PACIO Re-Assessment Timepoints Implementation Guide
1.0.0 - STU 1 US

This page is part of the PACIO Re-Assessment Timepoints Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: Re-Assessment Timepoints Encounter

Official URL: http://hl7.org/fhir/us/pacio-rt/StructureDefinition/reassessment-timepoints-encounter Version: 1.0.0
Active as of 2022-09-28 Computable Name: ReassessmentTimepointsEncounter

Re-Assessment Timepoints Encounter is a profile of the Encounter resource that allows longer-term post-acute admissions to be structured into smaller more consumable components, in line with the longer-term clinical care and progression of a patient.

Example Usage Scenarios:

Re-assessment timepoints are

  • defined by post-acute care providers, for which encounters may span several months, or even years, such as skilled nursing facilities and home health agencies.
  • used by clients accessing and displaying data on these lengthy encounters, to help users parse through the significant volume of associated data to find relevant information.

The Re-Assessment Timepoints profile layers additional structure onto US Core conformant data. This structure is added to existing encounters based on regulation, payer requirements, or internal processes that result in formal assessments during post-acute care services. These formal assessments, such as the CMS Minimum Data Set (MDS) or Outcome and Assessment Information Set (OASIS), happen at the boundaries between timepoints.

The following diagram provides an overview of the existing structure (orange) and the new Re-Asssessment Timepoint structure (blue).

Re-Assessment Timepoint FHIR Structure


The sections below provide additional detail on these structures and their relationships.

Assumed initial structure

The Re-Assessment Timepoints profile augments existing FHIR® structure for representing clinical care, specifically:

  • a US Core Encounter instance that represents a period during which a patient recieved clinical care.
  • Observation instances representing the formal assessments that initiate and/or end timepoints. Often, these will be represented as functional or cognitive status observations.

Timepoint structure

Re-Assessment Timepoint instances are created as children of the root encounter instance. Many of the associated fields duplicate the parent encounter. Specific information recorded as a part of the Re-Assessment Timepoint includes:

  1. The days within the parent encounter that the timepoint covers as the period
  2. The entity which drives the timepoint as the type (e.g., payer)
  3. The type of assessments that drive the timepoint’s definition as the serviceType (e.g., MDS)
  4. A link to the parent encounter as partOf
  5. The clinical assessments that bound the timepoint as an extension on basedOn

Clinical data structure

Clinical data SHOULD be linked explicitly to the Re-Assessment Timepoint Encounter through associated ClinicalImpression instances. This IG does not profile ClinicalImpression, so the intended use of the structure is described here. Each ClinicalImpression instance represents a formal assessment, such as the MDS 5-day or OASIS 120-day Follow-up. An entry in the investigation field lists references to the Observation instances that document these assessments in investigation.item.

ClinicalImpression instances are linked to relevant Re-Assessment Timepoints via the basedOn extension within the timepoint instance itself. ClinicalImpression instances will be linked in this way to the Re-Assessment Timepoint that the associated assessment initiates, the Re-Assessment Timepoint that the associated assessment concludes, or both.

Mandatory and Must Support Data Elements

The following data elements must always be present or must be supported if the data is present in the sending system (Must Support definition). They are presented below with a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Re-Assessment Timepoint Encounter must have:

  1. An encounter identifier
  2. A status
  3. A classification, such as home health or skilled nursing facility
  4. An encounter type, defining the type of entity that defines the assessment, such as payer
  5. A service type, representing the driving assessment, such as the CMS Minimum Data Set
  6. A patient
  7. Providers involved in the encounter
  8. When the timepoint occurred
  9. Reason for the visit
  10. Where the encounter occurred
  11. The organization providing care
  12. The parent encounter

Each Re-Assessment Timepoint Encounter must support:

  1. Relevant diagnoses
  2. The discharge disposition
  3. ClinicalImpression resources documenting specific clinical data associated with the timepoint
  4. Related episodes of care
  5. A history of prior statuses

Usage:

