Resource type: episodeofcare

Description

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.

Elements

PathShortDefinitionComments
An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibilityAn 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.
identifierBusiness Identifier(s) relevant for this EpisodeOfCareThe 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.
statusplanned | waitlist | active | onhold | finished | cancelled | entered-in-errorplanned | waitlist | active | onhold | finished | cancelled.This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid.
statusHistoryPast list of status codes (the current status may be included to cover the start date of the status)The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource).
statusHistory.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
statusHistory.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. 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 can 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.
statusHistory.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).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.
statusHistory.statusplanned | waitlist | active | onhold | finished | cancelled | entered-in-errorplanned | waitlist | active | onhold | finished | cancelled.
statusHistory.periodDuration the EpisodeOfCare was in the specified statusThe period during this EpisodeOfCare that the specific status applied.
typeType/class - e.g. specialist referral, disease managementA classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care.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.
diagnosisThe list of diagnosis relevant to this episode of careThe list of diagnosis relevant to this episode of care.
diagnosis.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
diagnosis.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. 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 can 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.
diagnosis.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).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.
diagnosis.conditionConditions/problems/diagnoses this episode of care is forA list of conditions/problems/diagnoses that this episode of care is intended to be providing care for.
diagnosis.roleRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …).
diagnosis.rankRanking of the diagnosis (for each role type)Ranking of the diagnosis (for each role type).
patientThe patient who is the focus of this episode of careThe patient who is the focus of this episode of care.
managingOrganizationOrganization that assumes careThe organization that has assumed the specific responsibilities for the specified duration.
periodInterval during responsibility is assumedThe interval during which the managing organization assumes the defined responsibility.
referralRequestOriginating Referral Request(s)Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals.
careManagerCare manager/care coordinator for the patientThe practitioner that is the care manager/care coordinator for this patient.
teamOther practitioners facilitating this episode of careThe list of practitioners that may be facilitating this episode of care for specific purposes.
accountThe set of accounts that may be used for billing for this EpisodeOfCareThe set of accounts that may be used for billing for this EpisodeOfCare.The billing system may choose to allocate billable items associated with the EpisodeOfCare to different referenced Accounts based on internal business rules.

Scope and Usage

The EpisodeOfCare Resource contains information about an association of a Patient with a Healthcare Provider for a period of time under which related healthcare activities may occur.

In many cases, this represents a period of time where the Healthcare Provider has some level of responsibility for the care of the patient regarding a specific condition or problem, even if not currently participating in an encounter.

These resources are typically known in existing systems as:

Multiple Organizations and Transfer of Care

Many organizations can be involved in an episode of care, however each organization will have its own EpisodeOfCare resource instance that tracks its responsibility with the patient.

When an Organization completes their involvement with the patient and transfers care to another Organization. This is often in the form of a referral to another Organization (or Organizations).

When an incoming referral is received a new EpisodeOfCare may be created for this organization. The initial step(s) in the intake workflow for the referral often involve some form of assessment(s), eligibility, capacity, care levels, which could take some time.
Once the intake process is completed and the patient is accepted, a CarePlan is often created.

Boundaries and Relationships

The primary difference between the EpisodeOfCare and the Encounter is that the Encounter records the details of an activity directly relating to the patient, while the EpisodeOfCare is the container that can link a series of Encounters together for problems/issues.
The Example scenarios below give some good examples as to when you might want to be using an EpisodeOfCare.

This difference is a similar difference between the EpisodeOfCare and a CarePlan. The EpisodeOfCare is a tracking resource, rather than a planning resource.
The EpisodeOfCare usually exists before the CarePlan. You don't need a CarePlan to use an EpisodeOfCare.

Background and Context

Systems collect a coherent group of activities (such as encounters) related to a patient's health condition or problem often referred to as a Care Episode. Information about an episode is often shared across systems, and in some cases organizational and disciplinary boundaries. An EpisodeOfCare contains details about the purpose of the care and can exist without any activities.
The minimal information that would be required in an episode of care would be a patient, organization and a reason for the ongoing association. Other reasons for creating an EpisodeOfCare could be for tracking the details required for government reporting or billing.

Expected Implementations

Status Management

History and Period

When an organization assumes responsibility for a patient, then the EpisodeOfCare is created and a start date entered to show when it has begun.
As the organization's responsibility changes, so does the status of the EpisodeOfCare.
This is described via an example below for an intake workflow.

Leave Handling

With long term care there is often a concept of the provision of care being suspended for various reasons. Many systems have extensive Leave Management/Tracking solutions which consider the complexities of this space, however this EpisodeOfCare resource is NOT intended to provide this level of tracking.
Extension(s) may be used on the status/status history to track the on-hold reason, which can facilitate the processing.

A more complete Leave Management solution may have to deal with:

Example Intake Workflow

This example sequence demonstrates some status transitions and how other resources interact.
The context could be in a Community/Aged Care/Disability/Mental Health setting.

In some jurisdictions an Organization may be funded by a government body for the days that a patient is under their care. These are known as "active days". This does not mean that they are actively receiving a service (an encounter), but that the organization is responsible for managing their care.
This monthly reporting value can be easily extracted from the status history as described above.
The actual provision of services may also be funded separately, and this would be via the Encounters.

EpisodeOfCare Outcomes Review

An Organization may perform analytics on their EpisodeOfCare resources to have an understanding of how their business is performing.
Observing that there was a 60/40 split of episodes being finished/cancelled is not very informative. The organization would prefer to know the reason why the episodes are completing so that they can plan their business effectively.
They’d be more interested in knowing whether it was due to services hitting their mandatory end date, client passing away, client transitioning to a higher level of services provided by them or to another provider etc.

Currently there are no attributes on this resource to provide this information. This would be very specific to each implementation and usage, so it would be recommended to use extensions to achieve this functionality.

Example Scenarios

A General Practitioner wants to review how well his patient is managing his diabetes over time from information within his clinic and also the regional community care organization's system(s).

The EpisodeOfCare enables the practitioner to easily separate the diabetes activities from the mental health problem's activities.

A Community Care organization wants to track all activities that occur with a patient relating to their disability to simplify the reporting to the government to receive funding to care for the patient

Search Parameters

care-managerCare manager/care coordinator for the patientEpisodeOfCare.careManager.where(resolve() is Practitioner)
conditionConditions/problems/diagnoses this episode of care is forEpisodeOfCare.diagnosis.condition.where(resolve() is Condition)
incoming-referralIncoming Referral RequestEpisodeOfCare.referralRequest.where(resolve() is ServiceRequest)
organizationThe organization that has assumed the specific responsibilities of this EpisodeOfCareEpisodeOfCare.managingOrganization.where(resolve() is Organization)
statusThe current status of the Episode of Care as provided (does not check the status history collection)EpisodeOfCare.status

Extension Definitions

These are extension definitions for this resource defined by the spec