Structure Definition: EpisodeOfCare Profile

Canonical URL: https://signalbhn.org/fhir/StructureDefinition/episodeofcare

Simplifier project page: EpisodeOfCare

Derived from: FHIR Core R4 EpisodeOfCare

Formal profile content

EpisodeOfCare	I		EpisodeOfCare	There are no (further) constraints on this element Element Id EpisodeOfCare Short description 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 Alternate names Case Program Problem 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. Data Type EpisodeOfCare Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: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-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 `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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event rim:n/a
identifier		0..*	Identifier	There are no (further) constraints on this element Element Id EpisodeOfCare.identifier Short description Business Identifier(s) relevant for this EpisodeOfCare 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. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier
status	Σ ?!	1..1	codeBinding	Element Id EpisodeOfCare.status Short description planned \| waitlist \| active \| onhold \| finished \| cancelled \| entered-in-error Definition planned \| waitlist \| active \| onhold \| finished \| cancelled. Comments This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid. Data Type code Binding The status of the episode of care. EpisodeOfCareStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.status w5:FiveWs.status
statusHistory		0..*	BackboneElement	There are no (further) constraints on this element Element Id EpisodeOfCare.statusHistory Short description Past list of status codes (the current status may be included to cover the start date of the status) Definition The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource). Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
status		1..1	codeBinding	There are no (further) constraints on this element Element Id EpisodeOfCare.statusHistory.status Short description planned \| waitlist \| active \| onhold \| finished \| cancelled \| entered-in-error Definition planned \| waitlist \| active \| onhold \| finished \| cancelled. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type code Binding The status of the episode of care. EpisodeOfCareStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
period	I	1..1	Period	There are no (further) constraints on this element Element Id EpisodeOfCare.statusHistory.period Short description Duration the EpisodeOfCare was in the specified status Definition The period during this EpisodeOfCare that the specific status applied. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
type	Σ	0..*	CodeableConceptBinding	Element Id EpisodeOfCare.type Short description Type/class - e.g. specialist referral, disease management Definition A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. 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. Data Type CodeableConcept Sliced: Unordered, Open, by coding.system(Value) Binding The type of the episode of care. SignalHealthcareServiceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.class
program	Σ	0..*	CodeableConceptBinding	Element Id EpisodeOfCare.type:program Short description Type/class - e.g. specialist referral, disease management Definition A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. 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. Data Type CodeableConcept Binding This value set defines the set of codes that could be can be used to classify signal specific programs SignalProgram (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.class
services	Σ	0..*	CodeableConceptBinding	Element Id EpisodeOfCare.type:services Short description Type/class - e.g. specialist referral, disease management Definition A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. 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. Data Type CodeableConcept Binding Signal specific healthcare service types being performed or delivered SignalHealthcareServiceType (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.class
diagnosis	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis Short description The list of diagnosis relevant to this episode of care Definition The list of diagnosis relevant to this episode of care. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
condition	Σ I	1..1	Reference(Condition)	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis.condition Short description Conditions/problems/diagnoses this episode of care is for Definition A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Condition) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.reasonReference w5:FiveWs.what[x]
role	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis.role Short description Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) Definition Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …). Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The type of diagnosis this condition represents. DiagnosisRole (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
rank	Σ	0..1	positiveInt	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis.rank Short description Ranking of the diagnosis (for each role type) Definition Ranking of the diagnosis (for each role type). Comments 32 bit number; for values larger than this, use decimal Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
patient	Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element Element Id EpisodeOfCare.patient Short description The patient who is the focus of this episode of care Definition The patient who is the focus of this episode of care. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] w5:FiveWs.subject
managingOrganization	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id EpisodeOfCare.managingOrganization Short description Organization that assumes care Definition The organization that has assumed the specific responsibilities for the specified duration. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id EpisodeOfCare.period Short description Interval during responsibility is assumed Definition The interval during which the managing organization assumes the defined responsibility. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow:Event.occurrence[x] w5:FiveWs.init
referralRequest	I	0..*	Reference(ServiceRequest)	There are no (further) constraints on this element Element Id EpisodeOfCare.referralRequest Short description Originating Referral Request(s) Definition Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(ServiceRequest) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.basedOn
careManager	I	0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element Id EpisodeOfCare.careManager Short description Care manager/care coordinator for the patient Definition The practitioner that is the care manager/care coordinator for this patient. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Practitioner \| PractitionerRole) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor
team	I	0..*	Reference(CareTeam)	There are no (further) constraints on this element Element Id EpisodeOfCare.team Short description Other practitioners facilitating this episode of care Alternate names CareTeam Definition The list of practitioners that may be facilitating this episode of care for specific purposes. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(CareTeam) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor
account	I	0..*	Reference(Account)	There are no (further) constraints on this element Element Id EpisodeOfCare.account Short description The set of accounts that may be used for billing for this EpisodeOfCare Definition The set of accounts that may be used for billing for this EpisodeOfCare. Comments The billing system may choose to allocate billable items associated with the EpisodeOfCare to different referenced Accounts based on internal business rules. Data Type Reference(Account) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

