| Course | NR 515 Informatics in Healthcare |
|---|---|
| Week | 6 |
| Paper type | Referral route map with commentary |
| Length | About 1,120 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Nursing Informatics |
| Updated | September 2026 |
Free sample paper for NR 515 Week 6
Referral Route Map With Commentary: One Cardiology Referral Across Four Parties, Nine Legs and Six Waiting States, and the Two Legs Nobody Owns
Student Name
College of Nursing, Chamberlain University
NR 515: Informatics in Healthcare
Instructor Name
Month Day, Year
Referral Route Map With Commentary: One Cardiology Referral Across Four Parties, Nine Legs and Six Waiting States, and the Two Legs Nobody Owns
How to Read the Map
The map follows one routine cardiology referral from our family practice for a patient with exertional palpitations. The boxes are parties, not software: the referring practice, the patient's insurer, the cardiology group's office and the patient. Each arrow is a leg, labeled with who carries it, the form it travels in and what triggers it. Waiting states, where the referral sits until a person picks it up, are drawn as separate rounded shapes, because most of a referral's life is spent waiting rather than moving. Leg durations are the medians from the three referrals walked for the Week 2 inventory, rounded, and they are illustrative rather than measured across the practice. A practice-wide measure would need a year of referral data, which the practice does not yet collect in one place; producing that data is one of the purposes of the changes this map recommends.
For this submission, the drawn map appears below as Table 1, with the legs listed in the order a referral travels.
Table 1
The Referral Route, Leg by Leg
| Leg | From, to | Carried by | Form | Waiting state after the leg | Typical wait |
|---|---|---|---|---|---|
| 1 | Physician to referral coordinator | Physician | EHR referral order | Coordinator's task queue | 1 day |
| 2 | Practice to insurer | Referral coordinator | Prior authorization portal | Authorization pending | 4 days |
| 3 | Insurer to practice | Insurer | Portal status change (no notice sent) | Unseen until the coordinator checks | 2 days |
| 4 | Practice to cardiology office | Referral coordinator | Fax packet: order, notes, authorization | Cardiology intake queue | 3 days |
| 5 | Cardiology office to patient | Cardiology scheduler | Phone call or voicemail | Waiting for the patient to call back | 5 days |
| 6 | Patient to cardiology office | Patient | Phone call to schedule, then the visit | Waiting for the appointment date | 35 days |
| 7 | Cardiology office to practice | Cardiologist and transcription | Faxed consultation note | Waiting for dictation and signature | 6 days |
| 8 | E-fax inbox to chart | Referral coordinator | Manual indexing of an image | Unindexed fax queue | 2 days |
| 9 | Chart to physician | EHR | Task in the physician's inbox | Unread in the inbox | 1 day |
Note. Durations are rounded medians from three referrals and are shown to illustrate the pattern, not as practice-wide measures.
Commentary on the Legs
Legs 1, 2 and 4 are owned. The referral coordinator carries them, and her work is visible in the spreadsheet described in the Week 2 inventory. These legs are slow but predictable.
Leg 3 is a silent return. The insurer changes a status in its portal but sends no notice. The referral waits until the coordinator happens to check, which she does every other day. Nothing is broken; the design simply relies on polling.
Leg 5 has no owner on our side. Once the packet reaches the cardiology office, our practice has no view of it. The cardiology scheduler calls the patient, often reaches voicemail, and waits. If the patient does not call back, the referral waits indefinitely, and nobody at our practice knows.
Leg 6 is carried by the patient. This is the leg that maps usually leave out. The patient must return the call, choose a date, arrange transportation and time off work, and attend. For a patient who works shifts or lives far from the specialist, this is where the referral most often stops. Patel et al. (2018) reported that 38.9% of the attempts to schedule a referral they studied never recorded an appointment date, and that wait times and distance separated completed from incomplete referrals.
Leg 7 has no owner at all. Returning the consultation note is the cardiology office's job, but no agreement says when, and our practice has no way to ask for a note it does not know is overdue. Mehrotra et al. (2011) reported that referring physicians are frequently left uncertain whether the specialist visit happened and what advice came out of it; in our practice, leg 7 is the place where that uncertainty is created.
Legs 8 and 9 are owned but manual. The note arrives as a fax image and waits to be indexed, then waits in the physician's inbox. Both are within our control.
Why Parties, Not Systems
A map drawn with software as boxes would show the EHR, the portal and the fax server, and it would make the process look like a technology problem. Drawing parties instead puts the responsibility where it sits. Sittig and Singh (2010) argue that health information technology has to be studied together with the people, workflow, organizational policies and external rules around it, and a referral route is a clear case: every leg runs on software, but every waiting state ends only when a person decides to act. The two unowned legs in this map are not caused by any system. They exist because no agreement between the parties says who acts, and by when. That is a finding a systems map could not have produced.
What the Map Shows
Of roughly 59 days from order to a physician reading the consultation note, about 50 are spent in waiting states, and only a few minutes are spent actually moving information. The longest wait, the appointment date, is outside anyone's control at our practice. The most dangerous waits are legs 5 and 7, because they are invisible: a referral stalled at leg 5 looks exactly like one progressing normally until someone asks.
Two changes follow from the map. First, the coordinator should give each referral a check date after leg 4, perhaps ten days, at which she calls the cardiology office to confirm an appointment has been made; this gives leg 5 an owner. Second, the practice should ask the cardiology group to agree to return consultation notes within a set number of days, and should flag any referral whose appointment date has passed without a note; this gives leg 7 an owner. Neither needs new software. The integration proposal in Week 7 considers whether a direct electronic link could shorten legs 4, 7 and 8 as well.