Formal Views of Profile Content

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

This structure is derived from USCoreEncounterProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*USCoreEncounterProfileAn interaction during which services are provided to the patient
... identifier 1..*IdentifierIdentifier(s) by which this timepoint is known
... status 1..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
... statusHistory S0..*BackboneElementList of past timepoint statuses
.... status 1..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
... classHistory 0..*BackboneElementList of past timepoint classes
.... class 1..1Codinginpatient | outpatient | ambulatory | emergency +
Binding: Timepoint Class Value Set (extensible)
... type 1..*CodeableConceptThe entity structuring the timepoint
Binding: Timepoint Entity Type Value Set (extensible)
... serviceType S1..1CodeableConceptThe assessment or instrument driving the timepoint
Binding: Timepoint Service Type Value Set (extensible)
... priority 0..1CodeableConceptIndicates the urgency of the timepoint
... subject 1..1Reference(US Core Patient Profile)The patient present at the timepoint
... episodeOfCare S0..*Reference(EpisodeOfCare)Episode(s) of care that this timepoint should be recorded against
... basedOn
.... clinicalImpression S0..*Reference(ClinicalImpression)Clinical Impression can reflect any and all clinical related data tied to the assessment/instrument driving the timepoint, or within the timepoint itself.
URL: http://hl7.org/fhir/us/pacio-rt/StructureDefinition/clinicalImpression
... participant 1..*BackboneElementClinicians or Care Teams active in a timepoint
.... type 0..*CodeableConceptRole of participant in timepoint
.... period 0..1PeriodPeriod of time during the timepoint that the participant participated
.... individual 0..1Reference(US Core Practitioner Profile)Persons involved in the timepoint other than the patient
... appointment 0..*Reference(Appointment)Scheduled appointment or appointments that start the timepoint.
... period 1..1PeriodThe start and end date/time of the timepoint
... length 0..1DurationDays in a given timepoint period.
... reasonCode 1..*CodeableConceptThe ICD or Snomed Code that is the subject of the given timepoint
... reasonReference S0..*Reference(US Core Condition Profile | US Core Procedure Profile | Observation)Reason the timepoint takes place (reference)
... diagnosis S0..*BackboneElementHolding all DX codes for given patient during a given timepoint.
.... condition 1..1Reference(Condition | Procedure)The diagnosis or procedure relevant to the timepoint
.... use 0..1CodeableConceptRole that this diagnosis has within the timepoint (e.g. admission, billing, discharge …)
... account 0..*Reference(Account)The set of accounts that may be used for billing for this timepoint.
... location 1..*BackboneElementList of locations where the patient has been during this timepoint.
.... location 1..1Reference(US Core Location Profile)The location where the timepoint takes place.
... serviceProvider S1..1Reference(US Core Organization Profile)The organization (facility) responsible for this timepoint
... partOf S1..1Reference(US Core Encounter Profile)The Encounter this timepoint is part of

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*USCoreEncounterProfileAn interaction during which services are provided to the patient
... 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
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..*IdentifierIdentifier(s) by which this timepoint is known
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
... statusHistory S0..*BackboneElementList of past timepoint statuses
.... 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..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
.... period 1..1PeriodThe time that the episode was in the specified status
... class SΣ1..1CodingClassification of patient timepoint
Binding: Timepoint Class Value Set (extensible)
... classHistory 0..*BackboneElementList of past timepoint classes
.... 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
.... class 1..1Codinginpatient | outpatient | ambulatory | emergency +
Binding: Timepoint Class Value Set (extensible)
.... period 1..1PeriodThe time that the episode was in the specified class
... type SΣ1..*CodeableConceptThe entity structuring the timepoint
Binding: Timepoint Entity Type Value Set (extensible)
... serviceType SΣ1..1CodeableConceptThe assessment or instrument driving the timepoint
Binding: Timepoint Service Type Value Set (extensible)
... priority 0..1CodeableConceptIndicates the urgency of the timepoint
Binding: ActPriority (example): Indicates the urgency of the encounter.

... subject SΣ1..1Reference(US Core Patient Profile)The patient present at the timepoint
... episodeOfCare SΣ0..*Reference(EpisodeOfCare)Episode(s) of care that this timepoint should be recorded against
... basedOn 0..*Reference(ServiceRequest)The ServiceRequest that initiated this encounter
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... clinicalImpression S0..*Reference(ClinicalImpression)Clinical Impression can reflect any and all clinical related data tied to the assessment/instrument driving the timepoint, or within the timepoint itself.
URL: http://hl7.org/fhir/us/pacio-rt/StructureDefinition/clinicalImpression
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... participant SΣ1..*BackboneElementClinicians or Care Teams active in a timepoint
.... 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
.... type SΣ0..*CodeableConceptRole of participant in timepoint
Binding: ParticipantType (extensible): Role of participant in encounter.


.... period S0..1PeriodPeriod of time during the timepoint that the participant participated
.... individual SΣ0..1Reference(US Core Practitioner Profile)Persons involved in the timepoint other than the patient
... appointment Σ0..*Reference(Appointment)Scheduled appointment or appointments that start the timepoint.
... period S1..1PeriodThe start and end date/time of the timepoint
... length 0..1DurationDays in a given timepoint period.
... reasonCode SΣ1..*CodeableConceptThe ICD or Snomed Code that is the subject of the given timepoint
Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.


