Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

8.10 Resource EpisodeOfCare - Content

Patient Administration icon Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Patient, Practitioner

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.

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

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

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

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

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

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

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

  • Chronic Disease Management Systems
  • Community Care Systems
    • Tracking progress of a specific condition
    • Tracking government funding
  • Problem based General Practice systems
  • Disability Support Systems
  • Aged Care Systems (Community and Residential)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare TUDomainResourceAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier(s) relevant for this EpisodeOfCare

... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: Episode Of Care Status (Required)
... statusHistory 0..*BackboneElementPast list of status codes (the current status may be included to cover the start date of the status)

.... status 1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: Episode Of Care Status (Required)
.... period 1..1PeriodDuration the EpisodeOfCare was in the specified status
... reason Σ0..*BackboneElementThe list of medical reasons that are expected to be addressed during the episode of care

.... use Σ0..1CodeableConceptWhat the reason value should be used for/as
Binding: Encounter Reason Use (Example)
.... value Σ0..*CodeableReference(Condition | Procedure | Observation | HealthcareService)Medical reason to be addressed
Binding: Encounter Reason Codes (Example)

... diagnosis Σ0..*BackboneElementThe list of medical conditions that were addressed during the episode of care

.... condition Σ0..*CodeableReference(Condition)The medical condition that was addressed during the episode of care
Binding: Condition/Problem/Diagnosis Codes (Example)

.... use Σ0..1CodeableConceptRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
Binding: Encounter Diagnosis Use (Preferred)
... patient Σ1..1Reference(Patient)The patient who is the focus of this episode of care
... managingOrganization Σ0..1Reference(Organization)Organization that assumes responsibility for care coordination
... period Σ0..1PeriodInterval during responsibility is assumed
... referralRequest 0..*Reference(ServiceRequest)Originating Referral Request(s)

... careManager 0..1Reference(Practitioner | PractitionerRole)Care manager/care coordinator for the patient
... careTeam 0..*Reference(CareTeam)Other practitioners facilitating this episode of care

... account 0..*Reference(Account)The set of accounts that may be used for billing for this EpisodeOfCare


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

EpisodeOfCare (DomainResource)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 purposesidentifier : Identifier [0..*]planned | waitlist | active | onhold | finished | cancelled (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)EpisodeOfCareStatus! »A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded caretype : CodeableConcept [0..*] « null (Strength=Example)EpisodeOfCareType?? »The patient who is the focus of this episode of carepatient : Reference [1..1] « Patient »The organization that has assumed the specific responsibilities for care coordination, care delivery, or other services for the specified durationmanagingOrganization : Reference [0..1] « Organization »The interval during which the managing organization assumes the defined responsibilityperiod : Period [0..1]Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referralsreferralRequest : Reference [0..*] « ServiceRequest »The practitioner that is the care manager/care coordinator for this patientcareManager : Reference [0..1] « Practitioner|PractitionerRole »The list of practitioners that may be facilitating this episode of care for specific purposescareTeam : Reference [0..*] « CareTeam »The set of accounts that may be used for billing for this EpisodeOfCareaccount : Reference [0..*] « Account »StatusHistoryplanned | waitlist | active | onhold | finished | cancelledstatus : code [1..1] « null (Strength=Required)EpisodeOfCareStatus! »The period during this EpisodeOfCare that the specific status appliedperiod : Period [1..1]ReasonWhat the reason value should be used as e.g. Chief Complaint, Health Concern, Health Maintenance (including screening)use : CodeableConcept [0..1] « null (Strength=Example)EncounterReasonUse?? »The medical reason that is expected to be addressed during the episode of care, expressed as a text, code or a reference to another resourcevalue : CodeableReference [0..*] « Condition|Procedure|Observation| HealthcareService; null (Strength=Example)EncounterReasonCodes?? »DiagnosisThe medical condition that was addressed during the episode of care, expressed as a text, code or a reference to another resourcecondition : CodeableReference [0..*] « Condition; null (Strength=Example) ConditionProblemDiagnosisCodes?? »Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)use : CodeableConcept [0..1] « null (Strength=Preferred)EncounterDiagnosisUse? »The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource)statusHistory[0..*]The list of medical reasons that are expected to be addressed during the episode of carereason[0..*]The list of medical conditions that were addressed during the episode of carediagnosis[0..*]

