ServiceRequest document of Referrals

Clinical
1

Hi openEHR colleagues. I have a specific challenge and am not sure how to address it. Within Slovenian MoH, they would like to standardise/normalise Service Request documents for different services. We are talking about generic referral documents from GP to specialist care or hospital, specific service request documents (for example, physiotherapy), preventive care programmes,… In general, Service Request Composition and Service Request Instruction covers 75% of the content and can be normalised. The devil is the clinical details, where each use case has it’s own specific (referral includes past diagnoses, surgical procedures, allergies,…), while preventive care referral includes observation data (blood pressure, body weight, BMI,…). So the challenge is how to model 1 generic template that covers most of the content.

I am looking after FHIR ServiceRequest resource which is a bit closer to my normalization challenge than existing openEHR archetypes.

Any guidance, feedback, help,… more than welcomed.

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Hi Samo,

This is a common issue with protocol-driven referrals because by definition they are really not ‘generic’ as you say, with lots of clinical detail.

There probably is a core set of archetypes that could be included in a general referral template, e.g Meds, Allergies, Alerts, Problems, Procedures, common Observations. However beyond that , you either just keep adding every bit of fine detail to the same template (which becomes huge). Or you combine the generic referral template with other condition specific templates, so each referral might actually be captured by more than one composition

I’d also say that there is a general move towards reducing the information that is sent in a referral but allowing the recipient to query for e.g the last blood pressure on ‘demand’.

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