Referral Transmission & Tracking | Medplum
Transmitting Referrals
Referrals need to be securely transmitted to receiving providers. This can be done using various methods depending on the technical capabilities of the receiving system.
The Communication resource is used to represent the transmission event, including details about the sender, recipient, and payload. For recipients without a FHIR API, a Bot can be used to generate and send a PDF of the referral information.
C-CDA Transitions of Care
For interoperability with external systems, referrals often need to be transmitted as C-CDA (Consolidated Clinical Document Architecture) documents. The Transitions of Care template is specifically designed for referral scenarios and includes structured sections for:
- Reason for referral
- Current medications
- Allergies and adverse reactions
- Problem list
- Relevant diagnostic results
- Care plan and instructions
See the C-CDA Transitions of Care documentation for implementation details on generating standards-compliant referral documents.
// Example of generating a C-CDA Transitions of Care document for a referral
const ccdaDocument = await medplum.generateCCDA({
patient: patientReference,
templateType: 'transitions-of-care',
serviceRequest: serviceRequestReference,
includeSection: [
'reason-for-referral',
'medications',
'allergies',
'problems',
'results',
'care-plan'
]
});
Essential Referral Data Requirements
Clinical Documentation Requirements
Successful referrals require comprehensive clinical documentation to ensure:
- Specialist acceptance: Clear justification for the referral
- Insurance authorization: Medical necessity documentation
- Reimbursement compliance: Proper diagnostic and procedural coding
- Continuity of care: Complete clinical context transfer
Core Data Elements
| Category | Required Elements | FHIR Resources | Billing Impact |
|---|---|---|---|
| Patient Demographics | Name, DOB, MRN, Insurance ID | Patient |
Required for claims processing |
| Clinical Justification | Primary/secondary diagnoses with ICD-10 codes | Condition |
Medical necessity for authorization |
| Diagnostic Evidence | Lab results, imaging reports, diagnostic tests | Observation, DiagnosticReport |
Supports medical necessity |
| Treatment History | Previous interventions, medications tried | MedicationRequest, Procedure |
Demonstrates step therapy compliance |
| Current Medications | Active prescriptions with dosages | MedicationRequest |
Drug interaction screening |
| Allergies & Intolerances | Known allergies and adverse reactions | AllergyIntolerance |
Safety screening |
| Insurance Information | Coverage details, authorization requirements | Coverage |
Claims processing and authorization |
Tracking Referral Status
Once a referral has been sent, it's important to track its status through the entire lifecycle. The Task resource is ideal for this purpose, as it provides a standard way to represent workflow status.
Requested
Authorization Pending
Authorized
Accepted
Rejected
Scheduled
In Progress
Completed
Enhanced Status Tracking
The Task resource should include business-specific status information:
{
"resourceType": "Task",
"businessStatus": {
"coding": [
{
"system": "http://example.org/referral-status",
"code": "prior-auth-pending",
"display": "Prior authorization pending"
}
]
},
"statusReason": {
"text": "Waiting for insurance authorization - submitted 2024-01-15"
}
}
Diagnostic Report Transfer
When diagnostic reports are required for the referral, ensure proper linkage:
{
"resourceType": "DiagnosticReport",
"id": "ecg-report-for-referral",
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0074",
"code": "CUS",
"display": "Cardiology"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "11524-6",
"display": "EKG study"
}
]
},
"basedOn": [
{
"reference": "ServiceRequest/cardiology-referral-example"
}
],
"presentedForm": [
{
"contentType": "application/pdf",
"data": "JVBERi0xLjMKJcTl8uXrp...",
"title": "ECG Report - John Smith"
}
]
}
Specialist Response Integration
When a specialist responds to a referral, their response can be captured as a DocumentReference and linked to the original referral through the ServiceRequest. If the response results in an appointment, an Appointment resource can be created and linked to the referral.
Billing Code Integration
Specialist responses should include appropriate billing codes for services rendered:
{
"resourceType": "Encounter",
"id": "specialist-consultation",
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"type": [
{
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99244",
"display": "Office consultation for a new or established patient"
}
]
}
],
"basedOn": [
{
"reference": "ServiceRequest/cardiology-referral-example"
}
],
"diagnosis": [
{
"condition": {
"reference": "Condition/final-cardiac-diagnosis"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "AD",
"display": "Admission diagnosis"
}
]
}
}
]
}
Example Specialist Response
{
"resourceType": "DocumentReference",
"id": "specialist-response-example",
"status": "current",
"docStatus": "final",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "11488-4",
"display": "Consultation note"
}
]
},
"subject": {
"reference": "Patient/example-patient-id",
"display": "John Smith"
},
"date": "2023-06-15T10:00:00Z",
"author": [
{
"reference": "Practitioner/cardiologist-id",
"display": "Dr. Helen Cardio"
}
],
"authenticator": {
"reference": "Practitioner/cardiologist-id",
"display": "Dr. Helen Cardio"
},
"content": [
{
"attachment": {
"contentType": "application/pdf",
"data": "JVBERi0xLjMKJcTl8uXrp...",
"title": "Cardiology Consultation Report - John Smith",
"creation": "2023-06-15T10:00:00Z"
}
}
],
"context": {
"related": [
{
"reference": "ServiceRequest/cardiology-referral-example"
}
]
}
}