Administrative Incubator
0.1.0 - International flag

Administrative Incubator, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/admin-incubator/ and changes regularly. See the Directory of published versions

Resource: EncounterHistory

Official URL: http://hl7.org/fhir/StructureDefinition/EncounterHistory Version: 0.1.0
Standards status: Trial-use Draft as of 2021-01-02 Maturity Level: 0 Computable Name: EncounterHistory
Other Identifiers: OID:2.16.840.1.113883.4.642.5.1784

A record of significant events/milestones key data throughout the history of an Encounter

Scope and Usage

The EncounterHistory is used to be able to record an ongoing history of significant events/changes that occur during a patient encounter. This information is not always up to date/accurate while entering encounter information and is often back-dated as more detailed information becomes available, or corrections need to be made during the completion of the encounter while it is being processed in coding or billing.

[%stu-note dstu%] In FHIR R4 and earlier this data was in the Encounter statusHistory and classHistory backbone elements, however with longer duration encounters (where a patient encounter might be considered active for years) this would become increasingly inefficient, so was re-factored into this resource.
The design notes for this change are on confluence. [%end-note%]

Boundaries and Relationships

The Encounter resource stores the complete set of current/most recent data about an Encounter. The EncounterHistory contains a snapshot of some key aspects (properties) of the encounter to track changes to the encounter over time - specifically those that contribute to significant changes/events/milestones during the encounter - such as moving between departments or locations.

Note that this historical information is different than what is tracked in the versions of the Encounter resource. Past movements of a patient are often updated after the fact to correct what actually happened.
FHIR History (_history) doesn't cater for this need as the information isn't always accurate and can be corrected/back populated too. Another challenge with _history is that it also includes corrections to errors in data entry which could not be differentiated from actual movements/changes.

No clinical resources are expected to ever refer to a specific EncounterHistory event, they are only attributed to the Encounter as a whole. If a resource is desiring to connect to a portion of an encounter (and wanting to use EncounterHistory) this is an indication that you should be using a child Encounter through the partOf property.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Resource Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. EncounterHistory 0..* DomainResource A record of significant events/milestones key data throughout the history of an Encounter

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... encounter 0..1 Reference(Encounter) The Encounter associated with this set of historic values
... identifier Σ 0..* Identifier Identifier(s) by which this encounter is known
... status ?!Σ 1..1 code planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown
Binding: EncounterStatus (required): Current state of the encounter.
... type Σ 0..* CodeableConcept Specific type of encounter
Binding: EncounterType (example): A specific code indicating type of service provided
... serviceType Σ 0..* CodeableReference(HealthcareService) Specific type of service
Binding: ServiceType (example): Broad categorization of the service that is to be provided.
... subject Σ 0..1 Reference(Patient | Group) The patient or group related to this encounter
... subjectStatus 0..1 CodeableConcept The current status of the subject in relation to the Encounter
Binding: EncounterSubjectStatus (example): Current status of the subject within the encounter.
... actualPeriod 0..1 Period The actual start and end time associated with this set of values associated with the encounter
... plannedStartDate 0..1 dateTime The planned start date/time (or admission date) of the encounter
... plannedEndDate 0..1 dateTime The planned end date/time (or discharge date) of the encounter
... length 0..1 Duration Actual quantity of time the encounter lasted (less time absent)
... location 0..* BackboneElement Location of the patient at this point in the encounter
.... location 1..1 Reference(Location) Location the encounter takes place
.... form 0..1 CodeableConcept The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.)
Binding: LocationForm (example): Physical form of the location.