EpisodeOfCare	I		EpisodeOfCare	There are no (further) constraints on this element Element Id EpisodeOfCare Short description 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 Alternate names Case Program Problem 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. Data Type EpisodeOfCare Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: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-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 `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-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event rim:n/a
identifier		0..*	Identifier	There are no (further) constraints on this element Element Id EpisodeOfCare.identifier Short description Business Identifier(s) relevant for this EpisodeOfCare 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. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier
status	Σ ?!	1..1	codeBinding	Element Id EpisodeOfCare.status Short description planned \| waitlist \| active \| onhold \| finished \| cancelled \| entered-in-error Definition planned \| waitlist \| active \| onhold \| finished \| cancelled. Comments This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid. Data Type code Binding The status of the episode of care. EpisodeOfCareStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.status w5:FiveWs.status
statusHistory		0..*	BackboneElement	There are no (further) constraints on this element Element Id EpisodeOfCare.statusHistory Short description Past list of status codes (the current status may be included to cover the start date of the status) Definition The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource). Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
status		1..1	codeBinding	There are no (further) constraints on this element Element Id EpisodeOfCare.statusHistory.status Short description planned \| waitlist \| active \| onhold \| finished \| cancelled \| entered-in-error Definition planned \| waitlist \| active \| onhold \| finished \| cancelled. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type code Binding The status of the episode of care. EpisodeOfCareStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
period	I	1..1	Period	There are no (further) constraints on this element Element Id EpisodeOfCare.statusHistory.period Short description Duration the EpisodeOfCare was in the specified status Definition The period during this EpisodeOfCare that the specific status applied. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
type	Σ	0..*	CodeableConceptBinding	Element Id EpisodeOfCare.type Short description Type/class - e.g. specialist referral, disease management Definition A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. 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. Data Type CodeableConcept Sliced: Unordered, Open, by coding.system(Value) Binding The type of the episode of care. SignalHealthcareServiceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.class
program	Σ	0..*	CodeableConceptBinding	Element Id EpisodeOfCare.type:program Short description Type/class - e.g. specialist referral, disease management Definition A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. 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. Data Type CodeableConcept Binding This value set defines the set of codes that could be can be used to classify signal specific programs SignalProgram (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.class
services	Σ	0..*	CodeableConceptBinding	Element Id EpisodeOfCare.type:services Short description Type/class - e.g. specialist referral, disease management Definition A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. 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. Data Type CodeableConcept Binding Signal specific healthcare service types being performed or delivered SignalHealthcareServiceType (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD workflow:Event.code w5:FiveWs.class
diagnosis	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis Short description The list of diagnosis relevant to this episode of care Definition The list of diagnosis relevant to this episode of care. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
condition	Σ I	1..1	Reference(Condition)	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis.condition Short description Conditions/problems/diagnoses this episode of care is for Definition A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Condition) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.reasonReference w5:FiveWs.what[x]
role	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis.role Short description Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) Definition Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …). Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data Type CodeableConcept Binding The type of diagnosis this condition represents. DiagnosisRole (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD
rank	Σ	0..1	positiveInt	There are no (further) constraints on this element Element Id EpisodeOfCare.diagnosis.rank Short description Ranking of the diagnosis (for each role type) Definition Ranking of the diagnosis (for each role type). Comments 32 bit number; for values larger than this, use decimal Data Type positiveInt Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
patient	Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element Element Id EpisodeOfCare.patient Short description The patient who is the focus of this episode of care Definition The patient who is the focus of this episode of care. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] w5:FiveWs.subject
managingOrganization	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element Id EpisodeOfCare.managingOrganization Short description Organization that assumes care Definition The organization that has assumed the specific responsibilities for the specified duration. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id EpisodeOfCare.period Short description Interval during responsibility is assumed Definition The interval during which the managing organization assumes the defined responsibility. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow:Event.occurrence[x] w5:FiveWs.init
referralRequest	I	0..*	Reference(ServiceRequest)	There are no (further) constraints on this element Element Id EpisodeOfCare.referralRequest Short description Originating Referral Request(s) Definition Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(ServiceRequest) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.basedOn
careManager	I	0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element Id EpisodeOfCare.careManager Short description Care manager/care coordinator for the patient Definition The practitioner that is the care manager/care coordinator for this patient. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(Practitioner \| PractitionerRole) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor
team	I	0..*	Reference(CareTeam)	There are no (further) constraints on this element Element Id EpisodeOfCare.team Short description Other practitioners facilitating this episode of care Alternate names CareTeam Definition The list of practitioners that may be facilitating this episode of care for specific purposes. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(CareTeam) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer.actor
account	I	0..*	Reference(Account)	There are no (further) constraints on this element Element Id EpisodeOfCare.account Short description The set of accounts that may be used for billing for this EpisodeOfCare Definition The set of accounts that may be used for billing for this EpisodeOfCare. Comments The billing system may choose to allocate billable items associated with the EpisodeOfCare to different referenced Accounts based on internal business rules. Data Type Reference(Account) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity)

