QI-Core Implementation Guide, Clinical Quality Improvement WG - CI build for vesion 4.0.0). This version is based on the current content of https://github.com/cqframework/qi-core/ and changes regularly. See the Directory of published versions
QDM defines Encounter as an identifiable grouping of healthcare-related activities characterized by the entity relationship between the subject of care and a healthcare provider; such a grouping is determined by the healthcare provider. A patient encounter represents interaction between a healthcare provider and a patient with a face-to-face patient visit to a clinician’s office, or any electronically remote interaction with a clinician for any form of diagnostic treatment or therapeutic event.
Implementation considerations must be considered when referencing encounter periods (start to end time). Some clinical sites may leave Encounters "open" until all documentation has been completed which may take 72 hours or more. However, the actual encounter may have lasted for a much shorter time period (e.g., 15 minutes for an ambulatory encounter). This issue is addressed in The Office of the National Coordinator for Health IT (ONC) Issue Tracking System as item QDM-235. Two approaches clinical sites have used to manage this issue include:
Undoubtedly, other clinical sites have implemented other solutions to documenting end times for ambulatory visits. Quality measure and clinical decision support (CDS) artifact authors should consider such issues when testing the validity and reliability of retrieved responses to data queries.
Encounter.diagnosis refers to the list of diagnosis/diagnoses relevant to the encounter. The Encounter.diagnosis.use value differentiates if the diagnosis is the admission diagnosis (AD), the discharge diagnosis (DD), the chief complaint (CC), a comorbidity diagnosis (CM), a pre-op diagnosis (pre-op), a post-op diagnosis (post-op) or a billing diagnosis (billing).
Some quality measures used to evaluate care provided in hospital settings use concepts to define principal diagnosis and present on admission:
Principal procedure defines a procedures relationship to an encounter (most often an inpatient encounter). It has not relationship to the inherent nature of the procedure. Therefore, QI-Core includes an extension modeling Encounter.procedure in the same way as Encounter.diagnosis. The Encounter.procedure has a code to indicate the procedure code and a rank to indicate its ordinality such that rank=1 identifies the procedure as a principal procedure.
|QDM Context||QI-Core R4||Comments|
|Encounter.status||consider constraint to - arrived, triaged, in-progress, on-leave, finished|
|Encounter.type||type of service by CPT|
|Code||Encounter.class||ambulatory, ED, inpatient, etc.|
|Relevant Period||Encounter.period||start and end time of encounter|
|Diagnosis (code)||Encounter.diagnosis.condition||can be used for coded diagnoses|
|Rank (integer)||Encounter.diagnosis.rank||for each diagnosis role|
|Procedures||Currently referenced as Procedure.priority in QDM 5.5. Principal procedures are more appropriately managed as Encounter.procedures; Elective procedures are more appropriately managed using Encounter.priority = elective with Encounter.procedure.rank =1.|
|Encounter.procedure.sequence||Extension for Procedure.sequence to be consistent with the FHIR Claim resource includes a Claim.procedure.sequence used to uniquely identify procedure entries. Claim.procedure.type provides a relative ranking with two example concepts - primary (the first procedure in a series to produce an overall patient outcome) and secondary the second procedure in a series required to product an overally patient outcome). However, type refers to procedures within a serier for which one is first. Such a sequence does not assure that the first procedure is the principal procedure for an encounter.|
|Length of Stay||Encounter.length|
|Negation Rationale||Not Addressed|
|Author dateTime||Not Addressed|
|Discharge Disposition||Encounter.hospitalization.dischargeDisposition||E.g., home, hospice, long-term care, etc.|
To address the QDM attribute Encounter, Order see Service Request
To address the QDM attribute Encounter, Recommended see Service Request