XML Template

<EpisodeOfCare xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier(s) relevant for this EpisodeOfCare --></identifier>
 <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
 <statusHistory>  <!-- 0..* Past list of status codes (the current status may be included to cover the start date of the status) -->
  <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
  <period><!-- 1..1 Period Duration the EpisodeOfCare was in the specified status --></period>
 </statusHistory>
 <type><!-- 0..* CodeableConcept Type/class  - e.g. specialist referral, disease management --></type>
 <reason>  <!-- 0..* The list of medical reasons that are expected to be addressed during the episode of care -->
  <use><!-- 0..1 CodeableConcept What the reason value should be used for/as --></use>
  <value><!-- 0..* CodeableReference(Condition|HealthcareService|Observation|
    Procedure) Medical reason to be addressed --></value>
 </reason>
 <diagnosis>  <!-- 0..* The list of medical conditions that were addressed during the episode of care -->
  <condition><!-- 0..* CodeableReference(Condition) The medical condition that was addressed during the episode of care --></condition>
  <use><!-- 0..1 CodeableConcept Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) --></use>
 </diagnosis>
 <patient><!-- 1..1 Reference(Patient) The patient who is the focus of this episode of care --></patient>
 <managingOrganization><!-- 0..1 Reference(Organization) Organization that assumes responsibility for care coordination --></managingOrganization>
 <period><!-- 0..1 Period Interval during responsibility is assumed --></period>
 <referralRequest><!-- 0..* Reference(ServiceRequest) Originating Referral Request(s) --></referralRequest>
 <careManager><!-- 0..1 Reference(Practitioner|PractitionerRole) Care manager/care coordinator for the patient --></careManager>
 <careTeam><!-- 0..* Reference(CareTeam) Other practitioners facilitating this episode of care --></careTeam>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this EpisodeOfCare --></account>
</EpisodeOfCare>

JSON Template

{doco
  "resourceType" : "EpisodeOfCare",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier(s) relevant for this EpisodeOfCare
  "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  "statusHistory" : [{ // Past list of status codes (the current status may be included to cover the start date of the status)
    "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    "period" : { Period } // R!  Duration the EpisodeOfCare was in the specified status
  }],
  "type" : [{ CodeableConcept }], // Type/class  - e.g. specialist referral, disease management
  "reason" : [{ // The list of medical reasons that are expected to be addressed during the episode of care
    "use" : { CodeableConcept }, // What the reason value should be used for/as
    "value" : [{ CodeableReference(Condition|HealthcareService|Observation|
    Procedure) }] // Medical reason to be addressed
  }],
  "diagnosis" : [{ // The list of medical conditions that were addressed during the episode of care
    "condition" : [{ CodeableReference(Condition) }], // The medical condition that was addressed during the episode of care
    "use" : { CodeableConcept } // Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
  }],
  "patient" : { Reference(Patient) }, // R!  The patient who is the focus of this episode of care
  "managingOrganization" : { Reference(Organization) }, // Organization that assumes responsibility for care coordination
  "period" : { Period }, // Interval during responsibility is assumed
  "referralRequest" : [{ Reference(ServiceRequest) }], // Originating Referral Request(s)
  "careManager" : { Reference(Practitioner|PractitionerRole) }, // Care manager/care coordinator for the patient
  "careTeam" : [{ Reference(CareTeam) }], // Other practitioners facilitating this episode of care
  "account" : [{ Reference(Account) }] // The set of accounts that may be used for billing for this EpisodeOfCare
}

