| Package | hl7.ehrs.ehrsfmr21 |
| Type | Requirements |
| Id | Id |
| FHIR Version | R5 |
| Source | http://hl7.org/ehrs/https://build.fhir.org/ig/mvdzel/ehrsfm-fhir-r5/Requirements-EHRSFMR2.1-CPS.1.4.html |
| Url | http://hl7.org/ehrs/Requirements/EHRSFMR2.1-CPS.1.4 |
| Version | 2.1.0 |
| Status | active |
| Date | 2024-11-26T16:30:50+00:00 |
| Name | CPS_1_4_Capture_Referral_Request |
| Title | CPS.1.4 Capture Referral Request (Function) |
| Experimental | False |
| Realm | uv |
| Authority | hl7 |
| Description | Enable the receipt and processing of referrals from care providers or healthcare organizations, including clinical and administrative details of the referral, and consents and authorizations for disclosures as required. |
| Purpose | Incoming referrals may be from physicians' offices, specialists, clinics, Emergency Medical Services (EMS), transfers from other hospitals or emergency departments, nursing homes, etc. Referrals may be received electronically (i.e., e-Referrals); or may be received non-electronically. If non-electronic, the system needs to allow the user to capture the referral information and manage referral request. If the system supports e-Referrals, then the system will also need to support additional functionality to manage the receipt of the referral request. When a system receives a referral request the request must be validated against established criteria to determine if it meets the recipient's requirements and is appropriate. Referrals may be received for patients who do not previously exist in the recipient system and the system must allow for the ability to triage the request and respond to the requestor. If appropriate the system should allow for the creation of a patient record including the capture of clinical and administrative information received with the referral request. The management of information on patients who are inbound to the care setting is an important component of information management. Data must be easily accessible, centrally retrievable, updatable, transportable and reusable. Clinical data from provider to provider is essential to quality-coordinated care for patients referred to the care setting. Knowledge of patients who are expected to arrive helps both care setting and administrative staff plan resource use in real time. |
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Note: links and images are rebased to the (stated) source
Enable the receipt and processing of referrals from care providers or healthcare organizations, including clinical and administrative details of the referral, and consents and authorizations for disclosures as required.
Incoming referrals may be from physicians' offices, specialists, clinics, Emergency Medical Services (EMS), transfers from other hospitals or emergency departments, nursing homes, etc. Referrals may be received electronically (i.e., e-Referrals); or may be received non-electronically. If non-electronic, the system needs to allow the user to capture the referral information and manage referral request. If the system supports e-Referrals, then the system will also need to support additional functionality to manage the receipt of the referral request. When a system receives a referral request the request must be validated against established criteria to determine if it meets the recipient's requirements and is appropriate. Referrals may be received for patients who do not previously exist in the recipient system and the system must allow for the ability to triage the request and respond to the requestor. If appropriate the system should allow for the creation of a patient record including the capture of clinical and administrative information received with the referral request. The management of information on patients who are inbound to the care setting is an important component of information management. Data must be easily accessible, centrally retrievable, updatable, transportable and reusable. Clinical data from provider to provider is essential to quality-coordinated care for patients referred to the care setting. Knowledge of patients who are expected to arrive helps both care setting and administrative staff plan resource use in real time.
