This page is part of the Bidirectional Services eReferrals (BSeR) (v0.2.0: STU 1 on FHIR STU3 Ballot 2) based on FHIR R3. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions 
The activity and sequence diagram below illustrate the full scope of the BSeR project and highlight the two activities and related interactions that form the scope of this BSeR FHIR Implementation Guide. The flow of events as depicted in the activity diagram include:
The activities within the scope of this BSeR Implementation Guide are: 2-Service Provider Referral and 5-Service Outcome Reporting.
The information exchanges depicted in the BSeR sequence diagram below are the full set interactions between actors in the BSeR domain. This BSeR FHIR Implementation Guide provides detail for the two highlighted information exchanges:
Each information exchange transactions represents a unique bundle of resources. The referral request transaction makes use of the BSeR Referral Request resource as its payload, and the referral feedback transaction make use of the BSeR Referral Feedback resource as its payload.
The following is an example of a rerral request bundle
<Bundle> <id value="DiabetesPreventionReferralRequestMessageBundle-A" /> <meta> <versionId value="3" /> <lastUpdated value="2019-01-12T17:49:02+00:00" /> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/DiabetesPreventionReferralRequestMessageBundle" /> </meta> <type value="message" /> <entry> <fullUrl value="urn:uuid:fc5857a1-98cb-4d3d-b6a0-fa0c18b3057d" /> <resource> <MessageHeader> <id value="fc5857a1-98cb-4d3d-b6a0-fa0c18b3057d" /> <event> <system value="http://terminology.www.hl7.org/CodeSystem/v2-0003" /> <code value="I12" /> <display value="Referral Request" /> </event> <receiver> <extension url="https://eip-fhir.experimental.aimsplatform.com/hapi-fhir/baseDstu3/StructureDefinition/Practioner-Role"> <valueReference> <reference value="urn:uuid:ffa2bf53-ee09-43a1-b11a-73ed0f1cd73b" /> </valueReference> </extension> <reference value="urn:uuid:421269ad-abef-49bc-8cac-d3a5d4b00299" /> </receiver> <sender> <extension url="https://eip-fhir.experimental.aimsplatform.com/hapi-fhir/baseDstu3/StructureDefinition/Practioner-Role"> <valueReference> <reference value="urn:uuid:538791da-3555-460e-9e7f-76d25988a546" /> </valueReference> </extension> <reference value="urn:uuid:598af951-66e4-4910-a964-7e41533b183c" /> </sender> <timestamp value="2018-12-11T05:05:11+00:00" /> <source> <name value="Centricity" /> <endpoint value="https://apisandbox.gehealthcare.com:9443/demoAPIServer" /> </source> <reason> <coding> <system value="https://www.hl7.org/fhir/valueset-message-reason-encounter.html" /> <code value="class-enroll" /> <display value="Enroll in Class" /> </coding> </reason> <focus> <reference value="urn:uuid:1b82e7bd-27bb-49bd-a404-0e5a7d2fa98c" /> </focus> </MessageHeader> </resource> </entry> <entry> <fullUrl value="urn:uuid:1b82e7bd-27bb-49bd-a404-0e5a7d2fa98c" /> <resource> <ReferralRequest> <id value="1b82e7bd-27bb-49bd-a404-0e5a7d2fa98c" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/BSeRReferralRequest" /> </meta> <identifier> <value value="71949668" /> </identifier> <status value="active" /> <intent value="order" /> <serviceRequested> <coding> <system value="http://snomed.info/sct" /> <code value="385804009" /> <display value="Diabetes care" /> </coding> </serviceRequested> <subject> <reference value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> </subject> <authoredOn value="2018-12-11" /> <requester> <agent> <extension url="https://eip-fhir.experimental.aimsplatform.com/hapi-fhir/baseDstu3/StructureDefinition/Practioner-Role"> <valueReference> <reference value="urn:uuid:538791da-3555-460e-9e7f-76d25988a546" /> </valueReference> </extension> <reference value="urn:uuid:598af951-66e4-4910-a964-7e41533b183c" /> </agent> </requester> <recipient> <extension url="https://eip-fhir.experimental.aimsplatform.com/hapi-fhir/baseDstu3/StructureDefinition/Practioner-Role"> <valueReference> <reference value="urn:uuid:ffa2bf53-ee09-43a1-b11a-73ed0f1cd73b" /> </valueReference> </extension> <reference value="urn:uuid:421269ad-abef-49bc-8cac-d3a5d4b00299" /> </recipient> <reasonCode> <coding> <system