Turtle Template

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


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

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier(s) relevant for this EpisodeOfCare
  fhir:status [ code ] ; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  fhir:statusHistory ( [ # 0..* Past list of status codes (the current status may be included to cover the start date of the status)
    fhir:status [ code ] ; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    fhir:period [ Period ] ; # 1..1 Duration the EpisodeOfCare was in the specified status
  ] ... ) ;
  fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type/class  - e.g. specialist referral, disease management
  fhir:reason ( [ # 0..* The list of medical reasons that are expected to be addressed during the episode of care
    fhir:use [ CodeableConcept ] ; # 0..1 What the reason value should be used for/as
    fhir:value  ( [ CodeableReference(Condition|HealthcareService|Observation|Procedure) ] ... ) ; # 0..* Medical reason to be addressed
  ] ... ) ;
  fhir:diagnosis ( [ # 0..* The list of medical conditions that were addressed during the episode of care
    fhir:condition  ( [ CodeableReference(Condition) ] ... ) ; # 0..* The medical condition that was addressed during the episode of care
    fhir:use [ CodeableConcept ] ; # 0..1 Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
  ] ... ) ;
  fhir:patient [ Reference(Patient) ] ; # 1..1 The patient who is the focus of this episode of care
  fhir:managingOrganization [ Reference(Organization) ] ; # 0..1 Organization that assumes responsibility for care coordination
  fhir:period [ Period ] ; # 0..1 Interval during responsibility is assumed
  fhir:referralRequest  ( [ Reference(ServiceRequest) ] ... ) ; # 0..* Originating Referral Request(s)
  fhir:careManager [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Care manager/care coordinator for the patient
  fhir:careTeam  ( [ Reference(CareTeam) ] ... ) ; # 0..* Other practitioners facilitating this episode of care
  fhir:account  ( [ Reference(Account) ] ... ) ; # 0..* The set of accounts that may be used for billing for this EpisodeOfCare
]

Changes from both R4 and R4B

EpisodeOfCare
EpisodeOfCare.reason
  • Added Element
EpisodeOfCare.reason.use
  • Added Element
EpisodeOfCare.reason.value
  • Added Element
EpisodeOfCare.diagnosis.condition
  • Min Cardinality changed from 1 to 0
  • Max Cardinality changed from 1 to *
  • Type changed from Reference(Condition) to CodeableReference
EpisodeOfCare.diagnosis.use
  • Renamed from role to use
EpisodeOfCare.careTeam
  • Renamed from team to careTeam
EpisodeOfCare.diagnosis.rank
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare TUDomainResourceAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierBusiness Identifier(s) relevant for this EpisodeOfCare

... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: Episode Of Care Status (Required)
... statusHistory 0..*BackboneElementPast list of status codes (the current status may be included to cover the start date of the status)

.... status 1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: Episode Of Care Status (Required)
.... period 1..1PeriodDuration the EpisodeOfCare was in the specified status
... reason Σ0..*BackboneElementThe list of medical reasons that are expected to be addressed during the episode of care

.... use Σ0..1CodeableConceptWhat the reason value should be used for/as
Binding: Encounter Reason Use (Example)
.... value Σ0..*CodeableReference(Condition | Procedure | Observation | HealthcareService)Medical reason to be addressed
Binding: Encounter Reason Codes (Example)

... diagnosis Σ0..*BackboneElementThe list of medical conditions that were addressed during the episode of care

.... condition Σ0..*CodeableReference(Condition)The medical condition that was addressed during the episode of care
Binding: Condition/Problem/Diagnosis Codes (Example)

.... use Σ0..1CodeableConceptRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
Binding: Encounter Diagnosis Use (Preferred)
... patient Σ1..1Reference(Patient)The patient who is the focus of this episode of care
... managingOrganization Σ0..1Reference(Organization)Organization that assumes responsibility for care coordination
... period Σ0..1PeriodInterval during responsibility is assumed
... referralRequest 0..*Reference(ServiceRequest)Originating Referral Request(s)

... careManager 0..1Reference(Practitioner | PractitionerRole)Care manager/care coordinator for the patient
... careTeam 0..*Reference(CareTeam)Other practitioners facilitating this episode of care

... account 0..*Reference(Account)The set of accounts that may be used for billing for this EpisodeOfCare


