Page History

...

There are several distinct steps in the process from requesting a referral to a skilled nursing facility to getting the patient to the best possible facility for their care. The following diagram shows the transaction flow from the point of view of the requester. (Note: this is work in progress, and not all transactions have been represented yet)

The following diagram shows an example of the possible sequences of messages from the initiator to multiple recipients:

Image Added

2.1 Sending the request

The referral request to a skilled nursing facility may be sent to multiple facilities. In order to enable the appropriate matching of the responses and allow for automation whenever possible, this implementation guide requires that each referral request contains a different unique referral ID. There are different ways to accomplish this in the initiator's system (e.g. parent referral order with multiple child orders, single referral order with a table correlating the IDs and the facilities, etc.) and different implementations can chose what is best for their purposes.

...

Once the choice is made, the initiator shall send a confirmation notification to the facility which will be taking care of the patient. The confirmation notification shall contain the date and time when the patient will be transferred. The initiator shall also send cancel notifications to the facilities, which had not already declined the request.

2.3.1 Confirmation Notification

The Confirmation Notification transaction contains a single OSU^O51 message, where ORC-1 will be set to the code SC (status change), and ORC-5 will be set to the code SC (in  process, scheduled).

2.3.2 Discontinue Notification

The Discontinue Notification transaction is different from the general Cancellation Request in the base 360X specification in that there is no response expected. It contains a single OSU^O51 message, where ORC-1 will be set to the code DC (discontinue), and  ORC-5 will be set to the code CA (cancelled).

2.4 Sending current information at time of discharge

...

Once the complete discharge summary is ready (possibly several days after the patient has been transferred to the SNF), it is sent to the facility, with a complete codean indication that the transfer is now considered complete, and the loop is closed. This will include all notes and final diagnostic test results.