value="http://snomed.info/sct" /> <code value="15777000" /> <display value="Prediabetes" /> </coding> </reasonCode> <supportingInfo> <reference value="urn:uuid:0bdbb1e5-5016-4291-8249-d16d8d07181f" /> </supportingInfo> <supportingInfo> <reference value="urn:uuid:29be9d88-0027-4f02-9b2c-f7a27aaaf10b" /> </supportingInfo> <supportingInfo> <reference value="urn:uuid:22449d51-3d71-49bd-a79a-c1f7557e09ef" /> </supportingInfo> </ReferralRequest> </resource> </entry> <entry> <fullUrl value="urn:uuid:ffa2bf53-ee09-43a1-b11a-73ed0f1cd73b" /> <resource> <PractitionerRole> <id value="ffa2bf53-ee09-43a1-b11a-73ed0f1cd73b" /> <practitioner> <reference value="urn:uuid:421269ad-abef-49bc-8cac-d3a5d4b00299" /> </practitioner> <organization> <reference value="urn:uuid:f5db0002-3a69-472b-9263-be8d977fdaff" /> </organization> <code> <coding> <system value="http://www.hl7.org/fhir/practitioner-role" /> <code value="doctor" /> <display value="Doctor" /> </coding> </code> <location> <reference value="urn:uuid:17d9e3c9-a6a8-4550-b4db-d6f5a453d983" /> </location> </PractitionerRole> </resource> </entry> <entry> <fullUrl value="urn:uuid:538791da-3555-460e-9e7f-76d25988a546" /> <resource> <PractitionerRole> <id value="538791da-3555-460e-9e7f-76d25988a546" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/ReferralInitiatorPractitionerRole" /> </meta> <practitioner> <reference value="urn:uuid:598af951-66e4-4910-a964-7e41533b183c" /> </practitioner> <organization> <reference value="urn:uuid:e6d1abc8-595f-41ab-a6dc-13a034d3fac7" /> </organization> <code> <coding> <system value="http://www.hl7.org/fhir/practitioner-role" /> <code value="doctor" /> <display value="Doctor" /> </coding> </code> <location> <reference value="urn:uuid:25fa3dbc-dc9e-42c2-b681-0352765645af" /> </location> </PractitionerRole> </resource> </entry> <entry> <fullUrl value="urn:uuid:421269ad-abef-49bc-8cac-d3a5d4b00299" /> <resource> <Practitioner> <id value="421269ad-abef-49bc-8cac-d3a5d4b00299" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/PractitionerPerson" /> </meta> <identifier> <system value="urn:oid:2.16.840.1.113883.4.6" /> <value value="1972548287" /> </identifier> <name> <family value="Liyanage" /> <given value="Udaya" /> <prefix value="Dr." /> </name> <telecom> <system value="phone" /> <value value="(618) 942-2002" /> <use value="work" /> </telecom> <address> <line value="220 S PARK AVE" /> <city value="HERRIN" /> <state value="IL" /> <postalCode value="62948" /> </address> </Practitioner> </resource> </entry> <entry> <fullUrl value="urn:uuid:25fa3dbc-dc9e-42c2-b681-0352765645af" /> <resource> <Location> <id value="25fa3dbc-dc9e-42c2-b681-0352765645af" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/ServiceDeliveryLocation" /> </meta> <identifier> <system value="urn:oid:2.16.840.1.113883.4.6" /> <value value="1659603009" /> </identifier> <name value="Alliance Of Chicago Therapeutic Services and Supplies" /> <type> <coding> <system value="http://www.hl7.org/CodeSystem/organization-type" /> <code value="prov" /> <display value="Healthcare Provider" /> </coding> </type> <telecom> <system value="phone" /> <value value="(909) 427-5000" /> <use value="work" /> </telecom> <address> <use value="work" /> <line value="2800 W PETERSON AVE" /> <city value="Chicago" /> <state value="IL" /> <postalCode value="60659" /> <country value="USA" /> </address> </Location> </resource> </entry> <entry> <fullUrl value="urn:uuid:17d9e3c9-a6a8-4550-b4db-d6f5a453d983" /> <resource> <Location> <id value="17d9e3c9-a6a8-4550-b4db-d6f5a453d983" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/ServiceDeliveryLocation" /> </meta> <identifier> <system value="urn:oid:2.16.840.1.113883.4.6" /> <value value="1215372123" /> </identifier> <name value="YMCA of Metropolitan Chicago" /> <type> <coding> <system value="http://www.hl7.org/CodeSystem/organization-type" /> <code value="prov" /> <display value="Healthcare Provider" /> </coding> </type> <telecom> <system value="phone" /> <value value="(909) 427-5000" /> <use value="work" /> </telecom> <address> <use value="work" /> <line value="1030 W Van Buren St" /> <city value="Chicago" /> <state value="IL" /> <postalCode value="60607" /> <country value="USA" /> </address> </Location> </resource> </entry> <entry> <fullUrl