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1. EMS Referral Message Handling

1.1. Document History

Version Date Who Notes
v0.1 - Draft 11th Jan 2021 Lee Dyson First Draft for Review - Scottish TrakCare
v0.2 - Draft 11th Jan 2021 Lee Dyson Updated for generic (non-Trakcare) referrals
v0.3 - Draft 9th May 2021 Lee Dyson Updated for Lorenzo mappings
v0.4 - Draft 19th May 2021 Lee Dyson Added NTE segment
v0.5 - Draft 16 June 2021 Robert McNaught Clarification regarding RF1:2
v1.0 - Release 28th June 2021 Robert McNaught Consistency updates
v1.1 - Release 30th June 2021 Robert McNaught No need to state segments are mandatory, notation covers this
v1.2 - Release 16th Jul 2021 Robert McNaught Disclaimer
v1.3 - Release 29th Sept 2021 Robert McNaught Formatting and fixes
v1.32 - Release 25th Nov 2021 Lee Dyson Fixed MSH:7 error

1.2. Introduction

The EMS Integration server is capable of accepting incoming Referral messages from PAS / EPR system.

As with all other EMS interfaces, messages received from another system are mapped into appropriate FHIR message types before being processsed by EMS. HL7 REF messages are mapped into FHIR ServiceRequest messages.

EMS allows the placer system to book, update and cancel a referral via the appropriate REF messages. In many ways the referral message is handled like an order message in that it is expected to contain the mandatory details necessary to create an endoscopy booking in EMS.

A number of mandatory data-items must be provided by the referring system in order for EMS to accept the referral automatically. If one or more of these data items is not provided, then the referral request will wait in the EMS referrals triage queue, requiring manual intervention before being processed further.

1.3. Message Flow

Message flow diagram

1.3.1. Messages Supported

Message Type Default Action
REF^I12, I13 create / update referral
REF^I14 delete referral

1.4. Message Structure

[] - Optional

{} - Repeating

1.4.1. REF

MSH
RF1
PID
PD1
PR1
PV1
{[NTE]}

1.4.2. Sample REF Message

MSH|^~\&|CSCLRC|RWH01|EMS|RWH01|20210326100304||REF^I13|650059135091|P|2.4|||AL
RF1|N|RW||||AP20210074787|||20210326000000
PID|||RWH3065821^^^RWH01^MR~9990537631^^^NHS^NH||XXTESTPATIENT-TFBG^Donotuse^^^MS||19941128|F|||C/O NHS DIGITAL TEST DATA MANAGER^SOLUTION ASSURANCE 1 TREVELYAN SQ.^LEEDS^^LS1 6AE^^HOME^BOAR LANE^WEST YORKSHIRE||07506625550^MOBILE|||||||||||||||||N
PD1|||Y90001^^Y90001^^^^NATNL|G9999998^GENERAL MEDICAL PRACTITIONER, PPD CODE NOT KNOWN^^^^DR^^NATGP^^^8
PR1|1||T123^Aspiration of pleural cavity^OPCS|||||||||C4440107^Khan^N^^^^^GMC^^^600000057545||1
PV1||W||||||G9999998^GENERAL MEDICAL PRACTITIONER, PPD CODE NOT KNOWN^^^^DR^^NATGP^Y90001^^8|C4440107^Khan^N^^^^^GMC^^^600000057545|340||||||||NHS|AP20210074787^^^LRC_APE

Note:

1.4.3. MSH

Please Refer to EMS Standard Segment Definitions

The following fields have specific meaning within the context of referral messaging

Field HL7 Name EMS Usage Example
7 Date Time of Message serviceRequest authoredOn if RF1-9 is not provided  
9.2 Message Type serviceRequest.ServiceRequestStatus I14 = Revoked, I12,I13 = Active

1.4.4. PID

Please Refer to EMS Standard Segment Definitions

Note:

1.4.5. PD1

Please Refer to EMS Standard Segment Definitions

1.4.6. RF1 Segment

Field HL7 Name DataType Optional EMS Usage Example
2 Referral Priority / Appointment Type     1. EMS AppointmentType Extension see DefaultReferenceData
2. Service Request Priority		 1. Urgent, 2 Week Wait, Routine
2. ASAP,ROUTINE,URGENT
5 Referral Category     EMS Referral Source Extension Source of Referral Consultant, GP,SCREEN
6 Originating Referral Identifier     ServiceRequest.Identifier Unique Order ID
7 Effective Date DTM   ServiceRequest.Occurrence Used as requested appointment date/time
9 Process Date DTM   ServiceRequest.AuthoredOn Used for “referral Date”

Note:

1.4.7. PR1 Segment

Field HL7 Name DataType Optional EMS Usage Example
1 SetId     Not used 1
3.1 Procedure Code   N ServiceRequest.code COLON, ERCP, FLEXISIG
3.2 Procedure Description   Y ServiceRequest.code  
3.3 Code Set   N Recognized code-set for PR1-3-1 OPCS,SNOMED
12 Performing Clinician XCN Y ServiceRequest.Performer  

Note:

1.4.8. PV1

Field HL7 Name DataType Optional EMS Usage Example
2 Patient Management   Y EMS PatientManagement Extension I,O see DefaultReferenceData
3 Assigned Patient Location        
3.1 Assigned Patient Location - Point Of Care     Location Code  
3.4 Assigned Patient Location - Facility     Site Code  
3.9 Assigned Patient Location - Building     Site Description  
7 Attending Consultant XCN see notes    
8 Requesting Consultant XCN see notes    
9 Referring Consultant XCN see notes    
10 Specialty     Specialty Code 340
18 Patient Type   Y Patient Treatment Category NHS,PRIVATE see DefaultReferenceData
19 Visit ID     EMS - RoundTrip Round trip data item, not used in EMS but can be returned if requested. INBOUND

Note:

1.4.9. NTE

NTE Segments present in the incoming message will be procesed by EMS.

Field HL7 Name DataType Optional EMS Usage e.g Info
1 Set ID   Y Not Used 1  
3 Comment FT Y Referral notes   Free text appears in Referral Notes in EMS. MUST be HL7-escaped