Referrals data model: Patient referral management and updates

This data model is used when a physician needs to refer a patient to someone outside their immediate health system to provide specialized care—often, these referrals are to the health professionals like counselors and specialists, but they could also be to community service providers such as food pantries or job assistance services. Whatever the referral, this data model provides information on the status of the referral process and provides key clinical information for the patient’s case.

It’s important to note that the referral request itself, with no detailing on its management or status, is treated as an order and can be obtained via our Orders Data Model. If you want referral management information, that’s often sent over a specific REF interface which a health system may or may not have. If it is not live, you may use the Orders and Results data model instead to send and receive referral ordering information.

Functionality: Read and/or Write
Type: Event Based

Key Information Included:

• Patient demographics
• Referral Information: priority, status, referral reason, referral recipient
• Details of referral authorization: date and time, reimbursement limit, etc.
• Requested and authorized treatment amounts

In the clinic or outpatient setting, this model can be used when a primary care physician decides to refer a patient to a larger academic medical center in a neighboring town to better manage his unique condition. The physician would begin by entering a request in the application, which immediately sends it directly to the medical center. As referral coordinators authorize the request, their work is documented and updated within the application, allowing the primary care physician to monitor it’s status in real time.

In the inpatient setting, this model can be used when a patient requiring in-home assistance is discharged from the hospital. The discharging physician would request a referral for home health care, and this request would be processed through an application that provides matching services in the patient’s area. These potential match-ups would help the clinician and patient determine which agency is right for their needs.