value="urn:uuid:598af951-66e4-4910-a964-7e41533b183c" /> <resource> <Practitioner> <id value="598af951-66e4-4910-a964-7e41533b183c" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/PractitionerPerson" /> </meta> <identifier> <system value="urn:oid:2.16.840.1.113883.4.6" /> <value value="1063784882" /> </identifier> <name> <family value="Heard" /> <given value="Elisa" /> <prefix value="Dr." /> </name> <telecom> <system value="phone" /> <value value="(847) 548-6000" /> <use value="work" /> </telecom> <address> <line value="18640 West Belvidere Road" /> <city value="Grayslake" /> <state value="IL" /> <postalCode value="60030" /> </address> </Practitioner> </resource> </entry> <entry> <fullUrl value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> <resource> <Patient> <id value="cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/PatientRole" /> </meta> <identifier> <type> <coding> <system value="http://www.hl7.org/fhir/v2/0203" /> <code value="MR" /> <display value="Medical Record Number" /> </coding> </type> <system value="urn:oid:2.16.840.1.113883.4.3.17" /> <value value="F255-9215-0094" /> </identifier> <name> <use value="official" /> <family value="Beal" /> <given value="Bradley" /> </name> <telecom> <system value="phone" /> <value value="(999) 607-2500" /> </telecom> <gender value="male" /> <birthDate value="1950-03-22" /> <address> <line value="609 Lizeth Streets" /> <city value="Chicago" /> <state value="IL" /> <postalCode value="60609" /> </address> <communication> <language> <coding> <system value="urn:ietf:bcp:47" /> <code value="en-US" /> <display value="English (United States)" /> </coding> </language> <preferred value="true" /> </communication> </Patient> </resource> </entry> <entry> <fullUrl value="urn:uuid:29be9d88-0027-4f02-9b2c-f7a27aaaf10b" /> <resource> <Observation> <id value="29be9d88-0027-4f02-9b2c-f7a27aaaf10b" /> <status value="final" /> <code> <coding> <system value="http://loinc.org" /> <code value="80913-7" /> <display value="Highest level of education" /> </coding> </code> <subject> <reference value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> </subject> <valueCodeableConcept> <coding> <system value="http://www.hl7.org/fhir/v3/EducationLevel/vs.html" /> <code value="BD" /> <display value="College or baccalaureate degree complete" /> </coding> </valueCodeableConcept> </Observation> </resource> </entry> <entry> <fullUrl value="urn:uuid:22449d51-3d71-49bd-a79a-c1f7557e09ef" /> <resource> <Observation> <id value="22449d51-3d71-49bd-a79a-c1f7557e09ef" /> <status value="final" /> <code> <coding> <system value="http://loinc.org" /> <code value="74165-2" /> <display value="History of employment status" /> </coding> </code> <subject> <reference value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> </subject> <valueCodeableConcept> <coding> <system value="http://www.hl7.org/fhir/v2-0066" /> <code value="1" /> <display value="Full time employed" /> </coding> </valueCodeableConcept> </Observation> </resource> </entry> <entry> <fullUrl value="urn:uuid:e6d1abc8-595f-41ab-a6dc-13a034d3fac7" /> <resource> <Organization> <id value="e6d1abc8-595f-41ab-a6dc-13a034d3fac7" /> <identifier> <system value="urn:oid:2.16.840.1.113883.4.6" /> <value value="1659603009" /> </identifier> <type> <coding> <system value="http://www.hl7.org/CodeSystem/organization-type" /> <code value="prov" /> <display value="Healthcare Provider" /> </coding> </type> <name value="Alliance Of Chicago Therapeutic Services and Supplies" /> <telecom> <system value="phone" /> <value value="(773)-661-4499" /> </telecom> <address> <use value="work" /> <line value="2800 W PETERSON AVE" /> <city value="Chicago" /> <state value="IL" /> <postalCode value="60659" /> <country value="USA" /> </address> </Organization> </resource> </entry> <entry> <fullUrl value="urn:uuid:f5db0002-3a69-472b-9263-be8d977fdaff" /> <resource> <Organization> <id value="f5db0002-3a69-472b-9263-be8d977fdaff" /> <identifier> <system value="urn:oid:2.16.840.1.113883.4.6" /> <value value="1215372123" /> </identifier> <type> <coding> <system value="http://www.hl7.org/CodeSystem/organization-type" /> <code value="prov" /> <display value="Healthcare