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Patient Administration icon Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Patient, Practitioner

Detailed Descriptions for the elements in the EpisodeOfCare resource.

EpisodeOfCare
Element Id EpisodeOfCare
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.

Short Display 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
Cardinality 0..*
Type DomainResource
Alternate Names Case Program Problem
Summary false
EpisodeOfCare.identifier
Element Id EpisodeOfCare.identifier
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.

Short Display Business Identifier(s) relevant for this EpisodeOfCare
Note This is a business identifier, not a resource identifier (see discussion)
Cardinality 0..*
Type Identifier
Summary false
EpisodeOfCare.status
Element Id EpisodeOfCare.status
Definition

planned | waitlist | active | onhold | finished | cancelled.

Short Display planned | waitlist | active | onhold | finished | cancelled | entered-in-error
Cardinality 1..1
Terminology Binding Episode Of Care Status (Required)
Type code
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)
Summary true
Comments

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

EpisodeOfCare.statusHistory
Element Id EpisodeOfCare.statusHistory
Definition

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

Short Display Past list of status codes (the current status may be included to cover the start date of the status)
Cardinality 0..*
Summary false
EpisodeOfCare.statusHistory.status
Element Id EpisodeOfCare.statusHistory.status
Definition

planned | waitlist | active | onhold | finished | cancelled.

Short Display planned | waitlist | active | onhold | finished | cancelled | entered-in-error
Cardinality 1..1
Terminology Binding Episode Of Care Status (Required)
Type code
Summary false
EpisodeOfCare.statusHistory.period
Element Id EpisodeOfCare.statusHistory.period
Definition

The period during this EpisodeOfCare that the specific status applied.

Short Display Duration the EpisodeOfCare was in the specified status
Cardinality 1..1
Type Period
Summary false
EpisodeOfCare.type
Element Id EpisodeOfCare.type
Definition

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

Short Display Type/class - e.g. specialist referral, disease management
Cardinality 0..*
Terminology Binding Episode Of Care Type (Example)
Type CodeableConcept
Summary true
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.

EpisodeOfCare.reason
Element Id EpisodeOfCare.reason
Definition

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

Short Display The list of medical reasons that are expected to be addressed during the episode of care
Cardinality 0..*
Summary true
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
EpisodeOfCare.reason.use
Element Id EpisodeOfCare.reason.use
Definition

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

Short Display What the reason value should be used for/as
Cardinality 0..1
Terminology Binding Encounter Reason Use (Example)
Type CodeableConcept
Summary true
EpisodeOfCare.reason.value
Element Id EpisodeOfCare.reason.value
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.

Short Display Medical reason to be addressed
Cardinality 0..*
Terminology Binding Encounter Reason Codes (Example)
Type CodeableReference(Condition | Procedure | Observation | HealthcareService)
Summary true
EpisodeOfCare.diagnosis
Element Id EpisodeOfCare.diagnosis
Definition

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

Short Display The list of medical conditions that were addressed during the episode of care
Cardinality 0..*
Summary true
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.

EpisodeOfCare.diagnosis.condition
Element Id EpisodeOfCare.diagnosis.condition
Definition

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

Short Display The medical condition that was addressed during the episode of care
Cardinality 0..*
Terminology Binding Condition/Problem/Diagnosis Codes (Example)
Type CodeableReference(Condition)
Summary true
EpisodeOfCare.diagnosis.use
Element Id EpisodeOfCare.diagnosis.use
Definition

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

Short Display Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
Cardinality 0..1
Terminology Binding Encounter Diagnosis Use (Preferred)
Type CodeableConcept
Summary true
EpisodeOfCare.subject
Element Id EpisodeOfCare.subject
Definition

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

Short Display The patient/group who is the focus of this episode of care
Cardinality 1..1
Type Reference(Patient | Group)
Summary true
EpisodeOfCare.managingOrganization
Element Id EpisodeOfCare.managingOrganization
Definition

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

Short Display Organization that assumes responsibility for care coordination
Cardinality 0..1
Type Reference(Organization)
Summary true
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.

EpisodeOfCare.period
Element Id EpisodeOfCare.period
Definition

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

Short Display Interval during responsibility is assumed
Cardinality 0..1
Type Period
Summary true
EpisodeOfCare.referralRequest
Element Id EpisodeOfCare.referralRequest
Definition

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

Short Display Originating Referral Request(s)
Cardinality 0..*
Type Reference(ServiceRequest)
Summary false
EpisodeOfCare.careManager
Element Id EpisodeOfCare.careManager
Definition

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

Short Display Care manager/care coordinator for the patient
Cardinality 0..1
Type Reference(Practitioner | PractitionerRole)
Summary false
EpisodeOfCare.careTeam
Element Id EpisodeOfCare.careTeam
Definition

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

Short Display Other practitioners facilitating this episode of care
Cardinality 0..*
Type Reference(CareTeam)
Alternate Names CareTeam
Summary false
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.

EpisodeOfCare.account
Element Id EpisodeOfCare.account
Definition

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

Short Display The set of accounts that may be used for billing for this EpisodeOfCare
Cardinality 0..*
Type Reference(Account)
Summary false
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.