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

EpisodeOfCare (DomainResource)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 purposesidentifier : Identifier [0..*]planned | waitlist | active | onhold | finished | cancelled (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)EpisodeOfCareStatus! »A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded caretype : CodeableConcept [0..*] « null (Strength=Example)EpisodeOfCareType?? »The patient who is the focus of this episode of carepatient : Reference [1..1] « Patient »The organization that has assumed the specific responsibilities for care coordination, care delivery, or other services for the specified durationmanagingOrganization : Reference [0..1] « Organization »The interval during which the managing organization assumes the defined responsibilityperiod : Period [0..1]Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referralsreferralRequest : Reference [0..*] « ServiceRequest »The practitioner that is the care manager/care coordinator for this patientcareManager : Reference [0..1] « Practitioner|PractitionerRole »The list of practitioners that may be facilitating this episode of care for specific purposescareTeam : Reference [0..*] « CareTeam »The set of accounts that may be used for billing for this EpisodeOfCareaccount : Reference [0..*] « Account »StatusHistoryplanned | waitlist | active | onhold | finished | cancelledstatus : code [1..1] « null (Strength=Required)EpisodeOfCareStatus! »The period during this EpisodeOfCare that the specific status appliedperiod : Period [1..1]ReasonWhat the reason value should be used as e.g. Chief Complaint, Health Concern, Health Maintenance (including screening)use : CodeableConcept [0..1] « null (Strength=Example)EncounterReasonUse?? »The medical reason that is expected to be addressed during the episode of care, expressed as a text, code or a reference to another resourcevalue : CodeableReference [0..*] « Condition|Procedure|Observation| HealthcareService; null (Strength=Example)EncounterReasonCodes?? »DiagnosisThe medical condition that was addressed during the episode of care, expressed as a text, code or a reference to another resourcecondition : CodeableReference [0..*] « Condition; null (Strength=Example) ConditionProblemDiagnosisCodes?? »Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)use : CodeableConcept [0..1] « null (Strength=Preferred)EncounterDiagnosisUse? »The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource)statusHistory[0..*]The list of medical reasons that are expected to be addressed during the episode of carereason[0..*]The list of medical conditions that were addressed during the episode of carediagnosis[0..*]

XML Template

<EpisodeOfCare xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier(s) relevant for this EpisodeOfCare --></identifier>
 <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
 <statusHistory>  <!-- 0..* Past list of status codes (the current status may be included to cover the start date of the status) -->
  <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error -->
  <period><!-- 1..1 Period Duration the EpisodeOfCare was in the specified status --></period>
 </statusHistory>
 <type><!-- 0..* CodeableConcept Type/class  - e.g. specialist referral, disease management --></type>
 <reason>  <!-- 0..* The list of medical reasons that are expected to be addressed during the episode of care -->
  <use><!-- 0..1 CodeableConcept What the reason value should be used for/as --></use>
  <value><!-- 0..* CodeableReference(Condition|HealthcareService|Observation|
    Procedure) Medical reason to be addressed --></value>
 </reason>
 <diagnosis>  <!-- 0..* The list of medical conditions that were addressed during the episode of care -->
  <condition><!-- 0..* CodeableReference(Condition) The medical condition that was addressed during the episode of care --></condition>
  <use><!-- 0..1 CodeableConcept Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) --></use>
 </diagnosis>
 <patient><!-- 1..1 Reference(Patient) The patient who is the focus of this episode of care --></patient>
 <managingOrganization><!-- 0..1 Reference(Organization) Organization that assumes responsibility for care coordination --></managingOrganization>
 <period><!-- 0..1 Period Interval during responsibility is assumed --></period>
 <referralRequest><!-- 0..* Reference(ServiceRequest) Originating Referral Request(s) --></referralRequest>
 <careManager><!-- 0..1 Reference(Practitioner|PractitionerRole) Care manager/care coordinator for the patient --></careManager>
 <careTeam><!-- 0..* Reference(CareTeam) Other practitioners facilitating this episode of care --></careTeam>
 <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this EpisodeOfCare --></account>
</EpisodeOfCare>

