Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm
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This page is part of the electronic Long-Term Services and Supports Implementation Guide (v2.0.0-ballot: STU2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: eLTSS EpisodeOfCare Profile

Official URL: http://hl7.org/fhir/us/eltss/StructureDefinition/EpisodeOfCare-eltss Version: 2.0.0-ballot
Standards status: Trial-use Maturity Level: 2 Computable Name: EpisodeOfCare_eltss

EpisodeOfCare for eLTSS

Implementer mapping guidance

The following aids in finding the location of eLTSS data elements. See R4 FHIR Mapping page for complete guidance, here we are providing a subset of fields for convenience.

eLTSS Grouping eLTSS Data Element Name Data Element Definition (includes examples, expected list of values and usage note where applicable) FHIR R4 Resource Element(s) FHIR R4 Resource Element Cardinality (with US Core Constraints) Additional Mapping Details Important change
Person Centered Planning Plan Monitor Name The name of the person responsible for monitoring the plan. CarePlan → encounter (Encounter)

Encounter → episodeOfCare(EpisodeOfCare)

EpisodeOfCare → careManager(Practitioner)

Practitioner → name → family
Practitioner → name → given
Practitioner → name → text		 CarePlan
...encounter(Encounter) 0..1
...... episodeOfCare(EpisodeOfCare)0..1
.........careManager(Practitioner) 0..1
............name 0..*
...............family 0-1
................given 0-*
................text 0-1		 1) Will use CarePlan → encounter to reference the EpisodeOfCare that defines the plan monitor (care manager) for the plan.
2) EpisodeOfCare → careManager references the Practitioner who is monitoring the plan.
3) given is used for both first name & MI, so need more than one.
4) family is a string with the person's surname.
5) text is a string that contains the full name of the person.
6) The values for Plan Monitor Name and Plan Monitor Printed Name would include the same information.
Person Centered Planning Plan Monitor Phone Number The primary phone number (and extension when applicable) of the plan monitor. CarePlan → encounter (Encounter)

Encounter → episodeOfCare(EpisodeOfCare)

EpisodeOfCare → careManager(Practitioner)

Practitioner → telecom → system
Practitioner → telecom → value		 CarePlan
...encounter(Encounter) 0..1
...... episodeOfCare(EpisodeOfCare)0..1
.........careManager(Practitioner) 0..1
............telecom 0..*
...............system 0..1
................value 0..1		 1) Will use CarePlan → encounter to reference the EpisodeOfCare that defines the plan monitor (care manager) for the plan.
2) EpisodeOfCare → careManager references the Practitioner who is monitoring the plan.
3) telecom is of type ContactPoint (https://www.hl7.org/fhir/datatypes.html#contactpoint) which contains elements to populate for the phone number.
4) system is required if value is provided, and can be: phone, fax, email, pager, url, sms, other.
5) Per FHIR, phone # should be formatted according to ITU-T E.123, so "(555) 675 5745" or "+22 555 675 5745".
Data Requirements Not Specific to eLTSS Dataset Data Elements
This section documents data elements that are mandatory per FHIR XML schemas or US Core requirements, but that do not align with individual eLTSS Dataset data elements.
FHIR Data Element Name
Requirement Source		 Data Element Definition FHIR R4 Resource Element(s) FHIR R4 Resource Element Cardinality (with US Core Constraints) Additional Mapping Details
EpisodeOfCare Status
FHIR		 Indicates the status of the episode of care. EpisodeOfCare → status EpisodeOfCare
...status 0..1		 1) status is required by FHIR, and must use the EpisodeOfCareStatus value set. Possible values are: planned, waitlist, active, onhold, finished, and cancelled.
EpisodeOfCare Patient
FHIR		 The patient who is the focus of this episode of care. EpisodeOfCare → patient(Patient) EpisodeOfCare
...patient 0..1		 1) patient is required by FHIR, and is a reference to a Patient.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from EpisodeOfCare

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare 0..*EpisodeOfCareAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... resource-pertainsToGoal S0..*Reference(Goal)The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources.
URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
... patient 1..1Reference(Patient_eltss)The patient who is the focus of this episode of care
... careManager S0..1Reference(Practitioner_eltss)Plan Monitor

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare 0..*EpisodeOfCareAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... resource-pertainsToGoal S0..*Reference(Goal)The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources.
URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: EpisodeOfCareStatus (required): The status of the episode of care.

... patient Σ1..1Reference(Patient_eltss)The patient who is the focus of this episode of care
... referralRequest 0..*Reference(ServiceRequest_eltss)Originating Referral Request(s)
... careManager S0..1Reference(Practitioner_eltss)Plan Monitor

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
EpisodeOfCare.statusrequiredEpisodeOfCareStatus

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorEpisodeOfCareIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorEpisodeOfCareIf 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-4errorEpisodeOfCareIf 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-5errorEpisodeOfCareIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceEpisodeOfCareA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare 0..*EpisodeOfCareAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... resource-pertainsToGoal S0..*Reference(Goal)The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources.
URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier(s) relevant for this EpisodeOfCare
... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: EpisodeOfCareStatus (required): The status of the episode of care.

