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This is an Implementation Guide for UK Core FHIR Assets in Development.
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StructureDefinition-UKCore-EpisodeOfCare

Canonical_URL	Status	Current_Version	Last_Updated	Description
https://fhir.hl7.org.uk/StructureDefinition/UKCore-EpisodeOfCare	draft	2.2.0	2023-12-16	This profile defines the UK constraints and extensions on the International FHIR resource EpisodeOfCare.

Profile_Purpose
This profile allows exchange of information about an association between a patient and an organisation / healthcare providers during which time encounters may occur. The managing organisation assumes a level of responsibility for the individual during this time. Relationship to Encounter 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: EpisodeOfCare: Case, Program, Problem, Episode Encounter: Visit, Contact.

Profile_Purpose

This profile allows exchange of information about an association between a patient and an organisation / healthcare providers during which time encounters may occur. The managing organisation assumes a level of responsibility for the individual during this time.

Relationship to Encounter

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:

EpisodeOfCare: Case, Program, Problem, Episode
Encounter: Visit, Contact.

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	S Σ ?!	1..1	codeBinding	There are no (further) constraints on this element 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..*	CodeableConcept	There are no (further) constraints on this element 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 Binding The type of the episode of care. EpisodeOfCareType (example) 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	S 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	S 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	S 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)

Detailed Descriptions

EpisodeOfCare
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.
Cardinality	0...*
Alias	Case Program Problem
Invariants	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
EpisodeOfCare.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	System.String
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
EpisodeOfCare.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a rim:N/A
EpisodeOfCare.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a
EpisodeOfCare.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a
EpisodeOfCare.text
Definition	A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a rim:N/A rim:Act.text?
EpisodeOfCare.contained
Definition	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim:Entity. Role, or Act rim:N/A
EpisodeOfCare.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
EpisodeOfCare.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
EpisodeOfCare.identifier
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.
Cardinality	0...*
Type	Identifier
Invariants	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
EpisodeOfCare.status
Definition	planned \| waitlist \| active \| onhold \| finished \| cancelled.
Cardinality	1...1
Type	code
Binding	The status of the episode of care. EpisodeOfCareStatus (required)
Must Support	True
Modifier	True
Summary	True
Comments	This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid.
Invariants	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
EpisodeOfCare.statusHistory
Definition	The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource).
Cardinality	0...*
Type	BackboneElement
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a
EpisodeOfCare.statusHistory.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	System.String
Mappings	rim:n/a
EpisodeOfCare.statusHistory.extension
Definition	May 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
EpisodeOfCare.statusHistory.modifierExtension
Definition	May 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).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
EpisodeOfCare.statusHistory.status
Definition	planned \| waitlist \| active \| onhold \| finished \| cancelled.
Cardinality	1...1
Type	code
Binding	The status of the episode of care. EpisodeOfCareStatus (required)
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a
EpisodeOfCare.statusHistory.period
Definition	The period during this EpisodeOfCare that the specific status applied.
Cardinality	1...1
Type	Period
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.
Invariants	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"]
EpisodeOfCare.type
Definition	A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care.
Cardinality	0...*
Type	CodeableConcept
Binding	The type of the episode of care. EpisodeOfCareType (example)
Summary	True
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.
Invariants	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
EpisodeOfCare.diagnosis
Definition	The list of diagnosis relevant to this episode of care.
Cardinality	0...*
Type	BackboneElement
Summary	True
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a
EpisodeOfCare.diagnosis.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	System.String
Mappings	rim:n/a
EpisodeOfCare.diagnosis.extension
Definition	May 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
EpisodeOfCare.diagnosis.modifierExtension
Definition	May 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).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim:n/a rim:N/A
EpisodeOfCare.diagnosis.condition
Definition	A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for.
Cardinality	1...1
Type	Reference(Condition)
Summary	True
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.
Invariants	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]
EpisodeOfCare.diagnosis.role
Definition	Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …).
Cardinality	0...1
Type	CodeableConcept
Binding	The type of diagnosis this condition represents. DiagnosisRole (preferred)
Summary	True
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.
Invariants	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
EpisodeOfCare.diagnosis.rank
Definition	Ranking of the diagnosis (for each role type).
Cardinality	0...1
Type	positiveInt
Summary	True
Comments	32 bit number; for values larger than this, use decimal
Invariants	ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim:n/a
EpisodeOfCare.patient
Definition	The patient who is the focus of this episode of care.
Cardinality	1...1
Type	Reference(Patient)
Must Support	True
Summary	True
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.
Invariants	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
EpisodeOfCare.managingOrganization
Definition	The organization that has assumed the specific responsibilities for the specified duration.
Cardinality	0...1
Type	Reference(Organization)
Summary	True
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.
Invariants	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
EpisodeOfCare.period
Definition	The interval during which the managing organization assumes the defined responsibility.
Cardinality	0...1
Type	Period
Must Support	True
Summary	True
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.
Invariants	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
EpisodeOfCare.referralRequest
Definition	Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals.
Cardinality	0...*
Type	Reference(ServiceRequest)
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.
Invariants	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
EpisodeOfCare.careManager
Definition	The practitioner that is the care manager/care coordinator for this patient.
Cardinality	0...1
Type	Reference(Practitioner \| PractitionerRole)
Must Support	True
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.
Invariants	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
EpisodeOfCare.team
Definition	The list of practitioners that may be facilitating this episode of care for specific purposes.
Cardinality	0...*
Type	Reference(CareTeam)
Alias	CareTeam
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.
Invariants	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
EpisodeOfCare.account
Definition	The set of accounts that may be used for billing for this EpisodeOfCare.
Cardinality	0...*
Type	Reference(Account)
Comments	The billing system may choose to allocate billable items associated with the EpisodeOfCare to different referenced Accounts based on internal business rules.
Invariants	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)