JSON Template

{doco
  "resourceType" : "EpisodeOfCare",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier(s) relevant for this EpisodeOfCare
  "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  "statusHistory" : [{ // Past list of status codes (the current status may be included to cover the start date of the status)
    "status" : "<code>", // R!  planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    "period" : { Period } // R!  Duration the EpisodeOfCare was in the specified status
  }],
  "type" : [{ CodeableConcept }], // Type/class  - e.g. specialist referral, disease management
  "reason" : [{ // The list of medical reasons that are expected to be addressed during the episode of care
    "use" : { CodeableConcept }, // What the reason value should be used for/as
    "value" : [{ CodeableReference(Condition|HealthcareService|Observation|
    Procedure) }] // Medical reason to be addressed
  }],
  "diagnosis" : [{ // The list of medical conditions that were addressed during the episode of care
    "condition" : [{ CodeableReference(Condition) }], // The medical condition that was addressed during the episode of care
    "use" : { CodeableConcept } // Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
  }],
  "patient" : { Reference(Patient) }, // R!  The patient who is the focus of this episode of care
  "managingOrganization" : { Reference(Organization) }, // Organization that assumes responsibility for care coordination
  "period" : { Period }, // Interval during responsibility is assumed
  "referralRequest" : [{ Reference(ServiceRequest) }], // Originating Referral Request(s)
  "careManager" : { Reference(Practitioner|PractitionerRole) }, // Care manager/care coordinator for the patient
  "careTeam" : [{ Reference(CareTeam) }], // Other practitioners facilitating this episode of care
  "account" : [{ Reference(Account) }] // The set of accounts that may be used for billing for this EpisodeOfCare
}

Turtle Template

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


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

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier(s) relevant for this EpisodeOfCare
  fhir:status [ code ] ; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
  fhir:statusHistory ( [ # 0..* Past list of status codes (the current status may be included to cover the start date of the status)
    fhir:status [ code ] ; # 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error
    fhir:period [ Period ] ; # 1..1 Duration the EpisodeOfCare was in the specified status
  ] ... ) ;
  fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type/class  - e.g. specialist referral, disease management
  fhir:reason ( [ # 0..* The list of medical reasons that are expected to be addressed during the episode of care
    fhir:use [ CodeableConcept ] ; # 0..1 What the reason value should be used for/as
    fhir:value  ( [ CodeableReference(Condition|HealthcareService|Observation|Procedure) ] ... ) ; # 0..* Medical reason to be addressed
  ] ... ) ;
  fhir:diagnosis ( [ # 0..* The list of medical conditions that were addressed during the episode of care
    fhir:condition  ( [ CodeableReference(Condition) ] ... ) ; # 0..* The medical condition that was addressed during the episode of care
    fhir:use [ CodeableConcept ] ; # 0..1 Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
  ] ... ) ;
  fhir:patient [ Reference(Patient) ] ; # 1..1 The patient who is the focus of this episode of care
  fhir:managingOrganization [ Reference(Organization) ] ; # 0..1 Organization that assumes responsibility for care coordination
  fhir:period [ Period ] ; # 0..1 Interval during responsibility is assumed
  fhir:referralRequest  ( [ Reference(ServiceRequest) ] ... ) ; # 0..* Originating Referral Request(s)
  fhir:careManager [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Care manager/care coordinator for the patient
  fhir:careTeam  ( [ Reference(CareTeam) ] ... ) ; # 0..* Other practitioners facilitating this episode of care
  fhir:account  ( [ Reference(Account) ] ... ) ; # 0..* The set of accounts that may be used for billing for this EpisodeOfCare
]

Changes from both R4 and R4B

EpisodeOfCare
EpisodeOfCare.reason
  • Added Element
EpisodeOfCare.reason.use
  • Added Element
EpisodeOfCare.reason.value
  • Added Element
EpisodeOfCare.diagnosis.condition
  • Min Cardinality changed from 1 to 0
  • Max Cardinality changed from 1 to *
  • Type changed from Reference(Condition) to CodeableReference
EpisodeOfCare.diagnosis.use
  • Renamed from role to use
EpisodeOfCare.careTeam
  • Renamed from team to careTeam
EpisodeOfCare.diagnosis.rank
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

PathValueSetTypeDocumentation
EpisodeOfCare.status EpisodeOfCareStatus Required

The status of the episode of care.

