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8.10 Resource EpisodeOfCare - Content

Patient Administration Work GroupMaturity Level: 2 Trial UseCompartments: Patient, Practitioner

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.

The EpisodeOfCare Resource contains information about an association of a Patient with a Healthcare Provider for a period of time under which related healthcare activities may occur.

In many cases, this represents a period of time where the Healthcare Provider has some level of responsibility for the care of the patient regarding a specific condition or problem, even if not currently participating in an encounter.

These resources are typically known in existing systems as:

  • EpisodeOfCare: Case, Program, Problem, Episode
  • Encounter: Visit, Contact

Many organizations can be involved in an EpisodeOfCare, however each organization will have their own EpisodeOfCare which tracks their responsibility with the patient.

When an Organization completes their involvement with the patient and transfers care to another Organization. This is often in the form of a referral to another Organization (or Organizations).

When an incoming referral is received a new EpisodeOfCare may be created for this organization. The initial step(s) in the intake workflow for the referral often involve some form of assessment(s), eligibility, capacity, care levels, which could take some time.
Once the intake process is completed and the patient is accepted, a CarePlan is often created.

The primary difference between the EpisodeOfCare and the Encounter is that the Encounter records the details of an activity directly relating to the patient, while the EpisodeOfCare is the container that can link a series of Encounters together for problems/issues.
The Example scenarios below give some good examples as to when you might want to be using an EpisodeOfCare.

This difference is a similar difference between the EpisodeOfCare and a CarePlan. The EpisodeOfCare is a tracking resource, rather than a planning resource.
The EpisodeOfCare usually exists before the CarePlan. You don't need a CarePlan to use an EpisodeOfCare.

Systems collect a coherent group of activities (such as encounters) related to a patient's health condition or problem often referred to as a Care Episode. Information about an episode is often shared across systems, and in some cases organizational and disciplinary boundaries. An Episode Of Care contains details about the purpose of the care and can exist without any activities.
The minimal information that would be required in an episode of care would be a patient, organization and a reason for the ongoing association. Other reasons for creating an EpisodeOfCare could be for tracking the details required for government reporting or billing.

  • Chronic Disease Management Systems
  • Community Care Systems
    • Tracking progress of a specific condition
    • Tracking government funding
  • Problem based General Practice systems
  • Disability Support Systems
  • Aged Care Systems (Community and Residential)

This resource is referenced by CarePlan, CareTeam, ChargeItem, ClinicalImpression, Communication, CommunicationRequest, Condition, DeviceRequest, DiagnosticReport, Encounter, GuidanceResponse, ImagingStudy, Media, MedicationAdministration, MedicationDispense, MedicationRequest, MedicationStatement, Observation, Procedure, QuestionnaireResponse, RequestGroup, RiskAssessment, ServiceRequest and Task

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare DomainResourceAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier(s) relevant for this EpisodeOfCare
... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
EpisodeOfCareStatus (Required)
... statusHistory 0..*BackboneElementPast list of status codes (the current status may be included to cover the start date of the status)
.... status 1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
EpisodeOfCareStatus (Required)
.... period 1..1PeriodDuration the EpisodeOfCare was in the specified status
... type Σ0..*CodeableConceptType/class - e.g. specialist referral, disease management
EpisodeOfCareType (Example)
... diagnosis Σ0..*BackboneElementThe list of diagnosis relevant to this episode of care
.... condition Σ1..1Reference(Condition)Conditions/problems/diagnoses this episode of care is for
.... role Σ0..1CodeableConceptRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
DiagnosisRole (Preferred)
.... rank Σ0..1positiveIntRanking of the diagnosis (for each role type)
... patient Σ1..1Reference(Patient)The patient who is the focus of this episode of care
... managingOrganization Σ0..1Reference(Organization)Organization that assumes care
... period Σ0..1PeriodInterval during responsibility is assumed
... referralRequest 0..*Reference(ServiceRequest)Originating Referral Request(s)
... careManager 0..1Reference(Practitioner)Care manager/care co-ordinator for the patient
... team 0..*Reference(CareTeam)Other practitioners facilitating this episode of care
... account 0..*Reference(Account)The set of accounts that may be used for billing for this EpisodeOfCare

doco Documentation for this format

UML Diagram (Legend)