Table View

EpisodeOfCare		..
EpisodeOfCare.status		..
EpisodeOfCare.patient		..
EpisodeOfCare.period		..
EpisodeOfCare.careManager		..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-EpisodeOfCare" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-EpisodeOfCare" />
    <version value="2.2.0" />
    <name value="UKCoreEpisodeOfCare" />
    <title value="UK Core EpisodeOfCare" />
    <status value="draft" />
    <date value="2023-12-16" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [EpisodeOfCare](https://hl7.org/fhir/R4/EpisodeOfCare.html)." />
    <purpose value="This profile allows exchange of information about an association between a patient and an organisation / healthcare providers during which time encounters may occur. The managing organisation assumes a level of responsibility for the individual during this time.\n\n   #### Relationship to Encounter \n 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: \n- **EpisodeOfCare:** Case, Program, Problem, Episode \n- **Encounter:** Visit, Contact." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <mapping>
        <identity value="workflow" />
        <uri value="http://hl7.org/fhir/workflow" />
        <name value="Workflow Pattern" />
    </mapping>
    <mapping>
        <identity value="rim" />
        <uri value="http://hl7.org/v3" />
        <name value="RIM Mapping" />
    </mapping>
    <mapping>
        <identity value="w5" />
        <uri value="http://hl7.org/fhir/fivews" />
        <name value="FiveWs Pattern Mapping" />
    </mapping>
    <kind value="resource" />
    <abstract value="false" />
    <type value="EpisodeOfCare" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare" />
    <derivation value="constraint" />
    <differential>
        <element id="EpisodeOfCare.status">
            <path value="EpisodeOfCare.status" />
            <mustSupport value="true" />
        </element>
        <element id="EpisodeOfCare.patient">
            <path value="EpisodeOfCare.patient" />
            <mustSupport value="true" />
        </element>
        <element id="EpisodeOfCare.period">
            <path value="EpisodeOfCare.period" />
            <mustSupport value="true" />
        </element>
        <element id="EpisodeOfCare.careManager">
            <path value="EpisodeOfCare.careManager" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-EpisodeOfCare",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-EpisodeOfCare",
    "version": "2.2.0",
    "name": "UKCoreEpisodeOfCare",
    "title": "UK Core EpisodeOfCare",
    "status": "draft",
    "date": "2023-12-16",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [EpisodeOfCare](https://hl7.org/fhir/R4/EpisodeOfCare.html).",
    "purpose": "This profile allows exchange of information about an association between a patient and an organisation / healthcare providers during which time encounters may occur. The managing organisation assumes a level of responsibility for the individual during this time.\n\n   #### Relationship to Encounter \n 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: \n- **EpisodeOfCare:** Case, Program, Problem, Episode \n- **Encounter:** Visit, Contact.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "mapping":  [
        {
            "identity": "workflow",
            "uri": "http://hl7.org/fhir/workflow",
            "name": "Workflow Pattern"
        },
        {
            "identity": "rim",
            "uri": "http://hl7.org/v3",
            "name": "RIM Mapping"
        },
        {
            "identity": "w5",
            "uri": "http://hl7.org/fhir/fivews",
            "name": "FiveWs Pattern Mapping"
        }
    ],
    "kind": "resource",
    "abstract": false,
    "type": "EpisodeOfCare",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/EpisodeOfCare",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "EpisodeOfCare.status",
                "path": "EpisodeOfCare.status",
                "mustSupport": true
            },
            {
                "id": "EpisodeOfCare.patient",
                "path": "EpisodeOfCare.patient",
                "mustSupport": true
            },
            {
                "id": "EpisodeOfCare.period",
                "path": "EpisodeOfCare.period",
                "mustSupport": true
            },
            {
                "id": "EpisodeOfCare.careManager",
                "path": "EpisodeOfCare.careManager",
                "mustSupport": true
            }
        ]
    }
}

Usage

This Profile has the following derived profiles:

This Profile is referenced in the following Extensions:

This Profile is referenced in the following Profiles:

Feedback

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Report issue for UKCore-EpisodeOfCare

Examples

Smoking Cessation Therapy -An example to illustrate an episode of care for smoking cessation therapy.
Example UKCore-EpisodeOfCare-SmokingCessationTherapy

Example Usage Scenarios

The following are example usage scenarios for the UK Core EpisodeOfCare profile:

Query for information about an episode of care associated with a patient
Record or update information about an episode of care for a patient

Profile Specific Implementation Guidance:

Minimum Viable Content

A minimum viable content that all provider and consumer systems SHALL support are the following elements.

Element	Reason
`EpisodeOfCare.patient`	The patient who is the focus of this episode of care.
`EpisodeOfCare.period`	The interval during which the managing organization assumes the defined responsibility.
`EpisodeOfCare.careManager`	The practitioner that is the care manager/care coordinator for this patient.

`diagnosis`

EpisodeOfCare.diagnosis.condition it is expected that the resource being referenced SHOULD conform to Profile UKCore-Condition.

`patient`

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Patient.

`managingOrganization`

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Organization.

`referralRequest`

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-ServiceRequest.

`careManager`

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`team`

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-CareTeam.