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Referral Request [PCC-55] (Future Use)

Referral Request [PCC-55] - the Referral Initiator sends a request to the Referral Recipient, which replies with an accept or a decline. The request is either:

• a Genetic Clinical Referral to a clinical genetics service - ServiceRequest.code / OBR-4 SNOMED CT 306119003; or
• a laboratory order (Genomic Test Order) to a genomic laboratory - OBR-4 a Genomic Test Directory code, with specimens in SPM. Here the Referral Initiator is the Order Placer and the Referral Recipient the Order Filler.

The examples are for a laboratory order.

References

• IHE PCC 360X Closed Loop Referral PCC TF-2 3.55
• Care Coordination and 360 Referrals (proof of concept) - Referral Request [PCC-55] - the general (non-genomic) version of this page
• NHS England Multicast Notification Service - Genomic Order Event
• eRS FHIR API, BaRS FHIR API
• HL7 v2 OMG_O19 and OSU_O51
• Equivalent IHE transactions for a laboratory or imaging order (a new order, then accepted or rejected by the Order Filler):
  • IHE PaLM Laboratory Testing Workflow (LTW) Placer Order Management [LAB-1] - see Laboratory Order (LAB-1)
  • IHE Inter-Laboratory Workflow (ILW) Sub-order Management [LAB-35] - see Sub Order Management (LAB-35)
  • IHE RAD Scheduled Workflow Placer Order Management [RAD-2]

Interaction

sequenceDiagram
    participant RI as Referral Initiator
    participant RR as Referral Recipient<br/>(Clinical Genetics)
    RI ->> RR: Referral Request<br/>OMG^O19 / FHIR Message O19
    RR -->> RI: Acknowledgement (ACK / HTTP)
    RR -->> RR: Triage
    alt accepted
        RR ->> RI: Referral Accept<br/>OSU^O51 OK/IP / Task accepted
    else declined
        RR ->> RI: Referral Decline<br/>OSU^O51 UA/CA / Task rejected
    end

Referral Request

Content

For a Genetic Clinical Referral, each data item is an element of the Genetic Clinical Referral logical model - see its Mappings tab. For a laboratory order the content is the Genomic Test Order logical model instead.

The referral carries only what the Referral Recipient cannot read for itself and references the rest - in particular the pathology report and patient summary are referenced as clinical documents (ideally shared via the NHS England Single Patient Record), not copied into the referral. See Genetic Clinical Referral - Clinical Documents.

Expected Actions

The Referral Recipient SHALL respond with an accept or a decline. It SHALL use the patient identifier and Referral ID from the request in every later message.

Referral Accept

Expected actions. The Referral Initiator's system SHALL show that the Referral Recipient has taken responsibility for the referral.

Referral Decline

Expected actions. The Referral Initiator's system SHALL show the decline and its reason. A new referral needs a new Referral ID (ServiceRequest.replaces may point to the declined one).

Status Updates from GOMS via MNS

Where the referral (or a resulting genomic test order) is managed by the NHS England Genomic Order Management Service (GOMS), status changes are published as events, not messages. The Regional Integration Engine (RIE) turns them into the status messages on this page:

sequenceDiagram
    participant GOMS as Genomic Order<br/>Management Service
    participant MNS as Multicast Notification<br/>Service (MNS)
    participant RIE as Regional Integration<br/>Engine (RIE)
    participant RI as Referral Initiator<br/>(EPR / GP system)
    GOMS ->> MNS: Task created / updated
    MNS ->> RIE: genomic-order-event-1<br/>(resourceType = Task)
    RIE ->> GOMS: GET Task (focus of the event)
    GOMS -->> RIE: Task
    RIE -->> RIE: Convert Task to O51
    RIE ->> RI: OSU^O51 or FHIR Message O51
    RI -->> RIE: ACK

1. GOMS creates or updates a Task (accept, decline, completion, reassignment).
2. MNS sends the RIE a genomic-order-event-1 notification. The notification is event-only - its focus references the changed resource, it does not carry it.
3. The RIE retrieves the Task from the GOMS FHIR API. For an outcome, Task.output references the reports in the NHS England Unified Genomic Record (UGR) - they are not retrieved or forwarded by the RIE.
4. The RIE converts the Task to a Referral Order Status (O51) FHIR Message or an HL7 v2 OSU^O51 - Task.status and Task.businessStatus map to ORC-1 / ORC-5 per the Order Control and Status table, Task.statusReason to ORC-16 - and sends it to the Referral Initiator's system.