EpisodeOfCare.statusHistory.status EpisodeOfCareStatus Required

The status of the episode of care.

EpisodeOfCare.type EpisodeOfCareType Example

This example value set defines a set of codes that can be used to express the usage type of an EpisodeOfCare record.

EpisodeOfCare.reason.use EncounterReasonUse Example

What a specific Encounter/EpisodeOfCare reason.value is to be used for.

EpisodeOfCare.reason.value EncounterReasonCodes Example

This examples value set defines the set of codes that can be used to indicate reasons for an encounter.

EpisodeOfCare.diagnosis.condition ConditionProblemDiagnosisCodes Example

Example value set for Condition/Problem/Diagnosis codes.

EpisodeOfCare.diagnosis.use EncounterDiagnosisUse Preferred

What a specific Encounter/EpisodeOfCare diagnosis.condition is to be used for.

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

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

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

  • Leave Types
  • Leave Entitlements
  • Billing/Funding implications while on different types of leave

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

  • ServiceRequest received
  • intake clerk processes referral and decides that the first level eligibility has been met
    (e.g. Have capacity in the facility for the patient, the patient is covered by VA)
  • EpisodeOfCare created with status of planned which is allocated as fulfilling the ServiceRequest
  • Further assessment of needs is scheduled to be taken, a care manager is probably allocated at this point
  • Assessment Practitioner sees the Patient and completes a series of relevant Questionnaires to rank the patient
  • The assessments are reviewed and a formal CarePlan is created
  • The EpisodeOfCare is updated to be marked as active, and the CareTeam is likely filled in
  • The provision of care is then managed through the care plan, with all activities will also being linked to the EpisodeOfCare
  • The patient is admitted to hospital for some procedures, and the EpisodeOfCare is marked as on hold
    Some of the services on the CarePlan (or scheduled appointments) would be reviewed to determine if they can be performed without the patient (e.g., home maintenance), or if they should be suspended while the patient is on hold.
  • The patient returns from the hospital and the EpisodeOfCare is marked as active again (and services reviewed again)
  • Patient wished to move to another area to be closer to family
  • Organization creates an outgoing ServiceRequest to a new Organization to continue the care
  • The EpisodeOfCare is closed

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

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

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

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

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

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

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
care-managerreferenceCare manager/care coordinator for the patientEpisodeOfCare.careManager.where(resolve() is Practitioner)
(Practitioner)
datedateThe provided date search value falls within the episode of care's periodEpisodeOfCare.period27 Resources
diagnosis-codetokenConditions/problems/diagnoses this episode of care is for (coded)EpisodeOfCare.diagnosis.condition.concept
diagnosis-referencereferenceConditions/problems/diagnoses this episode of care is for (resource reference)EpisodeOfCare.diagnosis.condition.reference
identifiertokenBusiness Identifier(s) relevant for this EpisodeOfCareEpisodeOfCare.identifier65 Resources
incoming-referralreferenceIncoming Referral RequestEpisodeOfCare.referralRequest
(ServiceRequest)
organizationreferenceThe organization that has assumed the specific responsibilities of this EpisodeOfCareEpisodeOfCare.managingOrganization
(Organization)
patientreferenceThe patient who is the focus of this episode of careEpisodeOfCare.patient
(Patient)
66 Resources
reason-codetokenReference to a concept (coded)EpisodeOfCare.reason.value.concept
reason-referencereferenceReference to a resource (resource reference)EpisodeOfCare.reason.value.reference
statustokenThe current status of the Episode of Care as provided (does not check the status history collection)EpisodeOfCare.status
typetokenType/class - e.g. specialist referral, disease managementEpisodeOfCare.type11 Resources