Outpatient Visits
Logical Data Model
The figure below details the data model that is supported by FHIR in respect of outpatient visits, appointments:
Discussion Points
Although FHIR supports Appointments, Encounters and EpisodesOfCare referencing multiple ReferralRequests, it may make sense and simplify the model in Notts and restrict it to a single
Similarly, it may make sense to restrict an Encounter to a single EpisodeOfCare. In which case there is effectively a 1:1 relationship between the ReferralRequest and the EpisodeOfCare.
Since the Appointment resource does not reference the EpisodeOfCare, the ReferralRequest could be used as the mechanism to link/group all related Appointments and Encounters
Encounters vs Appointments
Whilst the terms “Encounter” and “Appointment” might be used interchangeably in everyday speech, in FHIR they have specific meanings:
- An Appointment predominantly describes a plan for the future
- An Encounter generally describes something that is happening now, or has occurred in the past
In general therefore:
- An Appointment will lead to an Encounter - when the patient attends
- An Encounter may or may not come from an Appointment (i.e. scheduled vs unscheduled care)
Although FHIR allows an Encounter to be created with status “planned”, this is NOT recommended in the Notts Care Record - future planned attendances should be represented instead with an Appointment.
The main point of the Appointment is to show plans for the future – hence enabling providers to avoid certain days slots if the patient is already booked. It also would support proactive notifications … alert all providers who have an appointment with patient xyz in the next ‘n’ days, if that individual has an unplanned hospital admission.
However, providers SHOULD update the Appointment with cancellations/DNA using the Appointment.status
The Outpatient Encounter that results from an appointment (assuming the patient turns up and the Encounter happens) SHOULD be linked using Encounter.appointment**
Some settings (e.g. Mental and Community Health) will also have Appointments and Encounters for home visits or phone calls/video chats, although these will follow the same basic model as actual Outpatient Visits, however the Encounter will have a different Class to identify that it took place outside a healthcare facility