The RIE subscribes to MNS only for the Tasks it needs, using the MNS filtering attributes, for example:

eventType='genomic-order-event-1' AND resourceType='Task' AND requester='R0A'

Examples

The existing laboratory order ServiceRequest Coded Entries Example: Dr Samuel Darwin at Manchester University NHS Foundation Trust (R0A) orders R240.1 (diagnostic testing for known mutation(s)) for Octavia CHISLETT from the North West GLH (699X0). In every ORC, ORC-12 (the ordering clinician) and ORC-21 (the ordering organisation's ODS code) are mandatory, including in the status updates, as in the NW GMSA ORC.

Laboratory Order - OMG^O19

OMG_O19 used instead of OML_O21, with the specimen in SPM.

MSH|^~\&|EPIC|R0A|RIE|699X0|20250129103726+0000||OMG^O19^OMG_O19|MSG001601737|P|2.5.1|||AL|NE
PID|1||633^^^R0A^MR~9449305552^^^^NH||CHISLETT^Octavia||20080920|F|||1 RAVENSFIELD GARDENS^^EPSOM^SURREY^KT19 0ST
PV1|1|I|^^^R0A09^^^^^^^R0A||||C3456789^Darwin^Samuel^^^Dr^^^GMC|||892761000000102^Clinical haematology service^SNM3|||||||||1001166717^^^R0A^AN
ORC|NW|1601737^R0A|||||||20250129103726+0000|||C3456789^Darwin^Samuel^^^Dr^^^GMC|||||||||MANCHESTER UNIVERSITY NHS FOUNDATION TRUST^^R0A^^^ODS
OBR|1|1601737^R0A||R240.1^^England-GenomicTestDirectory||20250129||||||||||C3456789^Darwin^Samuel^^^Dr^^^GMC
SPM|1|25GEN-029GN00001&R0A||258580003^Whole blood specimen^SNM3|||||||||||||20250129103726+0000|||Y

FHIR Message: Bundle 'Message' - Genomics Order with Coded Entries (Laboratory Order, focus ServiceRequest Coded Entries Example).

Accept - OSU^O51

ORC-1 OK, ORC-5 IP; the laboratory's Filler Order Number in ORC-3.

MSH|^~\&|RIE|699X0|EPIC|R0A|20250130093000+0000||OSU^O51^OSU_O51|GLH-MSG-250130001|P|2.8|||AL|NE
PID|1||633^^^R0A^MR~9449305552^^^^NH||CHISLETT^Octavia||20080920|F|||1 RAVENSFIELD GARDENS^^EPSOM^SURREY^KT19 0ST
ORC|OK|1601737^R0A|R25012345^699X0||IP||||20250130093000+0000|||C3456789^Darwin^Samuel^^^Dr^^^GMC|||||||||MANCHESTER UNIVERSITY NHS FOUNDATION TRUST^^R0A^^^ODS

FHIR Message: Bundle Message - Order Status (O51), accepted (focus Task Genomic Test Accepted).

Decline - OSU^O51

The alternative first response: the patient does not meet the test directory eligibility criteria.

MSH|^~\&|RIE|699X0|EPIC|R0A|20250130093000+0000||OSU^O51^OSU_O51|GLH-MSG-250130002|P|2.8|||AL|NE
PID|1||633^^^R0A^MR~9449305552^^^^NH||CHISLETT^Octavia||20080920|F|||1 RAVENSFIELD GARDENS^^EPSOM^SURREY^KT19 0ST
ORC|UA|1601737^R0A|||CA||||20250130093000+0000|||C3456789^Darwin^Samuel^^^Dr^^^GMC||||not-eligible^Does not meet the R240 eligibility criteria - no known familial variant provided. Please contact the laboratory.^L|||||MANCHESTER UNIVERSITY NHS FOUNDATION TRUST^^R0A^^^ODS

FHIR Message: Bundle Message - Order Status (O51), declined (focus Task Genomic Test Declined).

More Information Requested

eRS allows a provider to return a referral to the referrer for more information; 360X has no such step. This guide uses businessStatus information-requested with Task.status on-hold, and the question in Task.note; the Referral Initiator updates ServiceRequest.supportingInfo and the Task returns to requested. HL7 v2 equivalent - Open.

NHS Implementations