Referral to a Higher Level of Care
Chapter 17 Bedside Questions · 5 questions · about 5 minutes
The national prescription (HITECH) was written without a history, differential, or discontinuation criteria, by a payer that is also specifier and auditor, and the informatics specialty was never consulted or even counted. Three foundations remain unfinished and cannot be fixed inside one organization: patient identity, a common language, and a record that follows the patient.
The rural physician stabilizing a head injury and writing the transfer note: a referral admits the problem exceeds local capability and demands care from someone with more capability. Recognizing the edge of your capability is visible competence.
Answer as your executive team would, with the evidence in hand. Each question has a factual answer in a system you already own.
Can your organization state, with evidence, its patient-matching accuracy within its walls and when exchanging data with others?
Add a note: where is the evidence, or who owns it?
Who, by name, is accountable for terminology governance, and how are billing-to-clinical vocabulary mappings maintained?
Add a note: where is the evidence, or who owns it?
When a record arrives through TEFCA or a regional network, does it join a coherent longitudinal record or become another document in a pile?
Add a note: where is the evidence, or who owns it?
Which national bodies, standards organizations, and specialty societies set your rules, and are you represented where they are made?
Add a note: where is the evidence, or who owns it?
If a unique patient identifier were permitted tomorrow, is your data governance mature enough to use it well?
Add a note: where is the evidence, or who owns it?
A reflection tool from the book, not a validated diagnostic test or benchmark. Your answers and notes stay in this browser unless you choose to send them. Please don't enter patient information.
Recognizing the edge of your own capability is not a failure; it is visible competence.
The Diagnostician, Chapter 17