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This page is used by 360X Payload Workgroup participants to iterate an implementation guide. Please contact Brett Andriesen if you have any trouble editing this page.

Note for editors: remember to click on the special edit icon in order to be able to edit the various sections (including this top-level organizing document).

<span id="ig-title">360X Project - Closed Loop Referral - Implementation Guide</span><br />

1.0 Preface and Introduction

2.0 Overview and Scope

3.0 Assumptions and Constraints for Transport and Payload

4.0 Referral Workflow

5.0 Package Structure and Transport

6.0 Content Structure and Data Representation

7.0 Transaction Contents

Appendices

Appendix A - XD* Metadata

Appendix B - Consolidated CDA

Appendix C - Use of HL7 V2 Messages

Appendix D - Data Used in the Examples

Work in progress

To be included in an informative appendix on possible variations:

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In all cases, the C-CDA SHALL include the reason for referral from the OMG object. It is important for system processing that the Order (referral request) and the associated clinical information (e.g., C-CDA) be related. Four (4) means of relationship were evaluated:

The order (referral request) is aware of the associated clinical data (C-CDA) and the C-CDA XML is embedded in the OBX segment of the OMG^O19; the XDM metadata would then contain just the order ID. This provides the tightest link but may have the most challenging implementation in current systems as extracting and storing C-CDAs would be part of order processing..
The order (referral request) is aware of the associated clinical data (C-CDA) and the C-CDA document instance identifier is embedded as a reference pointer in the order’s OBX segment, but the C-CDA XML is separate in the XDM; the XDM would contain both the order ID and the document ID. This would slightly ease implementation on receiving systems and preserve the tight link.
The associated clinical data (C-CDA) is aware of the order and puts the order’s Provider Order ID in the C-CDA US Realm Header; the XDM would contain both the order ID and the document ID. This would ease implementation on both sending and receiving systems and preserve the link but C-CDA specification is not defined to semantically represent placer order ID properly.
Neither the order (referral request) nor the associated clinical data (C-CDA) are aware of each other and the XDM meta data includes both the Provider Order ID from the order and the C-CDA document ID from the US realm header. This eases implementation on sending and receiving systems but provides the loosest link between the request and associated clinical information.

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Intended recipient structure

<Slot name="intendedRecipient">
<ValueList>
<Value>Bernstein Clinic^^^^^&1.2.840.114350.1.13.321.1.7.3.688884.100.8&ISO^^^^1.2.840.114350.1.13.321.1.7.3.688884.100.8|</Value>
</ValueList>
</Slot>

