Referral coordination evidence desk

The business situation

Illustrative reference architecture. Validate requirements for your organization.

Illustrative architecture: A hospital network receives specialty referrals with scanned attachments, incomplete records, and differing scheduling requirements. Coordinators need to locate missing administrative evidence without exposing unrelated patient records. This illustrative architecture supports referral operations; it does not diagnose, triage emergencies, or recommend treatment.

Problem

Patient identity mismatches and incomplete referral documentation create repeated handoffs. A model may incorrectly interpret missing information as a negative finding or mistake a scheduling preference for a clinical instruction. Administrative automation must preserve these distinctions.

Why a multi-agent system?

Specialists separately verify record identity, retrieve permitted documents, check locally defined packet requirements, and prepare scheduling choices. Clinical urgency and suitability remain explicit inputs from authorized clinicians, never inferred scheduling shortcuts.

Intended outcome

The intended result is a reviewable operational decision with source evidence and explicit ownership. Measure coordinator effort and documentation completeness alongside privacy and wrong-patient incidents. Scheduling speed alone is insufficient: the workflow must preserve clinician ownership and keep every unresolved item visible until a responsible person closes it.

Specialist agent team

Identity reconciliation agent

Compare referral identifiers with the patient index and surface possible mismatches.

Tools

• Patient index query
• referral metadata parser

Authority boundary

Cannot merge patient records or select among ambiguous identities.

Record retrieval agent

Collect the minimum authorized documents for the referral purpose with provenance.

Tools

• FHIR read adapter
• document repository

Authority boundary

Cannot retrieve unrelated encounters or alter clinical notes.

Completeness reviewer

Compare supplied documents with clinician-approved administrative requirements.

Tools

• Requirement catalog
• document field extractor

Authority boundary

Flags missing evidence without interpreting clinical adequacy.

Scheduling assistant

Prepare available appointment options consistent with recorded clinician instructions.

Tools

• Scheduling availability API
• referral draft API

Authority boundary

Cannot change urgency, issue clinical advice, or book outside approved coordinator actions.

Enterprise systems

Electronic health record

Authoritative patient identifiers and clinical records behind purpose-aware access controls.

Referral management platform

Owns referral state, responsible coordinator, clinician instructions, and outstanding document requests.

Scheduling and consent services

Supply appointment availability and permission context; bookings use an approved transactional adapter.

Architecture diagrams

flowchart LR
    N0["Referral coordination evidence desk"]
    N1["Identity reconciliation agent"]
    N2["Record retrieval agent"]
    N3["Completeness reviewer"]
    N4["Scheduling assistant"]
    N5["Evidence ledger"]
    N6["Human decision"]
    N7["Authorized adapter"]
N0 --> N1
    N1 --> N2
    N2 --> N3
    N3 --> N4
    N2 --> N5
    N4 --> N5
    N5 --> N6
    N6 --> N7

sequenceDiagram
    participant O as "Case orchestrator"
    participant S as "Electronic health record"
    participant H as "Accountable reviewer"
O->>S: Resolve referral patient identifiers
    S-->>O: Ambiguous identity match
    O->>H: Request registration resolution
    H-->>O: Confirm authorized patient record
    O->>S: Retrieve scoped referral documents
    O->>H: Present complete administrative packet

Runtime flow

1. 1

   Register referral

   Validate referring organization, patient identifiers, requested specialty, and assigned coordinator before creating a durable referral case.

2. 2

   Resolve identity

   Check the patient index deterministically; route ambiguous matches to trained staff without gathering candidate charts into a model prompt.

3. 3

   Retrieve permitted evidence

   Fetch only documents relevant to the referral purpose and capture record versions, provenance, and access decisions.

4. 4

   Check packet requirements

   Apply the approved administrative checklist; distinguish missing, unavailable, and explicitly documented information in the draft.

5. 5

   Prepare coordinator choices

   Present outstanding requests and appointment options while displaying clinician-supplied urgency and any unresolved identity issue.

6. 6

   Commit approved scheduling

   Recheck consent and slot availability, execute an approved booking once, then record the receipt and pending follow-up responsibilities.

Failure recovery

Security & decision boundaries

• Apply patient, organization, and purpose-of-use authorization before every document retrieval.
• Keep clinical urgency and treatment decisions under qualified clinician control.
• Show missing data as missing; never generate normal findings from absence.
• Exclude clinical document text from general application logs and tracing attributes.
• Bind scheduling approval to patient, specialty, slot, and current permission context.

Operational metrics

Measurement definitions, not promised improvements.

Packet completeness

Referrals meeting the approved administrative checklist divided by referrals submitted for coordinator review.

Identity escalation rate

Referrals requiring manual identity resolution divided by received referrals, monitored by source organization.

Coordination lead time

Elapsed time from referral receipt to a coordinator-approved next step, with patient waiting time reported separately.

Booking reconciliation rate

Booking attempts with uncertain or conflicting receipts divided by approved booking attempts.

Architecture tradeoffs

Rollout plan

Synthetic referral evaluation

Staff verify identity ambiguity, missing-document labeling, and forbidden clinical advice cases without patient data.

Read-only coordinator pilot

Approved users inspect live packets after access, provenance, and audit checks pass.

Bounded booking assistance

One specialty enables coordinator-approved booking after consent changes and slot-race recovery are demonstrated.

Connected concepts

• 21 — Authorization-Aware RAG
• 23 — Attribute-Based Access Control (ABAC)
• 25 — Data PII Masking
• 28 — Deterministic Data Grounding
• 38 — Data Lineage Tracking
• 41 — Idempotent Tool Execution
• 44 — Human-in-the-Loop (HITL)

Primary references

• HL7 FHIR R5: Security and privacy considerations
• NIST SP 800-207: Zero Trust Architecture
• Temporal: Workflow execution