type: resource-definitionsresource: EpisodeOfCare

EpisodeOfCare Definitions

EpisodeOfCare

An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility

Definition: An association between a patient and an organization / healthcare provider(s) during which time encounters may occur. The managing organization assumes a level of responsibility for the patient during this time.

Aliases: Case Program Problem

Cardinality: 0..*

Mappings: workflow=Event; rim=n/a; w5=workflow.encounter

EpisodeOfCare.identifier

Business Identifier(s) relevant for this EpisodeOfCare

Definition: The EpisodeOfCare may be known by different identifiers for different contexts of use, such as when an external agency is tracking the Episode for funding purposes.

Cardinality: 0..*

Type: Identifier

Mappings: workflow=Event.identifier; w5=FiveWs.identifier

EpisodeOfCare.status

Comments: This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid.

Cardinality: 1..1

Type: code

Binding: required:episode-of-care-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: workflow=Event.status; w5=FiveWs.status

EpisodeOfCare.statusHistory

Past list of status codes (the current status may be included to cover the start date of the status)

Definition: The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource).

Cardinality: 0..*

Type: BackboneElement

EpisodeOfCare.statusHistory.status

Cardinality: 1..1

Type: code

Binding: required:episode-of-care-status

EpisodeOfCare.statusHistory.period

Duration the EpisodeOfCare was in the specified status

Definition: The period during this EpisodeOfCare that the specific status applied.

Cardinality: 1..1

Type: Period

EpisodeOfCare.type

Type/class - e.g. specialist referral, disease management

Definition: A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care.

Comments: The type can be very important in processing as this could be used in determining if the EpisodeOfCare is relevant to specific government reporting, or other types of classifications.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:episodeofcare-type

Summary: true

Mappings: workflow=Event.code; w5=FiveWs.class

EpisodeOfCare.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

EpisodeOfCare.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

EpisodeOfCare.reason.value

Medical reason to be addressed

Definition: The medical reason that is expected to be addressed during the episode of care, expressed as a text, code or a reference to another resource.

Cardinality: 0..*

Type: CodeableReference

Binding: example:encounter-reason

Summary: true

Mappings: workflow=Event.reason; w5=FiveWs.what[x]

EpisodeOfCare.diagnosis

The list of medical conditions that were addressed during the episode of care

Definition: The list of medical conditions that were addressed during the episode of care.

Comments: The diagnosis communicates what medical conditions were actually addressed during the episode of care. If a diagnosis was provided as a reason, and was treated during the episode of care, it may be listed in both EpisodeOfCare.reason and EpisodeOfCare.diagnosis.

Diagnoses related to billing can be documented on the Account resources which supports ranking for the purpose of reimbursement.

Cardinality: 0..*

Type: BackboneElement

Summary: true

EpisodeOfCare.diagnosis.condition

The medical condition that was addressed during the episode of care

Definition: The medical condition that was addressed during the episode of care, expressed as a text, code or a reference to another resource.

Cardinality: 0..*

Type: CodeableReference

Binding: example:condition-code

Summary: true

Mappings: workflow=Event.reason; w5=FiveWs.what[x]

EpisodeOfCare.diagnosis.use

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

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

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:encounter-diagnosis-use

Summary: true

EpisodeOfCare.subject

The patient/group who is the focus of this episode of care

Definition: The patient/group who is the focus of this episode of care.

Cardinality: 1..1

Type: Reference(Patient, Group)

Summary: true

Mappings: workflow=Event.subject; w5=FiveWs.subject

EpisodeOfCare.managingOrganization

Organization that assumes responsibility for care coordination

Definition: The organization that has assumed the specific responsibilities for care coordination, care delivery, or other services for the specified duration.

Comments: If multiple organizations are involved in care delivery, the care teams from those organizations would be represented in EpisodeOfCare.team, while the primary organization managing the care would be listed in EpisodeOfCare.managingOrganization. Other organizations may have their own EpisodeOfCare for tracking their activities.

Cardinality: 0..1

Type: Reference(Organization)

Summary: true

Mappings: workflow=Event.performer.actor

EpisodeOfCare.period

Interval during responsibility is assumed

Definition: The interval during which the managing organization assumes the defined responsibility.

Cardinality: 0..1

Type: Period

Summary: true

Mappings: workflow=Event.occurrence[x]; w5=FiveWs.init

EpisodeOfCare.referralRequest

Originating Referral Request(s)

Definition: Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals.

Cardinality: 0..*

Type: Reference(ServiceRequest)

Mappings: workflow=Event.basedOn

EpisodeOfCare.careManager

Care manager/care coordinator for the patient

Definition: The practitioner that is the care manager/care coordinator for this patient.

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole)

Mappings: workflow=Event.performer.actor

EpisodeOfCare.careTeam

Other practitioners facilitating this episode of care

Definition: The list of practitioners that may be facilitating this episode of care for specific purposes.

Comments: Multiple care teams may represent different teams that provide care at different times, where those time periods would be distinguished in CareTeam.period. Also, a single episode may have different types of care teams, which would be distinguished in CareTeam.category.

Aliases: CareTeam

Cardinality: 0..*

Type: Reference(CareTeam)

Mappings: workflow=Event.performer.actor

EpisodeOfCare.account

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

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

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

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

Cardinality: 0..*

Type: Reference(Account)