... reasonReference SΣ0..*Reference(US Core Condition Profile | US Core Procedure Profile | Observation)Reason the timepoint takes place (reference)
... diagnosis SΣ0..*BackboneElementHolding all DX codes for given patient during a given timepoint.
.... 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 | Procedure)The diagnosis or procedure relevant to the timepoint
.... use 0..1CodeableConceptRole that this diagnosis has within the timepoint (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.

.... rank 0..1positiveIntRanking of the diagnosis (for each role type)
... account 0..*Reference(Account)The set of accounts that may be used for billing for this timepoint.
... hospitalization S0..1BackboneElementDetails about the admission to a healthcare service
.... 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
.... preAdmissionIdentifier 0..1IdentifierPre-admission identifier
.... origin 0..1Reference(Location | Organization)The location/organization from which the patient came before admission
.... admitSource 0..1CodeableConceptFrom where patient was admitted (physician referral, transfer)
Binding: AdmitSource (preferred): From where the patient was admitted.

.... reAdmission 0..1CodeableConceptThe type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.

.... dietPreference 0..*CodeableConceptDiet preferences reported by the patient
Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.


.... specialCourtesy 0..*CodeableConceptSpecial courtesies (VIP, board member)
Binding: SpecialCourtesy (preferred): Special courtesies.


.... specialArrangement 0..*CodeableConceptWheelchair, translator, stretcher, etc.
Binding: SpecialArrangements (preferred): Special arrangements.


.... destination 0..1Reference(Location | Organization)Location/organization to which the patient is discharged
.... dischargeDisposition S0..1CodeableConceptCategory or kind of location after discharge
Binding: DischargeDisposition (example): Discharge Disposition.

... location S1..*BackboneElementList of locations where the patient has been during this timepoint.
.... 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
.... location S1..1Reference(US Core Location Profile)The location where the timepoint takes place.
.... status 0..1codeplanned | active | reserved | completed
Binding: EncounterLocationStatus (required): The status of the location.

.... physicalType 0..1CodeableConceptThe physical type of the location (usually the level in the location hierachy - bed room ward etc.)
Binding: LocationType (example): Physical form of the location.

.... period 0..1PeriodTime period during which the patient was present at the location
... serviceProvider S1..1Reference(US Core Organization Profile)The organization (facility) responsible for this timepoint
... partOf S1..1Reference(US Core Encounter Profile)The Encounter this timepoint is part of

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*USCoreEncounterProfileAn interaction during which services are provided to the patient
... identifier Σ1..*IdentifierIdentifier(s) by which this timepoint is known
.... system Σ1..1uriThe namespace for the identifier value
.... value Σ1..1stringThe value that is unique
... status ?!Σ1..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
... statusHistory 0..*BackboneElementList of past timepoint statuses
... type Σ1..*CodeableConceptThe entity structuring the timepoint
Binding: Timepoint Entity Type Value Set (extensible)
... serviceType Σ1..1CodeableConceptThe assessment or instrument driving the timepoint
Binding: Timepoint Service Type Value Set (extensible)
... subject Σ1..1Reference(US Core Patient Profile)The patient present at the timepoint
... episodeOfCare Σ0..*Reference(EpisodeOfCare)Episode(s) of care that this timepoint should be recorded against
... basedOn 0..*Reference(ServiceRequest)The ServiceRequest that initiated this encounter
.... clinicalImpression 0..*Reference(ClinicalImpression)Clinical Impression can reflect any and all clinical related data tied to the assessment/instrument driving the timepoint, or within the timepoint itself.
URL: http://hl7.org/fhir/us/pacio-rt/StructureDefinition/clinicalImpression
... participant Σ1..*BackboneElementClinicians or Care Teams active in a timepoint
.... type Σ0..*CodeableConceptRole of participant in timepoint
Binding: ParticipantType (extensible): Role of participant in encounter.


.... period 0..1PeriodPeriod of time during the timepoint that the participant participated
.... individual Σ0..1Reference(US Core Practitioner Profile)Persons involved in the timepoint other than the patient
... period 1..1PeriodThe start and end date/time of the timepoint
... reasonCode Σ1..*CodeableConceptThe ICD or Snomed Code that is the subject of the given timepoint
Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.


... reasonReference Σ0..*Reference(US Core Condition Profile | US Core Procedure Profile | Observation)Reason the timepoint takes place (reference)
... diagnosis Σ0..*BackboneElementHolding all DX codes for given patient during a given timepoint.
... hospitalization 0..1BackboneElementDetails about the admission to a healthcare service
.... dischargeDisposition 0..1CodeableConceptCategory or kind of location after discharge
Binding: DischargeDisposition (example): Discharge Disposition.

