Question: use of HL7 v2 for specialist Letter

May 20, 2014

Question:

When sending a Specialist Letter HL7 V2 REF_I12 back to a GP, should the Referring Provider in the PRD segment point to the GP (the originator of the Referral) or the Specialist (the originator of the Specialist Letter please?

Would the Originating referral identifier RF1.6 for the Specialist Letter be the identifier of the original referral (I believe it would be this) or that of the specialist letter please? In the specialist letter HL7, would OBR-16 (ordering provider), refer to the GP?

Answer:

Well, I’m going to take this as an Australian question, because that’s the only context in which I’ve heard of a “Specialist Letter”.

The roles in the PRD are a repeating field. In the Australian context, we have a Role IR = Intended Recipient which should be used to indicate the recipient used of the message, and there should only be one of these in the message. This removes ambiguity of where the message is destined.  The other roles are the roles in the context of the scenario and not related to the messaging, so ”Referring Provider in the PRD segment points to the GP (the originator of the Referral)”

The definition for RF1-6:

The first component is a string of up to 15 characters that identifies an individual referral. It is assigned by the originating application, and it identifies a referral,and the subsequent referral transactions, uniquely among all such referrals from a particular processing application. 

And for RF1-11:

The first component is a string of up to 15 characters that identifies an individual referral. It is typically assigned by the referred-to provider application responding to a referral originating from a referring provider application, and it identifies a referral, and the subsequent referral transactions, uniquely among all such referrals for a particular referred-to providerprocessing application. For example, when a primary care provider (referring provider) sends a referral to a specialist (referred-to provider), the specialist’s application system may accept the referral and assignit a new referral identifier which uniquely identifies that particular referral within the specialist’s application system. This new referral identifier would be placed in the external referral identifier field when the specialist responds to the primary care physician.

So the purpose of RF1 is to identify the referral (not the message or documents within ie. OBR-3).

GP -> Specialist referral:

RF1||||||123^GP Practice^1CA696CA-C91D-466E-
BC11-B5C9B7B99ACA^GUID

Specialist referral -> GP:

RF1||||||123^GP Practice^1CA696CA-C91D-466E-
BC11-B5C9B7B99ACA^GUID|||||
AB354^Specialist Practice^1BC63E55-3FEC-4B2E-
8A61-0DE1796C3410^GUID

RF1-6 is a required field. So a problem may arise when the specialist sends a reply to the GP and the originating referral identifier is not known, say if the original referral was received not via REF^I12, ie rather paper/fax. In this case, all you could use would be very unique dummy value such as a GUID be used in this instance in RF1-6. Leaving it blank may not be acceptable to some receivers.

And so, yes, in the specialist letter HL7, OBR-16 (ordering provider), would refer to the GP.

Note: Thanks to Jared Davison from Medical Objects for this answer.