Retrieve clinical referral information as a service provider

This guide explains how to retrieve referral information from the e-Referral Service (e-RS), using our FHIR API.  The information is intended for secondary care providers who are receiving referrals.

As a secondary care provider, you can access:

• worklists for referral requests

• worklists for advice and guidance requests

• non-clinical information (meta-data) about the referral

• attachments which are linked to a referral request

• clinical information which has been provided by a referrer

• summary information for advice and guidance requests

• conversation history for advice and guidance requests

• attachments which are linked to an advice and guidance request and/or conversation

A referral is generally sent from a primary care referrer to a secondary care provider. Most referrals need a referral letter.

The referral letter provides a detailed summary of the patient's presenting complaint and medical history, to ensure a smooth transition of care.  The referral letter is also known as the 'Clinical Referral Information' (CRI).

A referral letter in e-RS can be associated with a referral via:

• an integrated primary care system

• the web-based e-RS professional application

Detailed information on the two different methods is described below.

Primary care providers integrated with e-RS via the HL7 API (for example, EMIS, SystmOne) or FHIR API (for example Medicus) have the option to associate structured clinical data, including attachments, when creating a referral.

For more details, review the HL7 V3 webpage.

Via this method, the HL7 API allows the user to associate attachments and clinical content under the following headings to a referral. This is also known as the message set.

Structured clinical content:

• Attachments
• Risk to Others
• Reason for Referral
• Expectation of Referral
• Medication and Medical Devices
• Past Medical History
• Allergies and Adverse Reaction
• Findings
• Family History
• Social Context

Attachments associated via this method have a file limit of 5MB.  There is no limit to the number of attachments which can be associated via the HL7 API.

Find out about which file types are supported by e-RS.

Users who create referrals via the web-based e-RS application have the ability to add attachments which forms the referral letter.  Attachments associated via this method currently have a file limit of 5MB.  There is no limit to the number of attachment which can be associated via the professional application.

Find out about which file types are supported by e-RS.

In order to ensure you retrieve all the relevant clinical information via our API, it is advised that all the listed endpoints are used, with relevancy for your use case:

• referral information 
• advice and guidance information 
• referral plus advice and guidance information 

For referral requests (those sent to directly bookable or triage services), the clinical referral information must be obtained by using the following set of endpoints:

• Retrieve referral request (A005)
• Retrieve attachment (A042)
• Retrieve clinical information (A007)

The diagram below illustrates how these endpoints can be used.

These endpoints are also available as application-restricted, unattended access and detailed as part of our security and authorisation options.

2.11 Retrieve referral request

This endpoint (Retrieve referral request (A005)) provides the following important information, relevant for obtaining all information about a referral: 

• referral summary information - such as referral priority, shortlist criteria and service information
• file attachment references - these references can be used to retrieve individual attachments
• related referrals - if the referral is part of a pathway, other related referrals are provided here

A referral pathway in e-RS can be made up of more than one referral (UBRN).  For example, a referral is booked and seen in a general knee clinical assessment service (UBRN #1), and the service decides to onward refer to a more specialist knee meniscus service (UBRN #2). This would result in two UBRNs for the referral pathway. Of course, there could be more related UBRNs if the referral is onward referred multiple times.

It is important that clinical information is obtained across all the related referrals in a pathway, as demonstrated in the process diagram below.

2.12 Retrieve attachment

This endpoint (Retrieve attachment (A042)) allows the retrieval of individual attachments associated with a referral.  These are attachments which may have been added as part of an integrated GP system, or via the web-based e-RS application.

2.13 Retrieve clinical information

This endpoint (Retrieve clinical information (A007)) provides a summarised PDF file which will always contain:

• summary referral information 
• patient information 

But can also contain:

• clinical information added by an integrated primary care system
• service provider activity
• advice and guidance conversation

Examples of each clinical information summary are provided below.

2.14 Referral correspondence

A referrer has the ability to update and amend referral attachments, up until a time set by the receiving service. This is known as 'freeze time' in e-RS. This prevent changes to the referral information within a defined number of days before the appointment.

For advice and guidance requests, the clinical referral information must be obtained by using the following set of endpoints:

• Retrieve advice and guidance request summary (A024)
• Retrieve advice and guidance conversation (A025)
• Retrieve attachment (A042)
• Retrieve advice and guidance overview PDF (A043)

The diagram below illustrates how these endpoints can be used.

These endpoints are also available as application-restricted, unattended access and detailed as part of our security and authorisation options.