| CPS.1.4#01 | SHALL |
The system SHALL provide the ability to capture referral(s) in some form (e.g., paper, fax, electronic) from other care provider(s), whether internal or external to the organization. |
| CPS.1.4#02 | SHALL |
The system SHALL capture and render the Source of Referral and the Reason for Referral. |
| CPS.1.4#03 | SHOULD |
The system SHOULD provide the ability to import or receive a referral(s) from other care provider(s), whether internal or external to the organization. |
| CPS.1.4#04 | SHALL |
The system SHALL conform to function [[CPS.2.1]] (Support externally-sourced Clinical Documents) to support the capture of referral documents. |
| CPS.1.4#05 | SHALL |
The system SHALL conform to function [[CPS.2.2]] (Support externally-sourced Clinical Data) to support the capture of referral data. |
| CPS.1.4#06 | SHOULD |
The system SHOULD conform to function [[CPS.2.3]] (Support Emergency Medical System Originated Data) to support the capture of referral data. |
| CPS.1.4#07 | SHALL |
The system SHALL conform to function [[CPS.2.4]] (Support externally-sourced Clinical Images) to support the capture of referral images. |
| CPS.1.4#08 | SHALL |
The system SHALL provide the ability to analyze and present recommendations for potential matches between the patient identified in a received referral and existing patients in the system. |
| CPS.1.4#09 | conditional SHALL |
IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to receive an e-referral for a patient that did not previously exist in the system. |
| CPS.1.4#10 | dependent conditional SHALL |
IF the system provides the ability to capture referrals electronically, THEN the system SHALL provide the ability to capture a definition of a minimum set of required information that must be included in an e-referral to be accepted, according to scope of practice and/or organizational policy. |
| CPS.1.4#11 | SHOULD |
The system SHOULD provide the ability to capture administrative details from a referral that was received (e.g., insurance information, or a consent and authorization for disclosure). |
| CPS.1.4#12 | SHOULD |
The system SHOULD provide the ability to capture clinical details from a referral that was received. |
| CPS.1.4#13 | conditional SHALL |
IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to present received e-referrals to a user for triage and approval. |
| CPS.1.4#14 | MAY |
The system MAY conform to function [[AS.9.2]] (Support Financial Eligibility Verification) and display the results of electronic referral eligibility and health plan/payer checking. |
| CPS.1.4#15 | conditional MAY |
IF the system provides the ability to capture referrals electronically, THEN the system MAY provide the ability to capture a definition of diagnosis-based requirements for accepting an e-referral to enable system triage of referrals (e.g., a breast cancer specialist would not want to receive a colon cancer patient referral). |
| CPS.1.4#16 | conditional MAY |
IF the system provides the ability to capture referrals electronically, THEN the system MAY provide the ability to capture a definition of clinical requirements (such as test results) for accepting an e-referral to enable system triage of referrals (e.g., a breast cancer specialist may require a positive mammogram before accepting the referral). |
| CPS.1.4#17 | conditional SHALL |
IF the system provides the ability to capture referrals electronically, THEN the system SHALL provide the ability for a user to enter information into a patient record from information received in the referral. |
| CPS.1.4#18 | conditional SHALL |
IF the system provides the ability to capture referrals electronically, THEN the system SHALL provide the ability for a user to tag an e-referral request as being rejected. |
| CPS.1.4#19 | conditional SHALL |
IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to capture the reason for an e-referral acceptance or rejection. |
| CPS.1.4#20 | conditional SHALL |
IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to transmit to the referring provider the acceptance or rejection of the e-referral request including the reasons provided for acceptance/rejection. |
| CPS.1.4#21 | conditional SHOULD |
IF the system provides the ability to electronically capture referrals, THEN the system SHOULD provide the ability to transmit to the referring provider a request additional information prior to accept/rejection of e-referral request. |
| CPS.1.4#22 | dependent conditional SHALL |
IF the referral includes a transfer of care (complete or partial or temporary), THEN the system SHALL provide the ability to capture the documentation of the transfer of care according to scope of practice, organizational policy, and/or jurisdictional law. |
| CPS.1.4#23 | SHOULD |
The system SHOULD provide the ability to receive and render location data electronically for patients who are en-route to the care setting (e.g., EMS system tracking patient arrival to the Emergency Department). |
| CPS.1.4#24 | SHOULD |
The system SHOULD conform to function [[AS.6.2]] (Manage Healthcare Resource Availability Information) to support the allocation of resources for incoming referred patients. |
| CPS.1.4#25 | MAY |
The system MAY provide the ability to transmit to the referring provider a notification that the patient has attended an appointment with the referred to provider. |
FHIR{
"resourceType" : "Requirements",
"id" : "EHRSFMR2.1-CPS.1.4",