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
EncounterHistory.status Base required Encounter Status 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.class Base extensible ActEncounterCode 📦3.0.0 THO v6.5
EncounterHistory.type Base example Encounter Type 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.serviceType Base example Service Type 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.subjectStatus Base example Encounter Subject Status 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.location.​form Base example Location Form 📦6.0.0-ballot3 FHIR Std. 
<EncounterHistory xmlns="http://hl7.org/fhir"> ​​doco
 ​<id value="[id]"/><!-- 0..1 ​* ​Logical id of this artifact  -->
 ​<meta><!-- ​I 0..1 ​* ​Metadata about the resource  --></meta>
 ​<implicitRules value="[uri]"/><!-- ​I 0..1 ​* ​A set of rules under which this content was created  -->
 ​<language value="[code]"/><!-- ​I 0..1 ​* Language of the resource content  -->
 ​<text><!-- ​I 0..1 ​* ​Text summary of the resource, for human interpretation  --></text>
 ​<contained><!-- 0..* ​* ​Contained, inline Resources  --></contained>
 ​<extension><!-- See Extensions  ​Additional content defined by implementations  --></extension>
 ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored  --></modifierExtension>
 <encounter><!-- 0..1 ​* ​The Encounter associated with this set of historic values  --></encounter>
 <identifier><!-- 0..* ​* ​Identifier(s) by which this encounter is known  --></identifier>
 <status value="[code]"/><!-- 1..1 ​* planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown  -->
 <class><!-- 1..1 ​* Classification of patient encounter  --></class>
 <type><!-- 0..* ​* Specific type of encounter  --></type>
 <serviceType><!-- 0..* ​* Specific type of service  --></serviceType>
 <subject><!-- 0..1 ​* ​The patient or group related to this encounter  --></subject>
 <subjectStatus><!-- 0..1 ​* The current status of the subject in relation to the Encounter  --></subjectStatus>
 <actualPeriod><!-- 0..1 ​* ​The actual start and end time associated with this set of values associated with the encounter  --></actualPeriod>
 <plannedStartDate value="[dateTime]"/><!-- 0..1 ​* ​The planned start date/time (or admission date) of the encounter  -->
 <plannedEndDate value="[dateTime]"/><!-- 0..1 ​* ​The planned end date/time (or discharge date) of the encounter  -->
 <length><!-- 0..1 ​* ​Actual quantity of time the encounter lasted (less time absent)  --></length>
 <location> ​I 0..* ​*  <!-- ​I 0..* Location of the patient at this point in the encounter -->
  ​<id value="[id]"/><!-- 0..1 ​* ​Unique id for inter-element referencing   -->
  ​<extension><!-- See Extensions  ​Additional content defined by implementations   --></extension>
  ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored even if unrecognized   --></modifierExtension>
  <location><!-- 1..1 ​* ​Location the encounter takes place   --></location>
  <form><!-- 0..1 ​* The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.)   --></form>
 </location>
</EncounterHistory>

​
{​​doco
  "resourceType" : "EncounterHistory",
  "id" : "<id>", // 0..1 ​Logical id of this artifact
  "meta" : { Meta }, // ​I 0..1 ​Metadata about the resource
  "implicitRules" : "<uri>", // ​I 0..1 ​A set of rules under which this content was created
  "language" : "<code>", // ​I 0..1 Language of the resource content
  "text" : { Narrative }, // ​I 0..1 ​Text summary of the resource, for human interpretation
  "contained" : [{ ​Resource }], // 0..* ​Contained, inline Resources
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
  "encounter" : { Reference(Encounter) }, // 0..1 ​The Encounter associated with this set of historic values
  "identifier" : [{ Identifier }], // 0..* ​Identifier(s) by which this encounter is known
  "status" : "<code>", // 1..1 planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown
  "class" : { CodeableConcept }, // 1..1 Classification of patient encounter
  "type" : [{ CodeableConcept }], // 0..* Specific type of encounter
  "serviceType" : [{ CodeableReference(HealthcareService) }], // 0..* Specific type of service
  "subject" : { Reference(Group|Patient) }, // 0..1 ​The patient or group related to this encounter
  "subjectStatus" : { CodeableConcept }, // 0..1 The current status of the subject in relation to the Encounter
  "actualPeriod" : { Period }, // 0..1 ​The actual start and end time associated with this set of values associated with the encounter
  "plannedStartDate" : "<dateTime>", // 0..1 ​The planned start date/time (or admission date) of the encounter
  "plannedEndDate" : "<dateTime>", // 0..1 ​The planned end date/time (or discharge date) of the encounter
  "length" : { Duration }, // 0..1 ​Actual quantity of time the encounter lasted (less time absent)
  "location" : [{ BackboneElement }] // ​I 0..* ​Location of the patient at this point in the encounter
    "id" : "<id>", // 0..1 ​Unique id for inter-element referencing
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
    "location" : { Reference(Location) }, // 1..1 ​Location the encounter takes place
    "form" : { CodeableConcept } // 0..1 The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.)
  }
}

