Canadian Baseline
1.2.0 - CI Build
Canadian Baseline
1.2.0 - CI Build
Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter | Version: 1.2.0 | |||
| Draft as of 2024-08-09 | Computable Name: EncounterProfile | |||
Proposed constraints and extensions on the Encounter Resource
This profile sets minimum expectations for the Encounter resource to represent various observations if no other, more specific profile is applicable.
This Encounter profile represents 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, or to communicate information on a visit-specific basis.
This profile defines localization concepts for use in the Canadian context.
All elements or attributes within the FHIR specification have cardinality as part of their definition - a minimum number of required appearances and a maximum number of allowable appearances.
Most elements in the FHIR specification have a minimum cardinality of 0, so most elements are not required and subsequently they may be missing from a resource when it is exchanged between systems.
Required elements in the Encounter profile:
Some elements are marked as Must Support. This means that implementations generating, receiving, or otherwise using resources with Must Support elements SHALL provide support for those elements in some meaningful way (see Must Support definition).
The following elements are marked as Must Support in the Encounter profile:
Must Support elements:
It is anticipated that many systems only need the current information of the encounter and therefore the Encounter resource represents the most recent information.
Systems that need to track historical information about the encounter should be able to do that by increasing complexity of the Encounter resource instance.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Encounter |
0..* | Encounter | Encounter Profile dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |
  implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
 identifier |
SΣ | 0..* | Identifier | Identifier(s) by which this encounter is known ele-1: All FHIR elements must have a @value or children |
| status |
?!SΣ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter. ele-1: All FHIR elements must have a @value or children |
| class |
SΣ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter. ele-1: All FHIR elements must have a @value or children |
| type |
SΣ | 0..* | CodeableConcept | Specific type of encounter Binding: Encounter Type (preferred): Valueset to describe the Encounter Type ele-1: All FHIR elements must have a @value or children |
 subject |
SΣ | 1..1 | Reference(Patient Profile) | The patient present at the encounter ele-1: All FHIR elements must have a @value or children |
 participant |
SΣ | 0..* | BackboneElement | A list of Practitioners participating in the encounter ele-1: All FHIR elements must have a @value or children |
 modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
 individual |
Σ | 0..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General)) | Persons involved in the encounter other than the patient ele-1: All FHIR elements must have a @value or children |
| reasonCode |
SΣ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place. ele-1: All FHIR elements must have a @value or children |
| reasonReference |
Σ | 0..* | Reference(Condition Profile | Procedure Profile | Observation Profile (General Use) | ImmunizationRecommendation Profile) | Reason the encounter takes place (reference) ele-1: All FHIR elements must have a @value or children |
| diagnosis |
SΣ | 0..* | BackboneElement | The list of diagnosis relevant to this encounter ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| condition |
Σ | 1..1 | Reference(Condition Profile | Procedure Profile) | The diagnosis or procedure relevant to the encounter ele-1: All FHIR elements must have a @value or children |
| rank |
S | 0..1 | positiveInt | Ranking of the diagnosis (for each role type) ele-1: All FHIR elements must have a @value or children |
| hospitalization |
S | 0..1 | BackboneElement | Details about the admission to a healthcare service ele-1: All FHIR elements must have a @value or children |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| origin |
0..1 | Reference(Location Profile | Organization Profile) | The location/organization from which the patient came before admission ele-1: All FHIR elements must have a @value or children | |
| destination |
0..1 | Reference(Location Profile | Organization Profile) | Location/organization to which the patient is discharged ele-1: All FHIR elements must have a @value or children | |
| dischargeDisposition |
0..1 | CodeableConcept | Category or kind of location after discharge Binding: EncounterDischargeDisposition  (preferred): Discharge Disposition.ele-1: All FHIR elements must have a @value or children | |
| serviceProvider |
0..1 | Reference(Organization Profile) | The organization (facility) responsible for this encounter ele-1: All FHIR elements must have a @value or children | |
| partOf |
0..1 | Reference(Encounter Profile) | Another Encounter this encounter is part of ele-1: All FHIR elements must have a @value or children | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| Encounter.status | required | EncounterStatushttp://hl7.org/fhir/ValueSet/encounter-status|4.0.1from the FHIR Standard | |
| Encounter.class | extensible | ActEncounterCodehttp://terminology.hl7.org/ValueSet/v3-ActEncounterCode | |
| Encounter.type | preferred | EncounterTypehttps://fhir.infoway-inforoute.ca/ValueSet/encountertypefrom this IG | |
| Encounter.reasonCode | preferred | EncounterReasonCodeshttp://hl7.org/fhir/ValueSet/encounter-reasonfrom the FHIR Standard | |
| Encounter.hospitalization.dischargeDisposition | preferred | EncounterDischargeDisposition https://fhir.infoway-inforoute.ca/ValueSet/encounterdischargedisposition |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | Encounter | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Encounter | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Encounter | 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() | |
| dom-5 | error | Encounter | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Encounter | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Other representations of profile: CSV, Excel, Schematron
The Encounter.class element is to provide the kind of stay that a subject is having. This is different than the Encounter.type that explains what is done to the subject within this encounter.
In other words, the Encounter.class identifies the setting for the encounter (inpatient/outpatient) in which the encounter took place.
Since it is important for interpreting the context of the encounter, for choosing the appropriate business rules to enforce the clinical/management process, this element is required (cardinality 1..1) and marked as Must Support.
The Encounter.class element does NOT identify the priority of the encounter (see Encounter.priority).
Therefore Encounter.class = "EMER" (Emergency) refers to an encounter happening at a dedicated healthcare service delivery location (e.g., Emergency Department) rather than the priority of the encounter.
The Encounter.type element is to provide a specific code indicating type of service provided.
This element is bound to EncounterType value set which includes codes from SNOMED CT decending from the 308335008 (Patient encounter procedure (procedure)) concept.
To extract all descendant of the SNOMED CT concept 308335008 use an ECL expression << 308335008.
- ISSUE #143: Need to better define the value set for the Encounter.type and explain the difference between Encounter.type and Encounter.serviceType based on use cases.
- Possible value sets:
- descendant of the SNOMED CT concept 308335008 | Patient encounter procedure (procedure);
- descendant of the SNOMED CT concept 308467007 | Seen in establishment (finding)
- descendant of the SNOMED CT concept 308930007 | Seen by health professional (finding)
The Encounter.serviceType element describes the service to be performed during the encounter. This element is connected to other resources such as Appointment (Appointment.serviceType), HealthcareService (HealthcareService.type) or Schedule (Schedule.serviceType)