... statusHistory 0..*BackboneElementPast list of status codes (the current status may be included to cover the start date of the status)
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... status 1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: EpisodeOfCareStatus (required): The status of the episode of care.

.... period 1..1PeriodDuration the EpisodeOfCare was in the specified status
... type Σ0..*CodeableConceptType/class - e.g. specialist referral, disease management
Binding: EpisodeOfCareType (example): The type of the episode of care.


... diagnosis Σ0..*BackboneElementThe list of diagnosis relevant to this episode of care
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... condition Σ1..1Reference(Condition)Conditions/problems/diagnoses this episode of care is for
.... role Σ0..1CodeableConceptRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.

.... rank Σ0..1positiveIntRanking of the diagnosis (for each role type)
... patient Σ1..1Reference(Patient_eltss)The patient who is the focus of this episode of care
... managingOrganization Σ0..1Reference(Organization)Organization that assumes care
... period Σ0..1PeriodInterval during responsibility is assumed
... referralRequest 0..*Reference(ServiceRequest_eltss)Originating Referral Request(s)
... careManager S0..1Reference(Practitioner_eltss)Plan Monitor
... team 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

Terminology Bindings

PathConformanceValueSet
EpisodeOfCare.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
EpisodeOfCare.statusrequiredEpisodeOfCareStatus
EpisodeOfCare.statusHistory.statusrequiredEpisodeOfCareStatus
EpisodeOfCare.typeexampleEpisodeOfCareType
EpisodeOfCare.diagnosis.rolepreferredDiagnosisRole

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorEpisodeOfCareIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorEpisodeOfCareIf 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-4errorEpisodeOfCareIf 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-5errorEpisodeOfCareIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceEpisodeOfCareA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from EpisodeOfCare

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare 0..*EpisodeOfCareAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... resource-pertainsToGoal S0..*Reference(Goal)The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources.
URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
... patient 1..1Reference(Patient_eltss)The patient who is the focus of this episode of care
... careManager S0..1Reference(Practitioner_eltss)Plan Monitor

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare 0..*EpisodeOfCareAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... resource-pertainsToGoal S0..*Reference(Goal)The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources.
URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: EpisodeOfCareStatus (required): The status of the episode of care.

... patient Σ1..1Reference(Patient_eltss)The patient who is the focus of this episode of care
... referralRequest 0..*Reference(ServiceRequest_eltss)Originating Referral Request(s)
... careManager S0..1Reference(Practitioner_eltss)Plan Monitor

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
EpisodeOfCare.statusrequiredEpisodeOfCareStatus

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorEpisodeOfCareIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorEpisodeOfCareIf 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-4errorEpisodeOfCareIf 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-5errorEpisodeOfCareIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceEpisodeOfCareA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. EpisodeOfCare 0..*EpisodeOfCareAn association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... resource-pertainsToGoal S0..*Reference(Goal)The resource-pertainsToGoal relates the resource to the goal(s) that pertain to it. Whenever there is a goal associated with a health concern or problem, this extension should be present and populated in activity (event or intent) resources.
URL: http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier(s) relevant for this EpisodeOfCare
... status ?!Σ1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: EpisodeOfCareStatus (required): The status of the episode of care.

... statusHistory 0..*BackboneElementPast list of status codes (the current status may be included to cover the start date of the status)
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... status 1..1codeplanned | waitlist | active | onhold | finished | cancelled | entered-in-error
Binding: EpisodeOfCareStatus (required): The status of the episode of care.

.... period 1..1PeriodDuration the EpisodeOfCare was in the specified status
... type Σ0..*CodeableConceptType/class - e.g. specialist referral, disease management
Binding: EpisodeOfCareType (example): The type of the episode of care.


... diagnosis Σ0..*BackboneElementThe list of diagnosis relevant to this episode of care
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... condition Σ1..1Reference(Condition)Conditions/problems/diagnoses this episode of care is for
.... role Σ0..1CodeableConceptRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.

.... rank Σ0..1positiveIntRanking of the diagnosis (for each role type)
... patient Σ1..1Reference(Patient_eltss)The patient who is the focus of this episode of care
... managingOrganization Σ0..1Reference(Organization)Organization that assumes care
... period Σ0..1PeriodInterval during responsibility is assumed
... referralRequest 0..*Reference(ServiceRequest_eltss)Originating Referral Request(s)
... careManager S0..1Reference(Practitioner_eltss)Plan Monitor
... team 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

Terminology Bindings

PathConformanceValueSet
EpisodeOfCare.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
EpisodeOfCare.statusrequiredEpisodeOfCareStatus
EpisodeOfCare.statusHistory.statusrequiredEpisodeOfCareStatus
EpisodeOfCare.typeexampleEpisodeOfCareType
EpisodeOfCare.diagnosis.rolepreferredDiagnosisRole

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorEpisodeOfCareIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorEpisodeOfCareIf 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-4errorEpisodeOfCareIf 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-5errorEpisodeOfCareIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceEpisodeOfCareA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron