type: resource-definitionsresource: Encounter

Encounter Definitions

Encounter

An interaction during which services are provided to the patient

Definition: An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient. Encounter is primarily used to record information about the actual activities that occurred, where Appointment is used to record planned activities.

Aliases: Visit

Cardinality: 0..*

Mappings: workflow=Event; rim=PatientEncounter[@moodCode='EVN']; w5=workflow.encounter

Encounter.identifier

Identifier(s) by which this encounter is known

Definition: Identifier(s) by which this encounter is known.

Cardinality: 0..*

Type: Identifier

Summary: true

Mappings: workflow=Event.identifier; w5=FiveWs.identifier; v2=PV1-19; rim=.id

Encounter.status

Definition: The current state of the encounter (not the state of the patient within the encounter - that is subjectState).

Comments: Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).

Cardinality: 1..1

Type: code

Binding: required:encounter-status

Summary: true

Is Modifier: true (Reason: This element is labeled 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: workflow=Event.status; w5=FiveWs.status; v2=No clear equivalent in HL7 V2; active/finished could be inferred from PV1-44, PV1-45, PV2-24; inactive could be inferred from PV2-16; rim=.statusCode

Encounter.businessStatus

A granular, workflows specific set of statuses that apply to the encounter

Definition: A granular, workflows specific set of statuses that apply to the encounter.

Comments: Note that Encounters have complex lifecycles, and may have multiple concurrent business statuses that are differentiated based on type. This property should only be used for current business statuses. Historical businessStatuses should be captured in EncounterHistory to avoid the Encounter resource becoming so large as to be difficult to process.

Cardinality: 0..*

Type: BackboneElement

Encounter.businessStatus.code

The current business status

Definition: The current business status.

Cardinality: 1..1

Type: CodeableConcept

Binding: example

Encounter.businessStatus.type

The kind of workflow the status is tracking

Definition: The kind of workflow the status is tracking.

Comments: For example, if an Encounter started as an emergency visit, but was upgraded to an inpatient admission, the Encounter may have two businessStatus codes, one with a type of "emergency", and one with a type of "inpatient".

Cardinality: 0..1

Type: Coding

Binding: example:encounter-businessstatus-type

Encounter.businessStatus.effectiveDate

When the encounter entered this business status

Definition: The date/time when the encounter entered this business status.

Cardinality: 0..1

Type: dateTime

Encounter.class

Classification of patient encounter context - e.g. Inpatient, outpatient

Definition: Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:encounter-class

Summary: true

Mappings: w5=FiveWs.class; v2=PV1-2; rim=.inboundRelationship[typeCode=SUBJ].source[classCode=LIST].code

Encounter.priority

Indicates the urgency of the encounter

Definition: Indicates the urgency of the encounter.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:v3-ActPriority

Mappings: w5=FiveWs.grade; v2=PV2-25; rim=.priorityCode

Encounter.type

Specific type of encounter (e.g. e-mail consultation, surgical day-care, ...)

Definition: Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).

Comments: Since there are many ways to further classify encounters, this element is 0..*.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:encounter-type

Summary: true

Mappings: workflow=Event.code; w5=FiveWs.what[x]; v2=PV1-4 / PV1-18; rim=.code

Encounter.serviceType

Specific type of service

Definition: Broad categorization of the service that is to be provided (e.g. cardiology).

Cardinality: 0..*

Type: CodeableReference

Binding: example:service-type

Summary: true

Mappings: workflow=Event.code; v2=PV1-10; rim=n/a

Encounter.subject

The patient or group related to this encounter

Definition: The patient or group related to this encounter. In some use-cases the patient MAY not be present, such as a case meeting about a patient between several practitioners or a careteam.

Comments: While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).

Aliases: patient

Cardinality: 0..1

Type: Reference(Patient, Group)

Summary: true

Mappings: workflow=Event.subject; w5=FiveWs.subject; v2=PID-3; rim=.participation[typeCode=SBJ]/role[classCode=PAT]

Encounter.subjectStatus

The current status of the subject in relation to the Encounter

Definition: The subjectStatus value can be used to track the patient's status within the encounter. It details whether the patient has arrived or departed, has been triaged or is currently in a waiting status.

Comments: Different use-cases are likely to have different permitted transitions between states, such as an Emergency department could use arrived when the patient first presents, then triaged once has been assessed by a nurse, then receiving-care once treatment begins, however other sectors may use a different set of these values, or their own custom set in place of this example valueset provided.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:encounter-subject-status

Encounter.episodeOfCare

Episode(s) of care that this encounter should be recorded against

Definition: Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).

