1. Use Case 1 (Physician Initiated Consultation) Referring Requester Patient Referring Physician Special Handling Specific Discipline Scheduled Workflows Dispatch XD* Consulting Physician Document Source Document Consumer Specific Discipline Scheduled Workflow Transaction Select Consultant Existing XD* Transactions Must take place before Consultation transaction Existing XD* Transactions Consultation Transaction (new) Organizational Boundary (XD* location is not significant) 1 4 3 2

2. Use Case 2 (Patient Initiated Consultation) Referring Requester Referring Physician Patient Special Handling Specific Discipline Scheduled Workflows Dispatch XD* Consulting Physician Document Source Document Consumer Specific Discipline Scheduled Workflow Transaction Select Consultant Existing XD* Transactions Must take place before Consultation transaction. (Media transaction can be simultaneous) Existing XD* Transactions Consultation Transaction (option B) Organizational Boundary (XD* location is not significant) Consultation Transaction (option A) Token Delivery (option B) Token Acceptance (option B) 1 3 4 5 2

3. Use Case 3 (Physician Initiated Transfer) Referring Requester Patient Referring Physician Special Handling Specific Discipline Scheduled Workflows Dispatch XD* Consulting Physician Document Source Document Consumer Specific Discipline Scheduled Workflow Transaction Select Consultant Existing XD* Transactions Existing XD* Transactions Transfer Transaction (new) Organizational Boundary (XD* location is not significant) Existing XD* Transactions Must take place before Consultation transaction 4 3 2 1 Transfer transaction includes acknowledgement of Responsibility by the Consulting Physician.

4. Use Case 4 (Patient Initiated Transfer) Referring Requester Referring Physician Patient Special Handling Specific Discipline Scheduled Workflows Dispatch XD* Consulting Physician Document Source Document Consumer Specific Discipline Scheduled Workflow Transaction Select Consultant Existing XD* Transactions Existing XD* Transactions Transfer Transaction (option B) Organizational Boundary (XD* location is not significant) Transfer Transaction (option A) Token Delivery (option B) Token Acceptance (option B) Existing XD* Transactions Must take place before Consultation transaction. (Media transaction can be simultaneous) 1 5 4 3 2

5. XD* Document List Must comply with an IHE Discipline list of required objects. These will include CDA documents (e.g., PCC Referral documents), and may include other documents (e.g., DICOM SOP Instances). The ITI will depend on disciplines to specify their minimum list. A documents like those defined in PCC are the expected minimum list, but this might also be used in areas that need different documents. Consultation and Transfer Transactions will convey a list of referenced documents (UUIDS, OIDS) so that dispatcher can use XD* to obtain documents XD* is used throughout to remind us that this should work with media, not just with healthcare networks. The Transfer and Consultation transactions will not be documents. There are likely to be documents created that record the performance of these transactions.