Provider-authored request for the delivery of patient care services.

Usage notes: Orders convey a provider’s intent to have a service performed on or for a patient, or to give instructions on future care.

Data Element
Referral Order
Description (*Please confirm or update this field for the new USCDI version*)

Provider-authored request to another provider, specialist, or organization for care services. 

Examples include but are not limited to referral orders to a wound care specialist and to a podiatrist.

Submitted By: Grace Glennon, on behalf of NCQA / NCQA
Data Element Information
Data Element Description Provider-authored request to another provider, specialist, or organization for care services.

Examples include referral orders to a wound specialist or podiatrist.
Use Case Description(s)
Use Case Description Referral orders represent another important type of order to support care coordination. Not all necessary medical services can be provided by a single provider, making referrals a necessary data point. Like other orders, referral orders are routinely captured and exchanged across care settings for routine care. These orders can be captured and exchanged via standard vocabulary (SNOMED).

In addition to being collected and exchanged as part of routine care for patients, quality measures currently utilize referral order information to assess appropriate care. NCQA continues to add follow-up components to many new and existing measures to assess for appropriate care following a significant medical finding; referral orders are one component to appropriate follow-up.
Estimate the breadth of applicability of the use case(s) for this data element (Level 2) – Use cases apply to most care settings or specialties.

Referral orders are documented, utilized and exchanged across care settings including primary care, outpatient and acute care settings, and a necessary process step to receive certain types of care.
ONC Priority
  • Address behavioral health integration with primary care and other physical care
  • Mitigate health and health care inequities and disparities
  • Address the needs of underserved communities
  • Address public health interoperability needs of reporting, investigation, and emergency response
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) SNOMED CT
Additional Specifications FHIR US Core (6.1.0, 7.0.0) ServiceRequest- must have a code defining what is being requested
Current Use (Level 2) Captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer
Extent of exchange (Level 2) Between more than two production EHRs or other HIT modules using available interoperability standards
Supporting Artifacts Referrals are used in quality measures today, and used as part of routine care across almost all provider types.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) No restrictions.
Restrictions on Use (e.g. licensing, user fees) No restrictions.
Privacy and Security Concerns Exchange of patient health information should follow HIPPA Privacy Rules.
Estimate of Overall Burden Given that USCDI already includes other orders elements, exchanged via the same structure as this orders element, implementation burden should be low.
Other Implementation Challenges No other known implementation challenges.
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by SuzyRoy on

Recommendation for required terminology standard designation

SNOMED International commends ONC for naming SNOMED CT as an applicable vocabulary standard for Referral Orders but we recommend that this be elevated to a required designation. SNOMED CT procedure hierarchy provides a comprehensive, nationally and internationally standardised vocabulary for referral and consultation coding including 307837007 |Referral to person (procedure)| and 306206005 |Referral to service (procedure)| and its descendants which enables consistent, computable referral documentation across care settings. NCQA's HEDIS quality measures already incorporate SNOMED CT-coded referral value sets, demonstrating validated real-world adoption at scale.

Reliance on local or proprietary referral codes which still remain prevalent in EHR implementations, creates barriers to the care coordination interoperability goals of the 21st Century Cures Act and ONC's TEFCA framework. SNOMED CT designation as a required standard for Referral Orders, consistent with its use in CMS Quality Payment Program (QPP) technical specifications, would drive convergence across implementations and eliminate the need for costly mapping between systems.

Submitted by pwilson@ncpdp.org on

NCPDP Comment

NCPDP supports the use of SNOMED, HCPCS and CPT which are used in the most recently named NCPDP SCRIPT Standard© and recommends HCPCS and CPT be added to the Applicable Vocabulary Standard(s).

Submitted by NCQA on

NCQA USCDI v7 recommendation for Referral Orders

Recommendation: Add an additional element to USCDI v7 in the Orders data class for Referral Orders, defined as a provider-authored request to another provider, specialist, or organization for care services. Examples include referral orders to a wound specialist or podiatrist. (Vocabulary standards: SNOMED CT)

Rationale: Referral Orders are another important order data element to support care coordination and are already routinely exchanged. Inclusion in USCDI should also facilitate the ability to close the loop on referrals to ensure services requested are carried out, and care is provided, which is the critical step for high-quality, equitable care. NCQA continues to add follow-up components to many new and existing measures to assess for appropriate care following a significant medical finding; referral orders are one component to appropriate follow-up.

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