EpisodeOfCare (DomainResource)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 purposesidentifier : Identifier [0..*]planned | waitlist | active | onhold | finished | cancelled (this element modifies the meaning of other elements)status : code [1..1] « The status of the episode of care. (Strength=Required)EpisodeOfCareStatus! »A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded caretype : CodeableConcept [0..*] « The type of the episode of care (Strength=Example)EpisodeOfCareType?? »The patient who is the focus of this episode of carepatient : Reference [1..1] « Patient »The organization that has assumed the specific responsibilities for the specified durationmanagingOrganization : Reference [0..1] « Organization »The interval during which the managing organization assumes the defined responsibilityperiod : Period [0..1]Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referralsreferralRequest : Reference [0..*] « ServiceRequest »The practitioner that is the care manager/care co-ordinator for this patientcareManager : Reference [0..1] « Practitioner »The list of practitioners that may be facilitating this episode of care for specific purposesteam : Reference [0..*] « CareTeam »The set of accounts that may be used for billing for this EpisodeOfCareaccount : Reference [0..*] « Account »StatusHistoryplanned | waitlist | active | onhold | finished | cancelledstatus : code [1..1] « The status of the episode of care. (Strength=Required)EpisodeOfCareStatus! »The period during this EpisodeOfCare that the specific status appliedperiod : Period [1..1]DiagnosisA list of conditions/problems/diagnoses that this episode of care is intended to be providing care forcondition : Reference [1..1] « Condition »Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)role : CodeableConcept [0..1] « The type of diagnosis this condition represents (Strength=Preferred)DiagnosisRole? »Ranking of the diagnosis (for each role type)rank : positiveInt [0..1]The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource)statusHistory[0..*]The list of diagnosis relevant to this episode of carediagnosis[0..*]

XML Template

<EpisodeOfCare xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier(s) relevant for this EpisodeOfCare --></identifier>
 <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
 <statusHistory>  <!-- 0..* Past list of status codes (the current status may be included to cover the start date of the status) -->
  <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
  <period><!-- 1..1 Period Duration the EpisodeOfCare was in the specified status --></period>
 </statusHistory>
 <type><!-- 0..* CodeableConcept Type/class  - e.g. specialist referral, disease management --></type>
 <diagnosis>  <!-- 0..* The list of diagnosis relevant to this episode of care -->
  <condition><!-- 1..1 Reference(Condition) Conditions/problems/diagnoses this episode of care is for --></condition>
  <role><!-- 0..1 CodeableConcept Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) --></role>
  <rank value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each role type) -->
 </diagnosis>
 <patient><!-- 1..1 Reference(Patient) The patient who is the focus of this episode of care --></patient>
 <managingOrganization><!-- 0..1 Reference(Organization) Organization that assumes care --></managingOrganization>
 <period><!-- 0..1 Period Interval during responsibility is assumed --></period>
 <referralRequest><!-- 0..* Reference(ServiceRequest) Originating Referral Request(s) --></referralRequest>
 <careManager><!-- 0..1 Reference(Practitioner) Care manager/care co-ordinator for the patient --></careManager>
 <team><!-- 0..* Reference(CareTeam) Other practitioners facilitating this episode of care --></team>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this EpisodeOfCare --></account>
</EpisodeOfCare>