The map also suggests what not to do. Adding a second portal, a reminder service or another spreadsheet would give each waiting state one more place to sit without giving it an owner. Every change the map supports is about responsibility first; any software added later should serve a leg that already has someone answering for it.
References
Mehrotra, A., Forrest, C. B., & Lin, C. Y. (2011). Dropping the baton: Specialty referrals in the United States. The Milbank Quarterly, 89(1), 39-68. https://doi.org/10.1111/j.1468-0009.2011.00619.x
Patel, M. P., Schettini, P., O'Leary, C. P., Bosworth, H. B., Anderson, J. B., & Shah, K. P. (2018). Closing the referral loop: An analysis of primary care referrals to specialists in a large health system. Journal of General Internal Medicine, 33(5), 715-721. https://doi.org/10.1007/s11606-018-4392-z
Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl. 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085
Reading the NR 515 Week 6 instructions
The Week 6 assignment asks you to map how information or a process moves between organizations, often a referral, transfer or discharge. Prompts usually ask for a diagram and a written explanation of the steps, the parties, the technologies used and the points where delays or errors occur. The map should be readable and show who carries each step. Include waiting states, since most of a referral's time is spent waiting. If you use durations, say where they come from. Many sections ask for recommendations based on the map. Check your section's rules on diagram software, file format and the length of the written commentary.
How the NR 515 Week 6 example is put together
The example explains its conventions first: parties as boxes, legs as labeled arrows and waiting states as separate shapes, with durations from three walked referrals. Table 1 reproduces the map as nine legs. The commentary is numbered to the legs and concentrates on the difficult ones: a silent insurer return, a scheduling call the practice cannot see, the patient's own leg, and the consultation note with no owner. Two referral studies support the analysis. A section explains why parties rather than systems were drawn, using a sociotechnical model. The paper ends by counting waiting time and recommending a check date and a return agreement.
Reading the NR 515 Week 6 grading rubric
The rubric for the route map typically rewards an accurate and readable map, a thorough written analysis, and recommendations tied to the findings. Graders look for all parties, including the patient where the patient carries a step. The analysis criterion rewards identifying waiting states and unowned steps rather than only describing the flow. Recommendations should address the problems the map reveals. Scholarly sources support claims about referral processes. Presentation points cover the diagram's clarity and a commentary that does not simply repeat the diagram in sentences. APA 7 format for the table, figure and references completes the rubric in most sections. A map that locates the longest and the least visible waits, and says which is more dangerous, earns the analysis points most drafts miss.
NR 515 Week 6 help from the desk
The largest loss comes from mapping systems instead of parties, which hides who is responsible for each step. Another is leaving the patient off the map, even though the patient often carries the leg where referrals stop. Students also draw arrows only and skip waiting states, missing where the time goes. A map without durations or with invented precision earns less; use real counts where you have them and label estimates. Keep the commentary tied to specific legs. Finally, avoid recommending new software as the first fix. If a leg has no owner, a new tool will not help until someone is named to act on it.
Get a NR 515 Week 6 example written to your instructions
Send the prompt, the rubric and whatever drawing tool your section expects, and a writer produces a custom NR 515 route map with its commentary, returned inside 24-48h with the first free. Name the referral type and the organizations involved and the map will be built around them rather than around a generic case.
More NR 515 papers and MSN samples
- NR 515 Week 1: Discussion Post on Data Custody
- NR 515 Week 2: System Inventory for One Referral
- NR 515 Week 3: Data Exchange Analysis, One Result
- NR 515 Week 4: Interface Failure Brief
- NR 515 Week 5: Standards Comparison, HL7 v2 and FHIR
- NR 515 Week 7: Integration Proposal
- NR 515 Week 8: Informatics Synthesis Paper
- NR 512 Week 6: Standards Appraisal, Oximetry Profile
NR 515 Week 6 questions, answered
What drawing tool do finished maps use?
Whatever the section permits, and the tool matters far less than the labeling. Presentation software, a word processor's shapes, or a free diagramming site all produce acceptable results. What gets marked is whether boxes are parties, whether arrows carry a format and a trigger, and whether waiting appears anywhere. A beautiful diagram with bare arrows scores below a plain one that is fully labeled.
How long should the commentary be?
Long enough to say what the picture cannot: why a leg takes the form it does, who complains when it stalls, and what happens to the referral while it waits. Two or three pages is typical. A commentary that walks through the diagram box by box has doubled the drawing rather than explaining it, and instructors mark that as padding.
Should the map show times?
Yes, as ranges marked clearly as estimates. Saying a prior authorization commonly sits several days is credible and useful, while claiming it takes exactly seventy-two hours invents a statistic. Times are what make the waiting states persuasive, so leaving them out weakens the map, but stating them with false precision costs more than it gains.
Where can I find a free NR 515 Week 6 sample paper?
The cardiology referral map above, with its leg table and commentary, is the full NR 515 Week 6 sample and is open to read. If you need a map of a transfer or discharge instead, the request form gets you one built on that process.
Should the NR 515 route map include the patient?
Yes, whenever the patient carries a step, such as returning a scheduling call or attending the visit. The sample includes the patient as a party because that leg is where many referrals stop and no one else owns it.