Provider" /> </coding> </type> <name value="YMCA of Metropolitan Chicago" /> <telecom> <system value="phone" /> <value value="(909) 427-5000" /> <use value="work" /> </telecom> <address> <use value="work" /> <line value="1030 W Van Buren St" /> <city value="Chicago" /> <state value="IL" /> <postalCode value="60607" /> <country value="USA" /> </address> </Organization> </resource> </entry> <entry> <fullUrl value="urn:uuid:0bdbb1e5-5016-4291-8249-d16d8d07181f" /> <resource> <Bundle> <id value="0bdbb1e5-5016-4291-8249-d16d8d07181f" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/DiabetesRequestSupportBundle" /> </meta> <type value="collection" /> <entry> <fullUrl value="urn:uuid:f08e2abf-30c5-49b0-9ada-105d52204ca6" /> <resource> <Observation> <id value="f08e2abf-30c5-49b0-9ada-105d52204ca6" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/BodyMassIndexObservation" /> </meta> <status value="final" /> <category> <coding> <system value="http://www.hl7.org/fhir/observation-category" /> <code value="vital-signs" /> <display value="Vital Signs" /> </coding> </category> <code> <coding> <system value="http://loinc.org" /> <code value="39156-5" /> <display value="Body mass index (BMI) [Ratio]" /> </coding> </code> <subject> <reference value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> </subject> <effectiveDateTime value="2018-12-11" /> <valueQuantity> <value value="31.2" /> <unit value="kg/m2" /> <system value="http://unitsofmeasure.org" /> <code value="kg/m2" /> </valueQuantity> </Observation> </resource> </entry> <entry> <fullUrl value="urn:uuid:6f99e55a-66a7-453f-b78f-e6821dc5e556" /> <resource> <Observation> <id value="6f99e55a-66a7-453f-b78f-e6821dc5e556" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/BodyWeightObservation" /> </meta> <status value="final" /> <category> <coding> <system value="http://www.hl7.org/fhir/observation-category" /> <code value="vital-signs" /> <display value="Vital Signs" /> </coding> </category> <code> <coding> <system value="http://loinc.org" /> <code value="29463-7" /> <display value="Body Weight" /> </coding> </code> <subject> <reference value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> </subject> <effectiveDateTime value="2018-12-11" /> <valueQuantity> <value value="105" /> <unit value="kg" /> <system value="http://unitsofmeasure.org" /> <code value="kg" /> </valueQuantity> </Observation> </resource> </entry> <entry> <fullUrl value="urn:uuid:cc841086-4f22-4b92-8ab4-4446fc506ebf" /> <resource> <Observation> <id value="cc841086-4f22-4b92-8ab4-4446fc506ebf" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/A1cObservation" /> </meta> <status value="final" /> <category> <coding> <system value="http://www.hl7.org/fhir/observation-category" /> <code value="vital-signs" /> <display value="Vital Signs" /> </coding> </category> <code> <coding> <system value="http://loinc.org" /> <code value="4548-4" /> <display value="Hemoglobin A1c/ΓÇïHemoglobin.total in Blood" /> </coding> </code> <subject> <reference value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> </subject> <effectiveDateTime value="2018-12-11" /> <valueQuantity> <value value="128" /> <unit value="mg/dL" /> <system value="http://unitsofmeasure.org" /> <code value="mg/dL" /> </valueQuantity> </Observation> </resource> </entry> <entry> <fullUrl value="urn:uuid:f4faa626-d79e-4b5b-b898-57f25c9dca0b" /> <resource> <Observation> <id value="f4faa626-d79e-4b5b-b898-57f25c9dca0b" /> <meta> <profile value="http://www.hl7.org/fhir/us/bser/StructureDefinition/BodyHeightObservation" /> </meta> <status value="final" /> <category> <coding> <system value="http://www.hl7.org/fhir/observation-category" /> <code value="vital-signs" /> <display value="Vital Signs" /> </coding> </category> <code> <coding> <system value="http://loinc.org" /> <code value="8302-2" /> <display value="Body height" /> </coding> </code> <subject> <reference value="urn:uuid:cec258d7-a76a-4a1d-bc4c-c656b0a5d6f8" /> </subject> <effectiveDateTime value="2018-12-11" /> <valueQuantity> <value value="182.88" /> <unit value="cm" /> <system value="http://unitsofmeasure.org" /> <code value="cm" /> </valueQuantity> </Observation> </resource> </entry> </Bundle> </resource> </entry> </Bundle>