Example metadata

<ns3:SubmitObjectsRequest xmlns:ns3="urn:oasis:names:tc:ebxml-regrep:xsd:lcm:3.0" xmlns:ns4="urn:ihe:iti:xds-b:2007" xmlns="urn:oasis:names:tc:ebxml-regrep:xsd:rim:3.0" xmlns:ns2="urn:oasis:names:tc:ebxml-regrep:xsd:rs:3.0">
  <RegistryObjectList>
    <ExtrinsicObject objectType="urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1" mimeType="text/xml" id="Document01">
      <Slot name="creationTime">
        <ValueList>
          <Value>20051224000000</Value>
        </ValueList>
      </Slot>
      <Slot name="languageCode">
        <ValueList>
          <Value>en-us</Value>
        </ValueList>
      </Slot>
      <Slot name="serviceStartTime">
        <ValueList>
          <Value>20041223080000</Value>
        </ValueList>
      </Slot>
      <Slot name="serviceStopTime">
        <ValueList>
          <Value>20041223080100</Value>
        </ValueList>
      </Slot>
      <Slot name="sourcePatientId">
        <ValueList>
          <Value> 998777350^^^&amp;2.16.840.1.113883.13.47&amp;ISO</Value>
        </ValueList>
      </Slot>
      <Slot name="sourcePatientInfo">
        <ValueList>
          <Value> PID-3|998777350^^^&amp;2.16.840.1.113883.13.47&amp;ISO</Value>
          <Value>PID-5|Jackson^Paul^^^</Value>
          <Value>PID-7|19620308</Value>
          <Value>PID-8|M</Value>
          <Value>PID-11|3754 SAMUEL STREET</Value>
        </ValueList>
      </Slot>
      <Name>
        <LocalizedString value="Physical"/>
      </Name>
      <Description/>
      <Classification id="cl01" classifiedObject="Document01" classificationScheme="urn:uuid:93606bcf-9494-43ec-9b4e-a7748d1a838d" nodeRepresentation="">
        <Slot name="authorPerson">
          <ValueList>
            <Value> |direct@medibridge.net^Richard^Braman^^^^^^&amp;2.16.840.1.113883.13.47&amp;ISO</Value>
          </ValueList>
        </Slot>
        <Slot name="authorInstitution">
          <ValueList>
            <Value>Cleveland Clinic</Value>
            <Value>Parma Community</Value>
          </ValueList>
        </Slot>
        <Slot name="authorRole">
          <ValueList>
            <Value>Attending</Value>
          </ValueList>
        </Slot>
        <Slot name="authorSpecialty">
          <ValueList>
            <Value>Orthopedic</Value>
          </ValueList>
        </Slot>
      </Classification>
      <Classification id="cl02" classifiedObject="Document01" classificationScheme="urn:uuid:41a5887f-8865-4c09-adf7-e362475b143a" nodeRepresentation="34133-9">
        <Slot name="codingScheme">
          <ValueList>
            <Value>2.16.840.1.113883.6.1</Value>
          </ValueList>
        </Slot>
        <Name>
          <LocalizedString value="Summarization of patient data"/>
        </Name>
      </Classification>
      <Classification id="cl03" classifiedObject="Document01" classificationScheme="urn:uuid:f4f85eac-e6cb-4883-b524-f2705394840f" nodeRepresentation="N">
        <Slot name="codingScheme">
          <ValueList>
            <Value>2.16.840.1.113883.5.25</Value>
          </ValueList>
        </Slot>
        <Name>
          <LocalizedString xml:lang="en-us" value="Normal" charset="UTF-8"/>
        </Name>
      </Classification>
      <Classification id="cl04" classifiedObject="Document01" classificationScheme="urn:uuid:a09d5840-386c-46f2-b5ad-9c3699a4309d" nodeRepresentation="urn:ihe:pcc:xds-ms:2007">
        <Slot name="codingScheme">
          <ValueList>
            <Value>1.3.6.1.4.1.19376.1.2.3</Value>
          </ValueList>
        </Slot>
        <Name>
          <LocalizedString xml:lang="en-us" value="Medical Summaries" charset="UTF-8"/>
        </Name>
      </Classification>
      <Classification id="cl05" classifiedObject="Document01" classificationScheme="urn:uuid:f33fb8ac-18af-42cc-ae0e-ed0b0bdb91e1" nodeRepresentation="225732001">
        <Slot name="codingScheme">
          <ValueList>
            <Value>2.16.840.1.113883.6.96</Value>
          </ValueList>
        </Slot>
        <Name>
          <LocalizedString value="Hospital-community"/>
        </Name>
      </Classification>
      <Classification id="cl06" classifiedObject="Document01" classificationScheme="urn:uuid:cccf5598-8b07-4b77-a05e-ae952c785ead" nodeRepresentation="HOSP">