JSON Template

{doco
  "resourceType" : "EpisodeOfCare",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier(s) relevant for this EpisodeOfCare
  "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  "statusHistory" : [{ // Past list of status codes (the current status may be included to cover the start date of the status)
    "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    "period" : { Period } // R!  Duration the EpisodeOfCare was in the specified status
  }],
  "type" : [{ CodeableConcept }], // Type/class  - e.g. specialist referral, disease management
  "diagnosis" : [{ // The list of diagnosis relevant to this episode of care
    "condition" : { Reference(Condition) }, // R!  Conditions/problems/diagnoses this episode of care is for
    "role" : { CodeableConcept }, // Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
    "rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
  }],
  "patient" : { Reference(Patient) }, // R!  The patient who is the focus of this episode of care
  "managingOrganization" : { Reference(Organization) }, // Organization that assumes care
  "period" : { Period }, // Interval during responsibility is assumed
  "referralRequest" : [{ Reference(ServiceRequest) }], // Originating Referral Request(s)
  "careManager" : { Reference(Practitioner) }, // Care manager/care co-ordinator for the patient
  "team" : [{ Reference(CareTeam) }], // Other practitioners facilitating this episode of care
  "account" : [{ Reference(Account) }] // The set of accounts that may be used for billing for this EpisodeOfCare
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:EpisodeOfCare;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:EpisodeOfCare.identifier [ Identifier ], ... ; # 0..* Business Identifier(s) relevant for this EpisodeOfCare
  fhir:EpisodeOfCare.status [ code ]; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  fhir:EpisodeOfCare.statusHistory [ # 0..* Past list of status codes (the current status may be included to cover the start date of the status)
    fhir:EpisodeOfCare.statusHistory.status [ code ]; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    fhir:EpisodeOfCare.statusHistory.period [ Period ]; # 1..1 Duration the EpisodeOfCare was in the specified status
  ], ...;
  fhir:EpisodeOfCare.type [ CodeableConcept ], ... ; # 0..* Type/class  - e.g. specialist referral, disease management
  fhir:EpisodeOfCare.diagnosis [ # 0..* The list of diagnosis relevant to this episode of care
    fhir:EpisodeOfCare.diagnosis.condition [ Reference(Condition) ]; # 1..1 Conditions/problems/diagnoses this episode of care is for
    fhir:EpisodeOfCare.diagnosis.role [ CodeableConcept ]; # 0..1 Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
    fhir:EpisodeOfCare.diagnosis.rank [ positiveInt ]; # 0..1 Ranking of the diagnosis (for each role type)
  ], ...;
  fhir:EpisodeOfCare.patient [ Reference(Patient) ]; # 1..1 The patient who is the focus of this episode of care
  fhir:EpisodeOfCare.managingOrganization [ Reference(Organization) ]; # 0..1 Organization that assumes care
  fhir:EpisodeOfCare.period [ Period ]; # 0..1 Interval during responsibility is assumed
  fhir:EpisodeOfCare.referralRequest [ Reference(ServiceRequest) ], ... ; # 0..* Originating Referral Request(s)
  fhir:EpisodeOfCare.careManager [ Reference(Practitioner) ]; # 0..1 Care manager/care co-ordinator for the patient
  fhir:EpisodeOfCare.team [ Reference(CareTeam) ], ... ; # 0..* Other practitioners facilitating this episode of care
  fhir:EpisodeOfCare.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this EpisodeOfCare
]

Changes since DSTU2

EpisodeOfCare
EpisodeOfCare.diagnosis
  • Added Element
EpisodeOfCare.diagnosis.condition
  • Added Element
EpisodeOfCare.diagnosis.role
  • Added Element
EpisodeOfCare.diagnosis.rank
  • Added Element
EpisodeOfCare.referralRequest
  • Type changed from Reference(ReferralRequest) to Reference(ServiceRequest)
EpisodeOfCare.team
  • Renamed from careTeam to team
  • Type changed from BackboneElement to Reference(CareTeam)
EpisodeOfCare.account
  • Added Element
EpisodeOfCare.condition
  • deleted
EpisodeOfCare.careTeam.role
  • deleted
EpisodeOfCare.careTeam.period
  • deleted
EpisodeOfCare.careTeam.member
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare DomainResourceAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier(s) relevant for this EpisodeOfCare
... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
EpisodeOfCareStatus (Required)
... statusHistory 0..*BackboneElementPast list of status codes (the current status may be included to cover the start date of the status)
.... status 1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
EpisodeOfCareStatus (Required)
.... period 1..1PeriodDuration the EpisodeOfCare was in the specified status
... type Σ0..*CodeableConceptType/class - e.g. specialist referral, disease management
EpisodeOfCareType (Example)
... diagnosis Σ0..*BackboneElementThe list of diagnosis relevant to this episode of care
.... condition Σ1..1Reference(Condition)Conditions/problems/diagnoses this episode of care is for
.... role Σ0..1CodeableConceptRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
DiagnosisRole (Preferred)
.... rank Σ0..1positiveIntRanking of the diagnosis (for each role type)
... patient Σ1..1Reference(Patient)The patient who is the focus of this episode of care
... managingOrganization Σ0..1Reference(Organization)Organization that assumes care
... period Σ0..1PeriodInterval during responsibility is assumed
... referralRequest 0..*Reference(ServiceRequest)Originating Referral Request(s)
... careManager 0..1Reference(Practitioner)Care manager/care co-ordinator for the patient
... team 0..*Reference(CareTeam)Other practitioners facilitating this episode of care
... account 0..*Reference(Account)The set of accounts that may be used for billing for this EpisodeOfCare

doco Documentation for this format

UML Diagram (Legend)

