Understanding the Redox Referral Data Model

When do I need to use the Referral Data Model?

The Referral Data Model deals with information when a referring provider turns the management of the patient over for a specific problem to another provider. It typically differs from a consultation, where a provider may review a patient without assuming authority over his or her care. Referrals can be internal to an organization (from one department to another, for instance) or between organizations.

It is most common with EHRs to maintain the administrative status of a referral order. Once an order has been received referring a patient from one hospital to another (or from one specialty to another), the referral data model is used to track the progress of that referral as back office users get authorization from insurance, schedule the referral, etc.

When and where can the Referral Data Model be supported?

EHRs with advanced referral management capabilities and robust interfacing libraries typically offer the Referral Data Model through an HL7v2 REF interface or vendor-specific API.

What if an EHR doesn’t have a referral interface?

Many EHRs create referrals on the fly when an order is sent in via the Order Data Model. When using the Orders Data Model the application may not be able to update any referral specific items after creation. Redox will help you determine the best path forward as you move through your implementations.

How is the Referral Data Model different from the Order Data Model?

Referral can be though of a specific type of Order when it pertains to transfer of patient responsibility across specialty care. When a healthcare organization receives an order for a referral, it creates a referral record. The appropriate administrative staff then work these records in terms of getting approval from insurance, scheduling, etc. These concepts can vary per EHR. Redox will help you determine the best path forward as you move through your implementations.