        <Slot name="codingScheme">
          <ValueList>
            <Value>2.16.840.1.113883.6.96</Value>
          </ValueList>
        </Slot>
        <Name>
          <LocalizedString value="Hospital"/>
        </Name>
      </Classification>
      <ExternalIdentifier id="ei01" value="998777350^^^&amp;2.16.840.1.113883.13.47&amp;ISO" identificationScheme="urn:uuid:58a6f841-87b3-4a3e-92fd-a8ffeff98427" registryObject="Document01">
        <Name>
          <LocalizedString value="XDSDocumentEntry.patientId"/>
        </Name>
      </ExternalIdentifier>
      <ExternalIdentifier id="ei02" value="2.16.840.1.113883.13.4721367.2005.3.9999.3" identificationScheme="urn:uuid:2e82c1f6-a085-4c72-9da3-8640a32e42ab" registryObject="Document01">
        <Name>
          <LocalizedString value="XDSDocumentEntry.uniqueId"/>
        </Name>
      </ExternalIdentifier>
    </ExtrinsicObject>
    <RegistryPackage id="SubmissionSet01">
      <Slot name="submissionTime">
        <ValueList>
          <Value>20041225235050</Value>
        </ValueList>
      </Slot>
      <Slot name="intendedRecipient">
        <ValueList>
          <!--Value>|john.smith@happyvalleyclinic.nhindirect.org^Smith^John^^^Dr^^^&amp;1.3.6.1.4.1.21367.3100.1&amp;ISO</Value-->
          <Value> |rbraman@medibridge.net^Smith^John^^^Dr^^^&amp;1.3.6.1.4.1.21367.3100.1&amp;ISO</Value>
        </ValueList>
      </Slot>
      <Name>
        <LocalizedString value="Physical"/>
      </Name>
      <Description>
        <LocalizedString value="Annual physical"/>
      </Description>
      <Classification id="cl08" classifiedObject="SubmissionSet01" classificationScheme="urn:uuid:a7058bb9-b4e4-4307-ba5b-e3f0ab85e12d" nodeRepresentation="">
        <Slot name="authorPerson">
          <ValueList>
            <Value>Sherry Dopplemeyer</Value>
          </ValueList>
        </Slot>
        <Slot name="authorInstitution">
          <ValueList>
            <Value>Cleveland Clinic</Value>
            <Value>Berea Community</Value>
          </ValueList>
        </Slot>
        <Slot name="authorRole">
          <ValueList>
            <Value>Primary Surgon</Value>
          </ValueList>
        </Slot>
        <Slot name="authorSpecialty">
          <ValueList>
            <Value>Orthopedic</Value>
          </ValueList>
        </Slot>
      </Classification>
      <Classification id="c109" classifiedObject="SubmissionSet01" classificationScheme="urn:uuid:aa543740-bdda-424e-8c96-df4873be8500" nodeRepresentation="History and Physical">
        <Slot name="codingScheme">
          <ValueList>
            <Value>Connect-a-thon contentTypeCodes</Value>
          </ValueList>
        </Slot>
        <Name>
          <LocalizedString value="History and Physical"/>
        </Name>
      </Classification>
      <ExternalIdentifier id="ei03" value="2.16.840.1.113883.13.47.2005.3.9999.34" identificationScheme="urn:uuid:96fdda7c-d067-4183-912e-bf5ee74998a8" registryObject="SubmissionSet01">
        <Name>
          <LocalizedString value="XDSSubmissionSet.uniqueId"/>
        </Name>
      </ExternalIdentifier>
      <ExternalIdentifier id="ei04" value="2.1" identificationScheme="urn:uuid:554ac39e-e3fe-47fe-b233-965d2a147832" registryObject="SubmissionSet01">
        <Name>
          <LocalizedString value="XDSSubmissionSet.sourceId"/>
        </Name>
      </ExternalIdentifier>
      <ExternalIdentifier id="ei05" value="998777350^^^&amp;2.16.840.1.113883.13.47&amp;ISO" identificationScheme="urn:uuid:6b5aea1a-874d-4603-a4bc-96a0a7b38446" registryObject="SubmissionSet01">
        <Name>
          <LocalizedString value="XDSSubmissionSet.patientId"/>
        </Name>
      </ExternalIdentifier>
    </RegistryPackage>
    <Classification id="cl10" classifiedObject="SubmissionSet01" classificationNode="urn:uuid:a54d6aa5-d40d-43f9-88c5-b4633d873bdd"/>
    <Association id="as01" targetObject="Document01" sourceObject="SubmissionSet01" associationType="urn:oasis:names:tc:ebxml-regrep:AssociationType:HasMember">
      <Slot name="SubmissionSetStatus">
        <ValueList>
          <Value>Original</Value>
        </ValueList>
      </Slot>
    </Association>
  </RegistryObjectList>
</ns3:SubmitObjectsRequest>