Cardinality: 0..*

Type: Reference(EpisodeOfCare)

Summary: true

Mappings: w5=FiveWs.context; v2=PV1-54, PV1-53; rim=n/a

Encounter.basedOn

The request that initiated this encounter

Definition: The request this encounter satisfies (e.g. incoming referral or procedure request).

Aliases: incomingReferral

Cardinality: 0..*

Type: Reference(CarePlan, DeviceRequest, MedicationRequest, ServiceRequest, RequestOrchestration, NutritionOrder, VisionPrescription)

Mappings: workflow=Event.basedOn; rim=.reason.ClinicalDocument

Encounter.careTeam

The group(s) that are allocated to participate in this encounter

Definition: The group(s) of individuals, organizations that are allocated to participate in this encounter. The participants backbone will record the actuals of when these individuals participated during the encounter.

Cardinality: 0..*

Type: Reference(CareTeam)

Mappings: rim=n/a

Encounter.partOf

Another Encounter this encounter is part of

Definition: Another Encounter of which this encounter is a part of (administratively or in time).

Comments: This is also used for associating a child's encounter back to the mother's encounter.

Refer to the Notes section in the Patient resource for further details.

Cardinality: 0..1

Type: Reference(Encounter)

Mappings: workflow=Event.partOf; rim=.inboundRelationship[typeCode=COMP].source[classCode=COMP, moodCode=EVN]

Encounter.serviceProvider

The organization (facility) responsible for this encounter

Definition: The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the colonoscopy example on the Encounter examples tab.

Cardinality: 0..1

Type: Reference(Organization)

Mappings: workflow=Event.performer.actor; v2=PL.6 & PL.1; rim=.participation[typeCode=PRF].role

Encounter.participant

List of participants involved in the encounter

Definition: The list of people responsible for providing the service.

Comments: Any Patient or Group present in the participation.actor must also be the subject, though the subject may be absent from the participation.actor for cases where the patient (or group) is not present, such as during a case review conference.

Cardinality: 0..*

Type: BackboneElement

Summary: true

Mappings: workflow=Event.performer; v2=ROL; rim=.participation[typeCode=PRF]

Encounter.participant.type

Role of participant in encounter

Definition: Role of participant in encounter.

Comments: The participant type indicates how an individual actor participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.

Conditions: enc-1, enc-2

Cardinality: 0..*

Type: CodeableConcept

Binding: extensible:encounter-participant-type

Summary: true

Mappings: workflow=Event.performer.function; v2=ROL-3 (or maybe PRT-4); rim=.functionCode

Encounter.participant.period

Period of time during the encounter that the participant participated

Definition: The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.

Cardinality: 0..1

Type: Period

Mappings: v2=ROL-5, ROL-6 (or maybe PRT-5); rim=.time

Encounter.participant.actor

The individual, device, or service participating in the encounter

Definition: Person involved in the encounter, the patient/group is also included here to indicate that the patient was actually participating in the encounter. Not including the patient here covers use cases such as a case meeting between practitioners about a patient - non contact times.

Comments: For planning purposes, Appointments may include a CareTeam participant to indicate that one specific person from the CareTeam will be assigned, but that assignment might not happen until the Encounter begins. Hence CareTeam is not included in Encounter.participant, as the specific individual should be assigned and represented as a Practitioner or other person resource.

Similarly, Location can be included in Appointment.participant to assist with planning. However, the patient location is tracked on the Encounter in the Encounter.location property to allow for additional metadata and history to be recorded.

The role of the participant can be used to declare what the actor will be doing in the scope of this encounter participation.

If the individual is not specified during planning, then it is expected that the individual will be filled in at a later stage prior to the encounter commencing.

Conditions: enc-1, enc-2

Cardinality: 0..1

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

Summary: true

Mappings: workflow=Event.performer.actor; w5=FiveWs.who; v2=ROL-4; rim=.role

Encounter.appointment

The appointment that scheduled this encounter

Definition: The appointment that scheduled this encounter.

Cardinality: 0..*

Type: Reference(Appointment)

Summary: true

Mappings: workflow=Event.basedOn; v2=SCH-1 / SCH-2; rim=.outboundRelationship[typeCode=FLFS].target[classCode=ENC, moodCode=APT]

Encounter.virtualService

Connection details of a virtual service (e.g. conference call)

Comments: There are two types of virtual meetings that often exist:

a persistent, virtual meeting room that can only be used for a single purpose at a time,
and a dynamic virtual meeting room that is generated on demand for a specific purpose.

