencing both the ServiceRequest and the Task created by the provider's system, is created on the provider's system. The patient gets an appointment with the cardiologist and the sub-Task is updated with that information, allowing the provider's system to inform the provider of the change.

The patient misplaces the information about the appointment and misses the visit with the cardiologist. The cardiologist's system updates the sub-Task to indicate the no-show and the PCP is alerted of the missed appointment. The provider's staff gets hold of the patient and schedules another appointment for her with the cardiologist. Because of the cardiologist's system scheduling the appointment, the sub-Task is updated with that information. The patient is seen and the sub-Task is updated accordingly. The cardiologist document the findings about the patient and updates the sub-Task as complete, adding references to the resources representing the findings. The PCP is alerted of the updates and marks the referral as complete, which updates the original Task and the ServiceRequest as complete as well.