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requirements:use-cases:use-case-referral-confirmation

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requirements:use-cases:use-case-referral-confirmation [2018/03/06 02:59]
Adrian Blakey
requirements:use-cases:use-case-referral-confirmation [2018/03/06 16:55] (current)
Adrian Blakey
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 ==== Business Problem / Opportunity ==== ==== Business Problem / Opportunity ====
  
-In order to close out a specific ​referral of a patient, a referring provider shall give the patient confirmation of the referral. In order to be able to do this the referral provider shall return a positive affirmation containing the specifics of the referral they have accepted so that this information may in turn may be supplied to the patient and used to update the patient'​s records that this event has occurred.+In order to close out the referral of a patient, a referring provider shall give the patient confirmation of the referral. In order to be able to do thisthe referral provider shall return a positive affirmation containing the specifics of the referral they have accepted ​to the referring provider, ​so that this information may in turn may be supplied to the patient and used to update the patient'​s records that this event has occurred.
  
-In the absence of a common, well understood protocol for this process and lack of a standards for what data shall be returned, either: the data is not communicated back at all; or missing or incorrect data is communicated;​ or data is returned at some time after the patient has left the presence of the referring provider; or the data is returned in a form that is not easily managed or disseminated (e.g. a fax); or not returned directly to the referring provider or the assistant to whom the referring provider has handed-off the patient so that they may move on to treat another patient. ​+In the absence of a common, well-understood protocol for this process and lack of a standards for what data shall be returned, either: the data is not communicated back at all; or missing or incorrect data is communicated;​ or data is returned at some time after the patient has left the presence of the referring provider; or the data is returned in a form that is not easily managed or disseminated (e.g. a fax); or not returned directly to the referring provider or the assistant to whom the referring provider has handed-off the patient so that they may move on to treat another patient. ​
  
 The opportunity is to correct these issues and improve the process so that a positive confirmation is made in either real time, or asynchronously - but in either case containing actionable information that is in turn communicated back to the patient, and used to update patient records. ​   ​ The opportunity is to correct these issues and improve the process so that a positive confirmation is made in either real time, or asynchronously - but in either case containing actionable information that is in turn communicated back to the patient, and used to update patient records. ​   ​
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 ==== Current Solution ==== ==== Current Solution ====
  
-Generally, vertically integrated health care systems have solved this issue for themselves by employing either home-grown or packaged software solutions built no database technology. This is the value add of this way of organizing care delivery, namely a homogeneous team-based approach to patient care. These types of systems are monolithic and closed.+Generally, vertically integrated health care systems have solved this issue for themselves by employing either home-grown or packaged software solutions built on database technology. This is the value add of this way of organizing care delivery, namely a homogeneous team-based approach to patient care. These types of systems are monolithic and closed.
  
-In less centralized arrangements such accountable care organizations (or less formal arrangements),​ this is much harder. Either because of a preponderance of systems that do not intercommunicate,​ or a lack of automated systems that could be made to intercommunicate. In the absence of support for the process the solution is to resort to improvise a solution using a standard form and the lowest common denominator of communication which can be actioned ​by hospital clerks (for whom time does not stand still), namely the fax machine.+In less centralized arrangements such accountable care organizations (or less formal arrangements),​ this is harder. Either because of a preponderance of systems that do not intercommunicate,​ or a lack of automated systems that could be made to intercommunicate. In the absence of support for the process the solution is to resort to improvise a solution using a proforma ​and the lowest common denominator of communication which can be operated ​by hospital clerks (for whom time does not stand still), namely the fax machine.
  
-In other areas of heath care there are primitive electronic data interchange standards - however they do not exist for referrals, perhaps because EDI was invented in the days of batch processing and referral processing is a structured real-time communication. ​+In other areas of health ​care there are primitive electronic data interchange standards - however they do not exist for referrals, perhaps because EDI was invented in the days of batch processing and referral processing is a structured real-time communication. ​
  
 ==== Why a Blockchain? ==== ==== Why a Blockchain? ====
  
-Blockchain is a trustworthy,​ shared distributed database system. Peer nodes may be deployed among the various provider entities in different care settings. In smaller settings or subsidiaries of a larger setting client access to one of more peers shall be provisioned.+Blockchain is a trustworthy,​ shareddistributed database system. Peer nodes may be deployed among the various provider entities in different care settings. In smaller settings or subsidiaries of a larger setting client access to one of more peers shall be provisioned.
  
 The confirmation of a referral would be made by writing a confirmation record to a shared ledger. In effect this would be a "​contract"​ that stated the referral provider had agreed to see the patient on a specific data and time at a specific location with the intent of providing specific services. It would affirm that the patient'​s payment terms had been verified and provide the patient with a financial statement itemizing estimated costs they had to cover for the referral. Any plan covering the referral would have a predetermination record - allowing them to adjust reserves in preparation for the event. In short - this would leave nothing to chance and every party would be fully information of the planned event. ​ The confirmation of a referral would be made by writing a confirmation record to a shared ledger. In effect this would be a "​contract"​ that stated the referral provider had agreed to see the patient on a specific data and time at a specific location with the intent of providing specific services. It would affirm that the patient'​s payment terms had been verified and provide the patient with a financial statement itemizing estimated costs they had to cover for the referral. Any plan covering the referral would have a predetermination record - allowing them to adjust reserves in preparation for the event. In short - this would leave nothing to chance and every party would be fully information of the planned event. ​
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 ===== Section 2 - States and Transactions ===== ===== Section 2 - States and Transactions =====
  
 +Patient referral visit written to the ledger and resources scheduled to facilitate the visit. Cost of the referral agreed to by the patient. Patient eligibility checked with health plan(s) of which the patient is a member. Patient financing affirmed with funding sources (health plan, health care savings account, personal finances).
  
 ===== Section 3 - Requirements ===== ===== Section 3 - Requirements =====
  
requirements/use-cases/use-case-referral-confirmation.txt ยท Last modified: 2018/03/06 16:55 by Adrian Blakey