EpisodeOfCare (DomainResource)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 purposesidentifier : Identifier [0..*]planned | waitlist | active | onhold | finished | cancelled (this element modifies the meaning of other elements)status : code [1..1] « The status of the episode of care. (Strength=Required)EpisodeOfCareStatus! »A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded caretype : CodeableConcept [0..*] « The type of the episode of care (Strength=Example)EpisodeOfCareType?? »The patient who is the focus of this episode of carepatient : Reference [1..1] « Patient »The organization that has assumed the specific responsibilities for the specified durationmanagingOrganization : Reference [0..1] « Organization »The interval during which the managing organization assumes the defined responsibilityperiod : Period [0..1]Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referralsreferralRequest : Reference [0..*] « ServiceRequest »The practitioner that is the care manager/care co-ordinator for this patientcareManager : Reference [0..1] « Practitioner »The list of practitioners that may be facilitating this episode of care for specific purposesteam : Reference [0..*] « CareTeam »The set of accounts that may be used for billing for this EpisodeOfCareaccount : Reference [0..*] « Account »StatusHistoryplanned | waitlist | active | onhold | finished | cancelledstatus : code [1..1] « The status of the episode of care. (Strength=Required)EpisodeOfCareStatus! »The period during this EpisodeOfCare that the specific status appliedperiod : Period [1..1]DiagnosisA list of conditions/problems/diagnoses that this episode of care is intended to be providing care forcondition : Reference [1..1] « Condition »Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)role : CodeableConcept [0..1] « The type of diagnosis this condition represents (Strength=Preferred)DiagnosisRole? »Ranking of the diagnosis (for each role type)rank : positiveInt [0..1]The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource)statusHistory[0..*]The list of diagnosis relevant to this episode of carediagnosis[0..*]

XML Template

<EpisodeOfCare xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier(s) relevant for this EpisodeOfCare --></identifier>
 <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
 <statusHistory>  <!-- 0..* Past list of status codes (the current status may be included to cover the start date of the status) -->
  <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
  <period><!-- 1..1 Period Duration the EpisodeOfCare was in the specified status --></period>
 </statusHistory>
 <type><!-- 0..* CodeableConcept Type/class  - e.g. specialist referral, disease management --></type>
 <diagnosis>  <!-- 0..* The list of diagnosis relevant to this episode of care -->
  <condition><!-- 1..1 Reference(Condition) Conditions/problems/diagnoses this episode of care is for --></condition>
  <role><!-- 0..1 CodeableConcept Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) --></role>
  <rank value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each role type) -->
 </diagnosis>
 <patient><!-- 1..1 Reference(Patient) The patient who is the focus of this episode of care --></patient>
 <managingOrganization><!-- 0..1 Reference(Organization) Organization that assumes care --></managingOrganization>
 <period><!-- 0..1 Period Interval during responsibility is assumed --></period>
 <referralRequest><!-- 0..* Reference(ServiceRequest) Originating Referral Request(s) --></referralRequest>
 <careManager><!-- 0..1 Reference(Practitioner) Care manager/care co-ordinator for the patient --></careManager>
 <team><!-- 0..* Reference(CareTeam) Other practitioners facilitating this episode of care --></team>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this EpisodeOfCare --></account>
</EpisodeOfCare>