Implementers may consider using Location.virtualService for persistent meeting rooms.

If each participant would have a different meeting link, an extension using the VirtualServiceContactDetail can be applied to the Encounter.participant BackboneElement.

Cardinality: 0..*

Type: VirtualServiceDetail

Mappings: rim=N/A

Encounter.actualPeriod

The actual start and end time of the encounter

Definition: The actual start and end time of the encounter.

Comments: If not (yet) known, the end of the Period may be omitted.

Cardinality: 0..1

Type: Period

Mappings: workflow=Event.occurrence[x]; w5=FiveWs.done[x]; v2=PV1-44, PV1-45; rim=.effectiveTime (low & high)

Encounter.plannedStartDate

The planned start date/time (or admission date) of the encounter

Definition: The planned start date/time (or admission date) of the encounter.

Cardinality: 0..1

Type: dateTime

Mappings: v2=PV2-8

Encounter.plannedEndDate

The planned end date/time (or discharge date) of the encounter

Definition: The planned end date/time (or discharge date) of the encounter.

Cardinality: 0..1

Type: dateTime

Mappings: v2=PV2-9

Encounter.length

Actual quantity of time the encounter lasted (less time absent)

Definition: Actual quantity of time the encounter lasted. This excludes the time during leaves of absence.

When missing it is the time in between the start and end values.

Comments: If the precision on these values is low (e.g. to the day only) then this may be considered was an all day (or multi-day) encounter, unless the duration is included, where that amount of time occurred sometime during the interval.

May differ from the time in Encounter.period due to leave of absence(s).

Cardinality: 0..1

Type: Duration

Mappings: workflow=Event.occurrence[x]; v2=(PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes or PV2-11 (which is actual length in days); rim=.lengthOfStayQuantity

Encounter.reason

The list of medical reasons that are expected to be addressed during the episode of care

Definition: The list of medical reasons that are expected to be addressed during the episode of care.

Comments: The reason communicates what medical problem the patient has that should be addressed during the episode of care. This reason could be patient reported complaint, a clinical indication that was determined in a previous encounter or episode of care, or some planned care such as an immunization recommendation. In the case where you have a primary reason, but are expecting to also address other problems, you can list the primary reason with a use code of 'Chief Complaint', while the other problems being addressed would have a use code of 'Reason for Visit'.

Examples:

pregnancy would use HealthcareService or a coding as the reason
patient home monitoring could use Condition as the reason

Cardinality: 0..*

Type: BackboneElement

Summary: true

Encounter.reason.use

What the reason value should be used for/as

Definition: What the reason value should be used as e.g. Chief Complaint, Health Concern, Health Maintenance (including screening).

Cardinality: 0..*

Type: CodeableConcept

Binding: example:encounter-reason-use

Summary: true

Encounter.reason.value

Reason the encounter takes place (core or reference)

Definition: Reason the encounter takes place, expressed as a code or a reference to another resource. For admissions, this can be used for a coded admission diagnosis.

Aliases: Indication, Admission diagnosis

Cardinality: 0..*

Type: CodeableReference

Binding: preferred:encounter-reason

Summary: true

Mappings: workflow=Event.reason; w5=FiveWs.why[x]; v2=EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 V2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations ); rim=.reasonCode

Encounter.diagnosis

The list of diagnosis relevant to this encounter

Definition: The list of diagnosis relevant to this encounter.

Comments: Also note that for the purpose of billing, the diagnoses are recorded in the account where they can be ranked appropriately for how the invoicing/claiming documentation needs to be prepared.

Cardinality: 0..*

Type: BackboneElement

Summary: true

Mappings: rim=.outboundRelationship[typeCode=RSON]

Encounter.diagnosis.condition

The diagnosis relevant to the encounter

Definition: The coded diagnosis or a reference to a Condition (with other resources referenced in the evidence.detail), the use property will indicate the purpose of this specific diagnosis.

Aliases: Admission diagnosis, discharge diagnosis, indication

Cardinality: 0..*

Type: CodeableReference

Binding: example:condition-code

Summary: true

Mappings: workflow=Event.reason; w5=FiveWs.why[x]; v2=Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively.; rim=.outboundRelationship[typeCode=RSON].target

Encounter.diagnosis.use

Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)

Definition: Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:encounter-diagnosis-use

Mappings: v2=DG1-6 (Diagnosis Type); rim=n/a

Encounter.account

The set of accounts that may be used for billing for this Encounter

Definition: The set of accounts that may be used for billing for this Encounter.

