type: resource-definitionsresource: CareTeam

CareTeam Definitions

CareTeam

Planned participants in the coordination and delivery of care

Definition: The Care Team includes all the people, organizations, and care teams who participate or plan to participate in the coordination and delivery of care.

Cardinality: 0..*

Mappings: rim=Role; interface=Participant; w5=clinical.careprovision

CareTeam.identifier

External Ids for this team

Definition: Business identifiers assigned to this care team by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

Comments: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

Requirements: Allows identification of the care team as it is known by various participating systems and in a way that remains consistent across servers.

Cardinality: 0..*

Type: Identifier

Summary: true

Mappings: w5=FiveWs.identifier; interface=Participant.identifier

CareTeam.status

proposed | active | suspended | inactive | entered-in-error

Definition: Indicates the current state of the care team.

Comments: This element is labeled as a modifier because the status contains the code entered-in-error that marks the care team as not currently valid.

Cardinality: 0..1

Type: code

Binding: required:care-team-status

Summary: true

Is Modifier: true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)

Mappings: w5=FiveWs.status; interface=Participant.active {map: active = true; :default = false}

CareTeam.category

Type of team

Definition: Identifies what kind of team. This is to support differentiation between multiple co-existing teams, such as care plan team, episode of care team, longitudinal care team.

Comments: There may be multiple axis of categorization and one team may serve multiple purposes.

Requirements: Used for filtering what teams(s) are retrieved and displayed to different types of users.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:care-team-category

Summary: true

Mappings: w5=FiveWs.class

CareTeam.name

Name of the team, such as crisis assessment team

Definition: A label for human use intended to distinguish like teams. E.g. the "red" vs. "green" trauma teams.

Comments: The meaning/purpose of the team is conveyed in CareTeam.category. This element may also convey semantics of the team (e.g. "Red trauma team"), but its primary purpose is to distinguish between identical teams in a human-friendly way. ("Team 18735" isn't as friendly.).

Cardinality: 0..1

Type: string

Summary: true

Mappings: interface=Participant.name

CareTeam.subject

Who care team is for

Definition: Identifies the patient or group whose intended care is handled by the team.

Comments: Use Group for care provision to all members of the group (e.g. group therapy). Use Patient for care provision to an individual patient.

Requirements: Allows the team to care for a group (e.g. marriage) therapy. Allows for an organization to designate a team such as the PICC line team.

Aliases: patient

Cardinality: 0..1

Type: Reference(Patient, Group)

Summary: true

Mappings: w5=FiveWs.subject

CareTeam.period

Time period team covers

Definition: Indicates when the team did (or is intended to) come into effect and end.

Requirements: Allows tracking what team(s) are in effect at a particular time.

Cardinality: 0..1

Type: Period

Summary: true

Mappings: w5=FiveWs.init

CareTeam.participant

Members of the team

Definition: Identifies all people and organizations who are expected to be involved in the care team.

Cardinality: 0..*

Type: BackboneElement

Constraints: ctm-2 | warning | CareTeam.participant.role or CareTeam.participant.member exists | role.exists() or member.exists()

Mappings: v2=REL (REL.4 is always the Patient) ( or PRT?); rim=.participation[typeCode=PRF]

CareTeam.participant.role

Type of involvement

Definition: Indicates specific responsibility of an individual within the care team, such as "Primary care physician", "Trained social worker counselor", "Caregiver", etc.

Comments: Roles may sometimes be inferred by type of Practitioner. These are relationships that hold only within the context of the care team. General relationships should be handled as properties of the Patient resource directly. If a participant has multiple roles within the team, then there should be multiple participants.

Conditions: ctm-2

Cardinality: 0..1

Type: CodeableConcept

Binding: example:participant-role

Summary: true

Mappings: v2=REL.2 (or PRT-4?); rim=.functionCode

CareTeam.participant.member

Who is involved

Definition: The specific person or organization who is participating/expected to participate in the care team.

Comments: Patient only needs to be listed if they have a role other than "subject of care".

Member is optional because some participants may be known only by their role, particularly in draft plans. Using Group is only allowed when the group represents a family or a household and should not represent groups of Practitioners.

Conditions: ctm-2

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, RelatedPerson, Patient, Organization, CareTeam, Group, HealthcareService)

Summary: true

Mappings: w5=FiveWs.actor; v2=REL.5 (or PRT-5 : ( PRV-4 {provider participations} ) / PRT-5 : ( PRV-4 {non-provider person participations} ) / PRT-5 : ( PRV-4 = (patient non-subject of care) ) / PRT-8?); rim=.role

CareTeam.participant.onBehalfOf

Entity that the participant is acting as a proxy of, or an agent of, or in the interest of, or as a representative of

Definition: Entity that the participant is acting as a proxy of, or an agent of, or in the interest of, or as a representative of.

Comments: Using Group is only allowed when the group represents a family or a household and should not represent groups of Practitioners.

Requirements: Allows specifying which organization a practitioner is acting on behalf of in context of this care team when practitioners are associated with multiple organizations.

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, RelatedPerson, Patient, Organization, CareTeam, Group, HealthcareService)

Summary: true

CareTeam.participant.effective[x]

When the member is generally available within this care team

Definition: When the member is generally available within this care team.

Comments: This is populated while creating / managing the CareTeam to ensure there is coverage when servicing CarePlan activities from the Schedule.

Requirements: To manage members who share the same role, but with different timing. For example, two physical therapists where one is available Monday through Friday whereas the other is available on the weekend.

Cardinality: 0..1

Type: Period, Timing

CareTeam.participant.supportingInfo

Basis for the member's participation

Definition: The basis for the member's role participation in care team. For example, supporting documentation that establishes legal power of attorney or court ordered guardianship.

Comments: Enables care providers a more efficient path to review the participation, if necessary.

Cardinality: 0..*

Type: Reference(Resource)

Summary: true

CareTeam.reason

Why the care team exists

Definition: Describes why the care team exists.

Cardinality: 0..*

Type: CodeableReference

Binding: example:clinical-findings

Mappings: w5=FiveWs.why[x]

CareTeam.managingOrganization

Organization responsible for the care team

Definition: The organization responsible for the care team.

Requirements: Allows for multiple organizations to collaboratively manage cross-organizational, longitudinal care plan.

Cardinality: 0..*

Type: Reference(Organization)

Summary: true

CareTeam.telecom

A contact detail for the care team (that applies to all members)

Definition: A central contact detail for the care team (that applies to all members).

Comments: The ContactPoint.use code of home is not appropriate to use. These contacts are not the contact details of individual care team members.

Cardinality: 0..*

Type: ContactPoint

CareTeam.note

Comments made about the CareTeam

Definition: Comments made about the CareTeam.

Cardinality: 0..*

Type: Annotation