"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>Enable the receipt and processing of referrals from care providers or healthcare organizations, including clinical and administrative details of the referral, and consents and authorizations for disclosures as required.</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>Incoming referrals may be from physicians' offices, specialists, clinics, Emergency Medical Services (EMS), transfers from other hospitals or emergency departments, nursing homes, etc. Referrals may be received electronically (i.e., e-Referrals); or may be received non-electronically. If non-electronic, the system needs to allow the user to capture the referral information and manage referral request. If the system supports e-Referrals, then the system will also need to support additional functionality to manage the receipt of the referral request. When a system receives a referral request the request must be validated against established criteria to determine if it meets the recipient's requirements and is appropriate. Referrals may be received for patients who do not previously exist in the recipient system and the system must allow for the ability to triage the request and respond to the requestor. If appropriate the system should allow for the creation of a patient record including the capture of clinical and administrative information received with the referral request. The management of information on patients who are inbound to the care setting is an important component of information management. Data must be easily accessible, centrally retrievable, updatable, transportable and reusable. Clinical data from provider to provider is essential to quality-coordinated care for patients referred to the care setting. Knowledge of patients who are expected to arrive helps both care setting and administrative staff plan resource use in real time.</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.1.4#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 referral(s) in some form (e.g., paper, fax, electronic) from other care provider(s), whether internal or external to the organization.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#02</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 capture and render the Source of Referral and the Reason for Referral.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#03</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 import or receive a referral(s) from other care provider(s), whether internal or external to the organization.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#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 conform to function [[CPS.2.1]] (Support externally-sourced Clinical Documents) to support the capture of referral documents.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#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 conform to function [[CPS.2.2]] (Support externally-sourced Clinical Data) to support the capture of referral data.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#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 conform to function [[CPS.2.3]] (Support Emergency Medical System Originated Data) to support the capture of referral data.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#07</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 conform to function [[CPS.2.4]] (Support externally-sourced Clinical Images) to support the capture of referral images.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#08</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 analyze and present recommendations for potential matches between the patient identified in a received referral and existing patients in the system.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#09</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>SHALL</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to receive an e-referral for a patient that did not previously exist in the system.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#10</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n <i>dependent</i>\n \n \n <i>conditional</i>\n \n \n <span>SHALL</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 referrals electronically, THEN the system SHALL provide the ability to capture a definition of a minimum set of required information that must be included in an e-referral to be accepted, according to scope of practice and/or organizational policy.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#11</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 administrative details from a referral that was received (e.g., insurance information, or a consent and authorization for disclosure).</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#12</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 clinical details from a referral that was received.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#13</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>SHALL</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to present received e-referrals to a user for triage and approval.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#14</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 conform to function [[AS.9.2]] (Support Financial Eligibility Verification) and display the results of electronic referral eligibility and health plan/payer checking.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#15</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>MAY</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 referrals electronically, THEN the system MAY provide the ability to capture a definition of diagnosis-based requirements for accepting an e-referral to enable system triage of referrals (e.g., a breast cancer specialist would not want to receive a colon cancer patient referral).</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#16</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>MAY</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 referrals electronically, THEN the system MAY provide the ability to capture a definition of clinical requirements (such as test results) for accepting an e-referral to enable system triage of referrals (e.g., a breast cancer specialist may require a positive mammogram before accepting 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.1.4#17</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>SHALL</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 referrals electronically, THEN the system SHALL provide the ability for a user to enter information into a patient record from information received in 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.1.4#18</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>SHALL</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 referrals electronically, THEN the system SHALL provide the ability for a user to tag an e-referral request as being rejected.