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


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

  fhir:id [ id ] ; # 0..1 Logical id of this artifact
  fhir:meta [ Meta ] ; # 0..1 ​I Metadata about the resource
  fhir:implicitRules [ uri ] ; # 0..1 ​I A set of rules under which this content was created
  fhir:language [ code ] ; # 0..1 ​I Language of the resource content
  fhir:text [ Narrative ] ; # 0..1 ​I Text summary of the resource, for human interpretation
  fhir:contained  ( [ Resource ] ... ) ; # 0..* Contained, inline Resources
  fhir:extension  ( [ Extension ] ... ) ; # 0..* ​I Additional content defined by implementations
  fhir:modifierExtension  ( [ Extension ] ... ) ; # 0..* ​I Extensions that cannot be ignored
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The Encounter associated with this set of historic values
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Identifier(s) by which this encounter is known
  fhir:status [ code ] ; # 1..1 planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown
  fhir:class [ CodeableConcept ] ; # 1..1 Classification of patient encounter
  fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Specific type of encounter
  fhir:serviceType  ( [ CodeableReference(HealthcareService) ] ... ) ; # 0..* Specific type of service
  fhir:subject [ Reference(Group|Patient) ] ; # 0..1 The patient or group related to this encounter
  fhir:subjectStatus [ CodeableConcept ] ; # 0..1 The current status of the subject in relation to the Encounter
  fhir:actualPeriod [ Period ] ; # 0..1 The actual start and end time associated with this set of values associated with the encounter
  fhir:plannedStartDate [ dateTime ] ; # 0..1 The planned start date/time (or admission date) of the encounter
  fhir:plannedEndDate [ dateTime ] ; # 0..1 The planned end date/time (or discharge date) of the encounter
  fhir:length [ Duration ] ; # 0..1 Actual quantity of time the encounter lasted (less time absent)
  fhir:location  ( [ BackboneElement ] ... ) ; # 0..* ​I Location of the patient at this point in the encounter
]

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. EncounterHistory 0..* DomainResource A record of significant events/milestones key data throughout the history of an Encounter

Elements defined in Ancestors:id, meta, implicitRules, language, text, contained, extension, modifierExtension
... encounter 0..1 Reference(Encounter) The Encounter associated with this set of historic values
... identifier Σ 0..* Identifier Identifier(s) by which this encounter is known
... status ?!Σ 1..1 code planned | in-progress | on-hold | discharged | completed | cancelled | discontinued | entered-in-error | unknown
Binding: EncounterStatus (required): Current state of the encounter.
... type Σ 0..* CodeableConcept Specific type of encounter
Binding: EncounterType (example): A specific code indicating type of service provided
... serviceType Σ 0..* CodeableReference(HealthcareService) Specific type of service
Binding: ServiceType (example): Broad categorization of the service that is to be provided.
... subject Σ 0..1 Reference(Patient | Group) The patient or group related to this encounter
... subjectStatus 0..1 CodeableConcept The current status of the subject in relation to the Encounter
Binding: EncounterSubjectStatus (example): Current status of the subject within the encounter.
... actualPeriod 0..1 Period The actual start and end time associated with this set of values associated with the encounter
... plannedStartDate 0..1 dateTime The planned start date/time (or admission date) of the encounter
... plannedEndDate 0..1 dateTime The planned end date/time (or discharge date) of the encounter
... length 0..1 Duration Actual quantity of time the encounter lasted (less time absent)
... location 0..* BackboneElement Location of the patient at this point in the encounter
.... location 1..1 Reference(Location) Location the encounter takes place
.... form 0..1 CodeableConcept The physical type of the location (usually the level in the location hierarchy - bed, room, ward, virtual etc.)
Binding: LocationForm (example): Physical form of the location.

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
EncounterHistory.status Base required Encounter Status 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.class Base extensible ActEncounterCode 📦3.0.0 THO v6.5
EncounterHistory.type Base example Encounter Type 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.serviceType Base example Service Type 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.subjectStatus Base example Encounter Subject Status 📦6.0.0-ballot3 FHIR Std.
EncounterHistory.location.​form Base example Location Form 📦6.0.0-ballot3 FHIR Std.

 

Other representations of resource: CSV, Excel

Notes:

Notes

Name Type Description Expression
encounter reference

The Encounter associated with this set of history values

 EncounterHistory.encounter
identifier token

Identifier(s) by which this encounter is known

 EncounterHistory.identifier
patient reference

The patient present at the encounter

 EncounterHistory.subject.where(resolve() is Patient)
status token

Status of the Encounter history entry

 EncounterHistory.status
subject reference

The patient or group present at the encounter

 EncounterHistory.subject