2.21 Retrieve advice and guidance summary

This endpoint (Retrieve advice and guidance request summary (A024)) provides important contextual information about an advice and guidance request, this includes information such as:

• where the advice and guidance request has come from 
• the service and specialty where the advice has been requested 
• whether the referrer has authorised the providing organisation to convert the advice and guidance request into an appointment request 
• any associated file attachments 

2.22 Retrieve advice and guidance conversation

This endpoint (Retrieve advice and guidance conversation (A025)) provides the advice and guidance conversation.

A conversation in e-RS takes the form of a message between a primary care referrer (seeking advice) and a secondary care provider or specialist (providing advice).

Each message can include file attachments and this endpoint provides references to these files.

If a message suggests structured clinical data was added or updated, then the overview PDF must be retrieved.

2.23 Retrieve attachment

Attachments can be associated to advice and guidance requests via two methods:

• attachments added via an integrated GP system
• attachment added as part of the advice and guidance conversation (via the web-based e-RS application)

If attachments were added via the integrated GP system, the file attachment references will be provided in Retrieve advice and guidance request summary (A024)

If attachments were added as part of an advice and guidance conversation, the file attachment references will be provided in Retrieve advice and guidance conversation (A025).

Both sets of attachments can be retrieved via the same endpoint (Retrieve attachment (A042)).

2.24 Retrieve advice and guidance overview PDF

This endpoint (Retrieve advice and guidance overview PDF (A043)) provides a summarised PDF file which will always contain:

• summary referral information 
• advice conversation

If the advice and guidance request has been created via an integrated system then there may also be additional structured clinical content.

Examples of the overview PDF are provided below.

In some scenarios, an advice and guidance request may get converted to a referral request.

When this occurs, the UBRN remains the same, but the referral request can inherit the clinical referral information of the previous advice and guidance request, as well as include additional referral-specific information.

This is the most complex scenario and the following set of endpoints are mandatory to obtain the full clinical set of information:

• Retrieve referral request (A005)
• Retrieve attachment (A042)
• Retrieve clinical information (A007)
• Retrieve advice and guidance request summary (A024)
• Retrieve advice and guidance conversation (A025)

The diagram below illustrates how these endpoints can be used.

These endpoints are also available as application-restricted, unattended access and detailed as part of our security and authorisation options.

Note: The advice and guidance overview PDF (Retrieve advice and guidance overview PDF (A043)) is not required in this scenario as the PDF obtained via Retrieve clinical information (A007) will contain all the historic advice and guidance information.

2.31 Retrieve referral request

This endpoint (Retrieve referral request (A005)) provides the following important information, relevant for obtaining all information about a referral and historic advice and guidance information:

• referral summary information - such as referral priority, shortlist criteria and service information
• file attachment references - these references can be used to retrieve individual attachments
• related referrals - a referral pathway in e-RS can be made up of more than one referral (UBRN) and as such, it is important that clinical information is obtained across all the related referrals in the pathway
• communication request - this references the previous advice and guidance request which was converted to a referral 

It is important that clinical information is obtained across all related referrals in a pathway, as described and shown in 'Referral information', under the 'Retrieve referral request' section above.

2.32 Retrieve attachment

This endpoint (Retrieve attachment (A042)) allows the retrieval of individual attachments associated with a referral and historic advice and guidance request.

In this scenario, there may be attachments associated via:

• an integrated GP system (for both advice and guidance request and/or referral request) or
• the web-based e-RS application

All attachment references will be present in Retrieve referral request (A005) and must be retrieved to obtain the full clinical information.

2.33 Retrieve clinical information

This endpoint (Retrieve clinical information (A007)) provides a summarised PDF file which will always contain:

• summary referral information 
• patient information 

But can also contain:

• clinical information added by an integrated primary care system
• service provider activity
• advice and guidance conversation

Examples of each clinical information summary are provided under the 'Retrieve clinical information' section above.

2.34 Retrieve advice and guidance summary

This endpoint (Retrieve advice and guidance request summary (A024)) provides important contextual information about an advice and guidance request, this includes information such as:

• where the advice and guidance request has come from 
• the service and specialty where the advice has been requested 
• whether the referrer has authorised the providing organisation to convert the advice and guidance request into an appointment request 

2.35 Retrieve advice and guidance conversation

This endpoint (Retrieve advice and guidance conversation (A025)) provides the advice and guidance conversation.

A conversation in e-RS takes the form of a message between a referrer (seeking advice) and a provider or specialist (providing advice).