... location 1..*BackboneElementList of locations where the patient has been during this timepoint.
.... location 1..1Reference(US Core Location Profile)The location where the timepoint takes place.
... serviceProvider 1..1Reference(US Core Organization Profile)The organization (facility) responsible for this timepoint
... partOf 1..1Reference(US Core Encounter Profile)The Encounter this timepoint is part of

doco Documentation for this format

Differential View

This structure is derived from USCoreEncounterProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*USCoreEncounterProfileAn interaction during which services are provided to the patient
... identifier 1..*IdentifierIdentifier(s) by which this timepoint is known
... status 1..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
... statusHistory S0..*BackboneElementList of past timepoint statuses
.... status 1..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
... classHistory 0..*BackboneElementList of past timepoint classes
.... class 1..1Codinginpatient | outpatient | ambulatory | emergency +
Binding: Timepoint Class Value Set (extensible)
... type 1..*CodeableConceptThe entity structuring the timepoint
Binding: Timepoint Entity Type Value Set (extensible)
... serviceType S1..1CodeableConceptThe assessment or instrument driving the timepoint
Binding: Timepoint Service Type Value Set (extensible)
... priority 0..1CodeableConceptIndicates the urgency of the timepoint
... subject 1..1Reference(US Core Patient Profile)The patient present at the timepoint
... episodeOfCare S0..*Reference(EpisodeOfCare)Episode(s) of care that this timepoint should be recorded against
... basedOn
.... clinicalImpression S0..*Reference(ClinicalImpression)Clinical Impression can reflect any and all clinical related data tied to the assessment/instrument driving the timepoint, or within the timepoint itself.
URL: http://hl7.org/fhir/us/pacio-rt/StructureDefinition/clinicalImpression
... participant 1..*BackboneElementClinicians or Care Teams active in a timepoint
.... type 0..*CodeableConceptRole of participant in timepoint
.... period 0..1PeriodPeriod of time during the timepoint that the participant participated
.... individual 0..1Reference(US Core Practitioner Profile)Persons involved in the timepoint other than the patient
... appointment 0..*Reference(Appointment)Scheduled appointment or appointments that start the timepoint.
... period 1..1PeriodThe start and end date/time of the timepoint
... length 0..1DurationDays in a given timepoint period.
... reasonCode 1..*CodeableConceptThe ICD or Snomed Code that is the subject of the given timepoint
... reasonReference S0..*Reference(US Core Condition Profile | US Core Procedure Profile | Observation)Reason the timepoint takes place (reference)
... diagnosis S0..*BackboneElementHolding all DX codes for given patient during a given timepoint.
.... condition 1..1Reference(Condition | Procedure)The diagnosis or procedure relevant to the timepoint
.... use 0..1CodeableConceptRole that this diagnosis has within the timepoint (e.g. admission, billing, discharge …)
... account 0..*Reference(Account)The set of accounts that may be used for billing for this timepoint.
... location 1..*BackboneElementList of locations where the patient has been during this timepoint.
.... location 1..1Reference(US Core Location Profile)The location where the timepoint takes place.
... serviceProvider S1..1Reference(US Core Organization Profile)The organization (facility) responsible for this timepoint
... partOf S1..1Reference(US Core Encounter Profile)The Encounter this timepoint is part of

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*USCoreEncounterProfileAn interaction during which services are provided to the patient
... 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
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier SΣ1..*IdentifierIdentifier(s) by which this timepoint is known
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
... statusHistory S0..*BackboneElementList of past timepoint statuses
.... 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..1codein-progress | finished | planned
Binding: Timepoint Status Value Set (required)
.... period 1..1PeriodThe time that the episode was in the specified status
... class SΣ1..1CodingClassification of patient timepoint
Binding: Timepoint Class Value Set (extensible)
... classHistory 0..*BackboneElementList of past timepoint classes
.... 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
.... class 1..1Codinginpatient | outpatient | ambulatory | emergency +
Binding: Timepoint Class Value Set (extensible)
.... period 1..1PeriodThe time that the episode was in the specified class
... type SΣ1..*CodeableConceptThe entity structuring the timepoint
Binding: Timepoint Entity Type Value Set (extensible)
... serviceType SΣ1..1CodeableConceptThe assessment or instrument driving the timepoint
Binding: Timepoint Service Type Value Set (extensible)
... priority 0..1CodeableConceptIndicates the urgency of the timepoint
Binding: ActPriority (example): Indicates the urgency of the encounter.