Comments: The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.

Also note that the Encounter.account properties are meant to represent long-running or perpetual accounts. For short-lived, episodic accounts, see Account.covers.

Cardinality: 0..*

Type: Reference(Account)

Mappings: rim=.pertains.A_Account

Encounter.dietPreference

Diet preferences reported by the patient

Definition: Diet preferences reported by the patient.

Comments: For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).

Requirements: Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:encounter-diet

Mappings: v2=PV1-38; rim=.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=EVN, code="diet"]

Encounter.specialArrangement

Wheelchair, translator, stretcher, etc

Definition: Any special requests that have been made for this encounter, such as the provision of specific equipment or other things.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:encounter-special-arrangements

Mappings: v2=PV1-15 / OBR-30 / OBR-43; rim=.specialArrangementCode

Encounter.specialCourtesy

Special courtesies (VIP, board member)

Definition: Special courtesies that may be provided to the patient during the encounter (VIP, board member, professional courtesy).

Comments: Although the specialCourtesy property can contain values like VIP, the purpose of this field is intended to be used for flagging additional benefits that might occur for the patient during the encounter.

It could include things like the patient is to have a private room, special room features, receive a friendly visit from hospital adminisitration, or should be briefed on treatment by senior staff during the stay.

It is not specifically intended to be used for securing the specific record - that is the purpose of the security meta tag, and where appropriate, both fields could be used.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:encounter-special-courtesy

Mappings: v2=PV1-16; rim=.specialCourtesiesCode

Encounter.admission

Details about the admission to a healthcare service

Definition: Details about the stay during which a healthcare service is provided.

This does not describe the event of admitting the patient, but rather any information that is relevant from the time of admittance until the time of discharge.

Comments: An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included.

The duration recorded in the period of this encounter covers the entire scope of this admission record.

Cardinality: 0..1

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP].target[classCode=ENC, moodCode=EVN]

Encounter.admission.preAdmissionIdentifier

Pre-admission identifier

Definition: Pre-admission identifier.

Cardinality: 0..1

Type: Identifier

Mappings: v2=PV1-5; rim=.id

Encounter.admission.origin

The location/organization from which the patient came before admission

Definition: The location/organization from which the patient came before admission.

Cardinality: 0..1

Type: Reference(Location, Organization)

Mappings: rim=.participation[typeCode=ORG].role

Encounter.admission.admitSource

From where patient was admitted (physician referral, transfer)

Definition: From where patient was admitted (physician referral, transfer).

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:encounter-admit-source

Mappings: v2=PV1-14; rim=.admissionReferralSourceCode

Encounter.admission.reAdmission

Indicates that the patient is being re-admitted

Definition: Indicates that this encounter is directly related to a prior admission, often because the conditions addressed in the prior admission were not fully addressed.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:v2-0092

Mappings: v2=PV1-13; rim=n/a

Encounter.admission.destination

Location/organization to which the patient is discharged

Definition: Location/organization to which the patient is discharged.

Cardinality: 0..1

Type: Reference(Location, Organization)

Mappings: v2=PV1-37; rim=.participation[typeCode=DST]

Encounter.admission.dischargeDisposition

Category or kind of location after discharge

Definition: Category or kind of location after discharge.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:encounter-discharge-disposition

Mappings: v2=PV1-36; rim=.dischargeDispositionCode

Encounter.location

List of locations where the patient has been

Definition: List of locations where the patient has been during this encounter.

Comments: Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.participation[typeCode=LOC]

Encounter.location.location

Location the encounter takes place

Definition: The location where the encounter takes place.

Cardinality: 1..1

Type: Reference(Location)

Mappings: workflow=Event.location; w5=FiveWs.where[x]; v2=PV1-3 / PV1-6 / PV1-11 / PV1-42 / PV1-43; rim=.role

Encounter.location.status

planned | active | reserved | completed

Definition: The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.

Comments: When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.

Cardinality: 0..1

Type: code

Binding: required:encounter-location-status

Mappings: rim=.role.statusCode

Encounter.location.form

The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.)

Definition: This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.

Comments: This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query.

There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:location-form

Encounter.location.period

Time period during which the patient was present at the location

Definition: Time period during which the patient was present at the location.

Cardinality: 0..1

Type: Period

Mappings: rim=.time