JSON Template

{doco
  "resourceType" : "EpisodeOfCare",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier(s) relevant for this EpisodeOfCare
  "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  "statusHistory" : [{ // Past list of status codes (the current status may be included to cover the start date of the status)
    "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    "period" : { Period } // R!  Duration the EpisodeOfCare was in the specified status
  }],
  "type" : [{ CodeableConcept }], // Type/class  - e.g. specialist referral, disease management
  "diagnosis" : [{ // The list of diagnosis relevant to this episode of care
    "condition" : { Reference(Condition) }, // R!  Conditions/problems/diagnoses this episode of care is for
    "role" : { CodeableConcept }, // Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
    "rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
  }],
  "patient" : { Reference(Patient) }, // R!  The patient who is the focus of this episode of care
  "managingOrganization" : { Reference(Organization) }, // Organization that assumes care
  "period" : { Period }, // Interval during responsibility is assumed
  "referralRequest" : [{ Reference(ServiceRequest) }], // Originating Referral Request(s)
  "careManager" : { Reference(Practitioner) }, // Care manager/care co-ordinator for the patient
  "team" : [{ Reference(CareTeam) }], // Other practitioners facilitating this episode of care
  "account" : [{ Reference(Account) }] // The set of accounts that may be used for billing for this EpisodeOfCare
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:EpisodeOfCare;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:EpisodeOfCare.identifier [ Identifier ], ... ; # 0..* Business Identifier(s) relevant for this EpisodeOfCare
  fhir:EpisodeOfCare.status [ code ]; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  fhir:EpisodeOfCare.statusHistory [ # 0..* Past list of status codes (the current status may be included to cover the start date of the status)
    fhir:EpisodeOfCare.statusHistory.status [ code ]; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    fhir:EpisodeOfCare.statusHistory.period [ Period ]; # 1..1 Duration the EpisodeOfCare was in the specified status
  ], ...;
  fhir:EpisodeOfCare.type [ CodeableConcept ], ... ; # 0..* Type/class  - e.g. specialist referral, disease management
  fhir:EpisodeOfCare.diagnosis [ # 0..* The list of diagnosis relevant to this episode of care
    fhir:EpisodeOfCare.diagnosis.condition [ Reference(Condition) ]; # 1..1 Conditions/problems/diagnoses this episode of care is for
    fhir:EpisodeOfCare.diagnosis.role [ CodeableConcept ]; # 0..1 Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
    fhir:EpisodeOfCare.diagnosis.rank [ positiveInt ]; # 0..1 Ranking of the diagnosis (for each role type)
  ], ...;
  fhir:EpisodeOfCare.patient [ Reference(Patient) ]; # 1..1 The patient who is the focus of this episode of care
  fhir:EpisodeOfCare.managingOrganization [ Reference(Organization) ]; # 0..1 Organization that assumes care
  fhir:EpisodeOfCare.period [ Period ]; # 0..1 Interval during responsibility is assumed
  fhir:EpisodeOfCare.referralRequest [ Reference(ServiceRequest) ], ... ; # 0..* Originating Referral Request(s)
  fhir:EpisodeOfCare.careManager [ Reference(Practitioner) ]; # 0..1 Care manager/care co-ordinator for the patient
  fhir:EpisodeOfCare.team [ Reference(CareTeam) ], ... ; # 0..* Other practitioners facilitating this episode of care
  fhir:EpisodeOfCare.account [ Reference(Account) ], ... ; # 0..* The set of accounts that may be used for billing for this EpisodeOfCare
]

Changes since DSTU2

EpisodeOfCare
EpisodeOfCare.diagnosis
  • Added Element
EpisodeOfCare.diagnosis.condition
  • Added Element
EpisodeOfCare.diagnosis.role
  • Added Element
EpisodeOfCare.diagnosis.rank
  • Added Element
EpisodeOfCare.referralRequest
  • Type changed from Reference(ReferralRequest) to Reference(ServiceRequest)
EpisodeOfCare.team
  • Renamed from careTeam to team
  • Type changed from BackboneElement to Reference(CareTeam)
EpisodeOfCare.account
  • Added Element
EpisodeOfCare.condition
  • deleted
EpisodeOfCare.careTeam.role
  • deleted
EpisodeOfCare.careTeam.period
  • deleted
EpisodeOfCare.careTeam.member
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.).

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron + JSON Schema, ShEx (for Turtle)

PathDefinitionTypeReference
EpisodeOfCare.status
EpisodeOfCare.statusHistory.status
The status of the episode of care.RequiredEpisodeOfCareStatus
EpisodeOfCare.type The type of the episode of careExampleEpisodeOfCareType
EpisodeOfCare.diagnosis.role The type of diagnosis this condition representsPreferredDiagnosisRole

When an organization assumes responsibility for a patient, then the EpisodeOfCare is created and a start date entered to show when it has begun.
As the organization's responsibility changes, so does the status of the EpisodeOfCare.
This is described via an example below for an intake workflow.