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#19</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>SHALL</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to capture the reason for an e-referral acceptance or rejection.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#20</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>SHALL</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to transmit to the referring provider the acceptance or rejection of the e-referral request including the reasons provided for acceptance/rejection.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#21</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 electronically capture referrals, THEN the system SHOULD provide the ability to transmit to the referring provider a request additional information prior to accept/rejection of e-referral request.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#22</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n <i>dependent</i>\n \n \n <i>conditional</i>\n \n \n <span>SHALL</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>IF the referral includes a transfer of care (complete or partial or temporary), THEN the system SHALL provide the ability to capture the documentation of the transfer of care according to scope of practice, organizational policy, and/or jurisdictional law.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#23</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 receive and render location data electronically for patients who are en-route to the care setting (e.g., EMS system tracking patient arrival to the Emergency Department).</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#24</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 conform to function [[AS.6.2]] (Manage Healthcare Resource Availability Information) to support the allocation of resources for incoming referred patients.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>CPS.1.4#25</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 to the referring provider a notification that the patient has attended an appointment with the referred to provider.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n </table>\n</div>"
},
"url" : "http://hl7.org/ehrs/Requirements/EHRSFMR2.1-CPS.1.4",
"version" : "2.1.0",
"name" : "CPS_1_4_Capture_Referral_Request",
"title" : "CPS.1.4 Capture Referral Request (Function)",
"status" : "active",
"date" : "2024-11-26T16:30:50+00:00",
"publisher" : "EHR WG",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/ehr"
}
]
}
],
"description" : "Enable the receipt and processing of referrals from care providers or healthcare organizations, including clinical and administrative details of the referral, and consents and authorizations for disclosures as required.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001",
"display" : "World"
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}
],
"purpose" : "Incoming referrals may be from physicians' offices, specialists, clinics, Emergency Medical Services (EMS), transfers from other hospitals or emergency departments, nursing homes, etc. Referrals may be received electronically (i.e., e-Referrals); or may be received non-electronically. If non-electronic, the system needs to allow the user to capture the referral information and manage referral request. If the system supports e-Referrals, then the system will also need to support additional functionality to manage the receipt of the referral request. When a system receives a referral request the request must be validated against established criteria to determine if it meets the recipient's requirements and is appropriate. Referrals may be received for patients who do not previously exist in the recipient system and the system must allow for the ability to triage the request and respond to the requestor. If appropriate the system should allow for the creation of a patient record including the capture of clinical and administrative information received with the referral request. The management of information on patients who are inbound to the care setting is an important component of information management. Data must be easily accessible, centrally retrievable, updatable, transportable and reusable. Clinical data from provider to provider is essential to quality-coordinated care for patients referred to the care setting. Knowledge of patients who are expected to arrive helps both care setting and administrative staff plan resource use in real time.",
"statement" : [
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-01",
"label" : "CPS.1.4#01",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL provide the ability to capture referral(s) in some form (e.g., paper, fax, electronic) from other care provider(s), whether internal or external to the organization."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-02",
"label" : "CPS.1.4#02",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture and render the Source of Referral and the Reason for Referral."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-03",
"label" : "CPS.1.4#03",
"conformance" : [
"SHOULD"
],
"conditionality" : false,
"requirement" : "The system SHOULD provide the ability to import or receive a referral(s) from other care provider(s), whether internal or external to the organization."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-04",
"label" : "CPS.1.4#04",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL conform to function [[CPS.2.1]] (Support externally-sourced Clinical Documents) to support the capture of referral documents."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-05",
"label" : "CPS.1.4#05",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL conform to function [[CPS.2.2]] (Support externally-sourced Clinical Data) to support the capture of referral data."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-06",
"label" : "CPS.1.4#06",
"conformance" : [
"SHOULD"
],
"conditionality" : false,
"requirement" : "The system SHOULD conform to function [[CPS.2.3]] (Support Emergency Medical System Originated Data) to support the capture of referral data."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-07",
