Generated Narrative: StructureDefinition ACP-Encounter Name Flags Card. Type Description & Constraints Encounter 0..* Zib Encounter(2.1.6) Encounter #xD; class 1..1 Coding ContactType #xD; subject 1..1 Reference(ACP Patient(1.0.0-rc1)) The patient ro group present at the encounter #xD; participant 0..* BackboneElement List of participants involved in the encounter #xD; individual 0..1 Reference(ACP ContactPerson(1.0.0-rc1) | ACP HealthProfessional Practitioner(1.0.0-rc1)) ContactWith #xD; period #xD; start 1..1 dateTime StartDateTime #xD; diagnosis #xD; condition 1..1 Reference(HCIM Procedure(2.1.12) | HCIM Problem(3.0.7)) Condition that this encounter was created for #xD; Documentation for this format
Any interaction, regardless of the situation, between a patient and the healthcare provider, in which the healthcare provider has primary responsibility for diagnosing, evaluating and treating the patient’s condition and informing the patient. These can be visits, appointments or non face-to-face interactions. Based on nl-core-Encounter and HCIM Encounter.
Copyright and related rights waived via CC0, https://creativecommons.org/publicdomain/zero/1.0/. This does not apply to information from third parties, for example a medical terminology system. The implementer alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize third party IP in connection with the specification or otherwise.
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.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL NOT contain any narrative
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
Additional Content defined by implementations
May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Identifier(s) by which this encounter is known
Identifier(s) by which this encounter is known.
planned | arrived | triaged | in-progress | onleave | finished | cancelled +
planned | arrived | triaged | in-progress | onleave | finished | cancelled +.
Note that internal business rules will detemine the appropraite transitions that may occur between statuses (and also classes). This element is labeled as a modifier because the status contains codes that mark the encounter as not currently valid.
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
The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.
The current status is always found in the current version of the resource, not the status history.
All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
The time that the episode was in the specified status
The time that the episode was in the specified status.
The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transisions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kindof discharge from emergency to inpatient.
inpatient | outpatient | ambulatory | emergency +
inpatient | outpatient | ambulatory | emergency +.
The time that the episode was in the specified class
The time that the episode was in the specified class.
Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).
Since there are many ways to further classify encounters, this element is 0..*.
The patient ro group present at the encounter
The patient ro group present at the encounter.
While the encounter is always about the patient, the patient may 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).
Episode(s) of care that this encounter should be recorded against
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).
The ReferralRequest that initiated this encounter
The referral request this encounter satisfies (incoming referral).
List of participants involved in the encounter
The list of people responsible for providing the service.
The participant type indicates how an individual partitipates 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.
Extensions are always sliced by (at least) url
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The role the healthcare provider fulfils in the healthcare process. For healthcare providers, this could be for example main practitioner, referrer or general practitioner.
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Period of time during the encounter that the participant participated
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.
The healthcare provider with whom the contact took place. The specialty and role of the healthcare provider can be entered in the HealthcareProvider information model as well.
Gesprek gevoerd in bijzijn van (Contactpersoon)
Optional Extension Element - found in all resources.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Logical reference, when literal reference is not known
An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
The appointment that scheduled this encounter
The appointment that scheduled this encounter.
.outboundRelationship[typeCode=FLFS].target[classCode=ENC, moodCode=APT]
The start and end time of the encounter.
If not (yet) known, the end of the Period may be omitted.
The date and time at which the contact took place.
If the low element is missing, the meaning is that the low boundary is not known.
The date and time at which the contact ended. If the contact takes place over a period of time, this indicates the end of the period, in the case of an admission, for example. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
Quantity of time the encounter lasted (less time absent)
Quantity of time the encounter lasted. This excludes the time during leaves of absence.
May differ from the time the Encounter.period lasted because of leave of absence.
(PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes
A deviating result which serves as the reason for the contact.
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
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 )
The list of diagnosis relevant to this encounter
The list of diagnosis relevant to this encounter.
Condition that this encounter was created for
Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis.
Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively.
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).
The type of diagnosis this condition represents
Ranking of the diagnosis (for each role type)
Ranking of the diagnosis (for each role type).
The set of accounts that may be used for billing for this Encounter
The set of accounts that may be used for billing for this Encounter.
The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
Details about the admission to a healthcare service
Details about the admission to a healthcare service.
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 hospitalization record.
.outboundRelationship[typeCode=COMP].target[classCode=ENC, moodCode=EVN]
The location from which the patient came before admission
The location from which the patient came before admission.
Location from which the patient came before the encounter. In most cases this will only be used when the patient is admitted.
The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Whether this hospitalization is a readmission and why if known.
The reason for re-admission of this hospitalization encounter.
Diet preferences reported by the patient
Diet preferences reported by the patient.
For example a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
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.
Medical, cultural or ethical food preferences to help with catering requirements.
.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=EVN, code="diet"]
Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
Location to which the patient is discharged
Location to which the patient is discharged.
Location to which the patient will go after the encounter. In most cases this will only be used when the patient is discharged.
List of locations where the patient has been
List of locations where the patient has been during this encounter.
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".
The location where the encounter takes place.
The status of the participants' presence at the specified location during the period specified. If the participant is is no longer at the location, then the period will have an end date/time.
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.
Time period during which the patient was present at the location
Time period during which the patient was present at the location.
The physical location at which the contact took place.
PV1-10 / PL.6 & PL.1 (note: HL7 v2 definition is "the treatment or type of surgery that the patient is scheduled to receive"; seems slightly out of alignment with the concept name 'hospital service'. Would not trust that implementations apply this semantic by default)
Another Encounter this encounter is part of
Another Encounter of which this encounter is a part of (administratively or in time).
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.
.inboundRelationship[typeCode=COMP].source[classCode=COMP, moodCode=EVN]