{
    "resourceType": "StructureDefinition",
    "id": "signal-epdisodeofcare-profile",
    "url": "https://signalbhn.org/fhir/StructureDefinition/episodeofcare",
    "name": "SignalEpisodeOfCare",
    "title": "EpisodeOfCare Profile",
    "status": "active",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "EpisodeOfCare",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/EpisodeOfCare",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "EpisodeOfCare.status",
                "path": "EpisodeOfCare.status",
                "binding": {
                    "strength": "required",
                    "valueSet": "http://hl7.org/fhir/ValueSet/episode-of-care-status"
                }
            },
            {
                "id": "EpisodeOfCare.type",
                "path": "EpisodeOfCare.type",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "coding.system"
                        }
                    ],
                    "rules": "open"
                },
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://signalbhn.org/fhir/ValueSet/signal-healthcare-service-type"
                }
            },
            {
                "id": "EpisodeOfCare.type:program",
                "path": "EpisodeOfCare.type",
                "sliceName": "program",
                "binding": {
                    "strength": "required",
                    "description": "This value set defines the set of codes that could be can be used to classify signal specific programs",
                    "valueSet": "https://signalbhn.org/fhir/ValueSet/signal-program"
                }
            },
            {
                "id": "EpisodeOfCare.type:services",
                "path": "EpisodeOfCare.type",
                "sliceName": "services",
                "binding": {
                    "strength": "required",
                    "description": "Signal specific healthcare service types being performed or delivered",
                    "valueSet": "https://signalbhn.org/fhir/ValueSet/signal-healthcare-service-type"
                }
            }
        ]
    }
}

Profile usage

The EpisodeOfCare resource represents the container for all services or contact points between a patient (client) and a healthcare services (provider). This resource is also called the 'admission' and captures the entire case history for a patient for a program and selected services (service types).

EpisodeOfCare will rarely change once it is created. Some instances of changes will be: an updated period.start date in the case of a referral or a period.end date for a discharge. In the latter case, the status should also be updated to 'complete'. Additional encounters will point to an EpisodeOfCare resource and not the other way around.

Referrals in EpisodeOfCare

Any referrals from the Jolata system (called referrals) will reference a Structure Definition: ServiceRequest Profile on the EpisodeOfCare.referralRequest element. This will often begin a patient's admission record and SHOULD contain an Encounter record for the first contact or any interaction attempt with related codes. Although this first attempt may start an admission and encounter records, the EpisodeOfCare.period.start date MAY correspond to when an admission took place, usually beginning with a survey assessment.

Profile element notes

.type

Will remain FHIR default (example) but will be unused at this time (see slices)

.type:program

Represents the same concept as the HealthcareService.program element
SHALL be used to group services offered by one or more organizations under a formal "program" label; e.g. SUD, CYMHTA, CCS.
Programs are relatively static within the organization and create the main taxonomy for the service categories and procedures available.

.type:services

Represents the same concept as the HealthcareService.type:services element
Custom code system for Signal that represents the "services" or "service type" codes that are available based on Organization qualifications; e.g. asam-0.5, da, crisis-mobile, etc.

.managingOrganization

Represents the UI field 'Primary Service Location'
Although this represents a single provider location, encounters pointing to this EpisodeOfCare may have different locations and/or with entirely different provider agencies
This will primarily be used to provide default HealthcareService offerings on the UI
The higher-level Provider Agency (accessed via the highest level of Organization.partOf) should be considered for all HealthcareService offerings available to the UI

.referralRequest

SHOULD point to the ServiceRequest resource that represents the referral from the Jolata system
This will only represent required information contained in the Jolata referral system. Edits to referral information should come from Jolata.

.careManager

SHALL point to the practitioner that is designated as the care manager when .referralRequest is populated

.team

Not presently used

Structure Definition: EpisodeOfCare Profile

Formal profile content

Profile usage

Referrals in EpisodeOfCare

Profile element notes

Examples