"label" : "CPS.1.4#07",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL conform to function [[CPS.2.4]] (Support externally-sourced Clinical Images) to support the capture of referral images."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-08",
"label" : "CPS.1.4#08",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL provide the ability to analyze and present recommendations for potential matches between the patient identified in a received referral and existing patients in the system."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-09",
"label" : "CPS.1.4#09",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to receive an e-referral for a patient that did not previously exist in the system."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : true
}
],
"key" : "EHRSFMR2.1-CPS.1.4-10",
"label" : "CPS.1.4#10",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to capture referrals electronically, THEN the system SHALL provide the ability to capture a definition of a minimum set of required information that must be included in an e-referral to be accepted, according to scope of practice and/or organizational policy."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-11",
"label" : "CPS.1.4#11",
"conformance" : [
"SHOULD"
],
"conditionality" : false,
"requirement" : "The system SHOULD provide the ability to capture administrative details from a referral that was received (e.g., insurance information, or a consent and authorization for disclosure)."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-12",
"label" : "CPS.1.4#12",
"conformance" : [
"SHOULD"
],
"conditionality" : false,
"requirement" : "The system SHOULD provide the ability to capture clinical details from a referral that was received."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-13",
"label" : "CPS.1.4#13",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to present received e-referrals to a user for triage and approval."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-14",
"label" : "CPS.1.4#14",
"conformance" : [
"MAY"
],
"conditionality" : false,
"requirement" : "The system MAY conform to function [[AS.9.2]] (Support Financial Eligibility Verification) and display the results of electronic referral eligibility and health plan/payer checking."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-15",
"label" : "CPS.1.4#15",
"conformance" : [
"MAY"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to capture referrals electronically, THEN the system MAY provide the ability to capture a definition of diagnosis-based requirements for accepting an e-referral to enable system triage of referrals (e.g., a breast cancer specialist would not want to receive a colon cancer patient referral)."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-16",
"label" : "CPS.1.4#16",
"conformance" : [
"MAY"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to capture referrals electronically, THEN the system MAY provide the ability to capture a definition of clinical requirements (such as test results) for accepting an e-referral to enable system triage of referrals (e.g., a breast cancer specialist may require a positive mammogram before accepting the referral)."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-17",
"label" : "CPS.1.4#17",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to capture referrals electronically, THEN the system SHALL provide the ability for a user to enter information into a patient record from information received in the referral."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-18",
"label" : "CPS.1.4#18",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to capture referrals electronically, THEN the system SHALL provide the ability for a user to tag an e-referral request as being rejected."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-19",
"label" : "CPS.1.4#19",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to capture the reason for an e-referral acceptance or rejection."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-20",
"label" : "CPS.1.4#20",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to electronically capture referrals, THEN the system SHALL provide the ability to transmit to the referring provider the acceptance or rejection of the e-referral request including the reasons provided for acceptance/rejection."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-21",
"label" : "CPS.1.4#21",
"conformance" : [
"SHOULD"
],
"conditionality" : true,
"requirement" : "IF the system provides the ability to electronically capture referrals, THEN the system SHOULD provide the ability to transmit to the referring provider a request additional information prior to accept/rejection of e-referral request."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : true
}
],
"key" : "EHRSFMR2.1-CPS.1.4-22",
"label" : "CPS.1.4#22",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF the referral includes a transfer of care (complete or partial or temporary), THEN the system SHALL provide the ability to capture the documentation of the transfer of care according to scope of practice, organizational policy, and/or jurisdictional law."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-23",
"label" : "CPS.1.4#23",
"conformance" : [
"SHOULD"
],
"conditionality" : false,
"requirement" : "The system SHOULD provide the ability to receive and render location data electronically for patients who are en-route to the care setting (e.g., EMS system tracking patient arrival to the Emergency Department)."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-24",
"label" : "CPS.1.4#24",
"conformance" : [
"SHOULD"
],
"conditionality" : false,
"requirement" : "The system SHOULD conform to function [[AS.6.2]] (Manage Healthcare Resource Availability Information) to support the allocation of resources for incoming referred patients."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-CPS.1.4-25",
"label" : "CPS.1.4#25",
"conformance" : [
"MAY"
],
"conditionality" : false,
"requirement" : "The system MAY provide the ability to transmit to the referring provider a notification that the patient has attended an appointment with the referred to provider."
}
]
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.