With long term care there is often a concept of the provision of care being suspended for various reasons. Many systems have extensive Leave Management/Tracking solutions which consider the complexities of this space, however this EpisodeOfCare resource is NOT intended to provide this level of tracking.
Extension(s) may be used on the status/status history to track the on hold reason, which can facilitate the processing.

A more complete Leave Management solution may have to deal with:

  • Leave Types
  • Leave Entitlements
  • Billing/Funding implications while on different types of leave

This example sequence demonstrates some status transitions and how other resources interact.
The context could be in a Community/Aged Care/Disability/Mental Health setting.

  • ServiceRequest received
  • intake clerk processes referral and decides that the first level eligibility has been met
    (e.g. Have capacity in the facility for the patient, the patient is covered by VA)
  • EpisodeOfCare created with status of planned which is allocated as fulfilling the ServiceRequest
  • Further assessment of needs is scheduled to be taken, a care manager is probably allocated at this point
  • Assessment Practitioner sees the Patient and completes a series of relevant Questionnaires to rank the patient
  • The assessments are reviewed and a formal CarePlan is created
  • The EpisodeOfCare is updated to be marked as active, and the CareTeam is likely filled in
  • The provision of care is then managed through the care plan, with all activities will also being linked to the EpisodeOfCare
  • The patient is admitted to hospital for some procedures, and the EpisodeOfCare is marked as on hold
    Some of the services on the CarePlan (or scheduled appointments) would be reviewed to determine if they can be performed without the patient (e.g., home maintenance), or if they should be suspended while the patient is on hold.
  • The patient returns from the hospital and the EpisodeOfCare is marked as active again (and services reviewed again)
  • Patient wished to move to another area to be closer to family
  • Organization creates an outgoing ServiceRequest to a new Organization to continue the care
  • The EpisodeOfCare is closed

In some jurisdictions an Organization may be funded by a government body for the days that a patient is under their care. These are known as "active days". This does not mean that they are actively receiving a service (an encounter), but that the organization is responsible for managing their care.
This monthly reporting value can be easily extracted from the status history as described above.
The actual provision of services may also be funded separately, and this would be via the Encounters.

An Organization may perform analytics on their Episodes Of Care to have an understanding of how their business is performing.
Observing that there was a 60/40 split of episodes being finished/cancelled is not very informative. The organization would prefer to know the reason why the episodes are completing so that they can plan their business effectively.
They’d be more interested in knowing whether it was due to services hitting their mandatory end date, client passing away, client transitioning to a higher level of services provided by them or to another provider etc.

Currently there are no attributes on this resource to provide this information. This would be very specific to each implementation and usage, so it would be recommended to use extensions to achieve this functionality.

A General Practitioner wants to review how well his patient is managing his diabetes over time from information within his clinic and also the regional community care organization's system(s).

The EpisodeOfCare enables the practitioner to easily separate the diabetes activities from the mental health problem's activities.

A Community Care organization wants to track all activities that occur with a patient relating to their disability to simplify the reporting to the government to receive funding to care for the patient

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
care-managerreferenceCare manager/care co-ordinator for the patientEpisodeOfCare.careManager
(Practitioner)
conditionreferenceConditions/problems/diagnoses this episode of care is forEpisodeOfCare.diagnosis.condition
(Condition)
datedateThe provided date search value falls within the episode of care's periodEpisodeOfCare.period17 Resources
identifiertokenBusiness Identifier(s) relevant for this EpisodeOfCareEpisodeOfCare.identifier26 Resources
incomingreferralreferenceIncoming Referral RequestEpisodeOfCare.referralRequest
(ServiceRequest)
organizationreferenceThe organization that has assumed the specific responsibilities of this EpisodeOfCareEpisodeOfCare.managingOrganization
(Organization)
patientreferenceThe patient who is the focus of this episode of careEpisodeOfCare.patient
(Patient)
30 Resources
statustokenThe current status of the Episode of Care as provided (does not check the status history collection)EpisodeOfCare.status
typetokenType/class - e.g. specialist referral, disease managementEpisodeOfCare.type5 Resources