... subject SΣ1..1Reference(US Core Patient Profile)The patient present at the timepoint
... episodeOfCare SΣ0..*Reference(EpisodeOfCare)Episode(s) of care that this timepoint should be recorded against
... basedOn 0..*Reference(ServiceRequest)The ServiceRequest that initiated this encounter
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... clinicalImpression S0..*Reference(ClinicalImpression)Clinical Impression can reflect any and all clinical related data tied to the assessment/instrument driving the timepoint, or within the timepoint itself.
URL: http://hl7.org/fhir/us/pacio-rt/StructureDefinition/clinicalImpression
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... participant SΣ1..*BackboneElementClinicians or Care Teams active in a timepoint
.... 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
.... type SΣ0..*CodeableConceptRole of participant in timepoint
Binding: ParticipantType (extensible): Role of participant in encounter.


.... period S0..1PeriodPeriod of time during the timepoint that the participant participated
.... individual SΣ0..1Reference(US Core Practitioner Profile)Persons involved in the timepoint other than the patient
... appointment Σ0..*Reference(Appointment)Scheduled appointment or appointments that start the timepoint.
... period S1..1PeriodThe start and end date/time of the timepoint
... length 0..1DurationDays in a given timepoint period.
... reasonCode SΣ1..*CodeableConceptThe ICD or Snomed Code that is the subject of the given timepoint
Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.


... reasonReference SΣ0..*Reference(US Core Condition Profile | US Core Procedure Profile | Observation)Reason the timepoint takes place (reference)
... diagnosis SΣ0..*BackboneElementHolding all DX codes for given patient during a given timepoint.
.... 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 | Procedure)The diagnosis or procedure relevant to the timepoint
.... use 0..1CodeableConceptRole that this diagnosis has within the timepoint (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.

.... rank 0..1positiveIntRanking of the diagnosis (for each role type)
... account 0..*Reference(Account)The set of accounts that may be used for billing for this timepoint.
... hospitalization S0..1BackboneElementDetails about the admission to a healthcare service
.... 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
.... preAdmissionIdentifier 0..1IdentifierPre-admission identifier
.... origin 0..1Reference(Location | Organization)The location/organization from which the patient came before admission
.... admitSource 0..1CodeableConceptFrom where patient was admitted (physician referral, transfer)
Binding: AdmitSource (preferred): From where the patient was admitted.

.... reAdmission 0..1CodeableConceptThe type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.

.... dietPreference 0..*CodeableConceptDiet preferences reported by the patient
Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.


.... specialCourtesy 0..*CodeableConceptSpecial courtesies (VIP, board member)
Binding: SpecialCourtesy (preferred): Special courtesies.


.... specialArrangement 0..*CodeableConceptWheelchair, translator, stretcher, etc.
Binding: SpecialArrangements (preferred): Special arrangements.


.... destination 0..1Reference(Location | Organization)Location/organization to which the patient is discharged
.... dischargeDisposition S0..1CodeableConceptCategory or kind of location after discharge
Binding: DischargeDisposition (example): Discharge Disposition.

... location S1..*BackboneElementList of locations where the patient has been during this timepoint.
.... 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
.... location S1..1Reference(US Core Location Profile)The location where the timepoint takes place.
.... status 0..1codeplanned | active | reserved | completed
Binding: EncounterLocationStatus (required): The status of the location.

.... physicalType 0..1CodeableConceptThe physical type of the location (usually the level in the location hierachy - bed room ward etc.)
Binding: LocationType (example): Physical form of the location.

.... period 0..1PeriodTime period during which the patient was present at the location
... serviceProvider S1..1Reference(US Core Organization Profile)The organization (facility) responsible for this timepoint
... partOf S1..1Reference(US Core Encounter Profile)The Encounter this timepoint is part of

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Encounter.languagepreferredCommonLanguages
Max Binding: AllLanguages
Encounter.identifier.userequiredIdentifierUse
Encounter.identifier.typeextensibleIdentifier Type Codes
Encounter.statusrequiredTimepointStatusValueSet
Encounter.statusHistory.statusrequiredTimepointStatusValueSet
Encounter.classextensibleTimepointClassValueSet
Encounter.classHistory.classextensibleTimepointClassValueSet
Encounter.typeextensibleTimepointEntityTypeValueSet (a valid code from Timepoint Entity Code System)
Encounter.serviceTypeextensibleTimepointServiceTypeValueSet (a valid code from Timepoint Service Type Code System)
Encounter.priorityexampleActPriority
Encounter.basedOn.typeextensibleResourceType
Encounter.participant.typeextensibleParticipantType
Encounter.reasonCodepreferredEncounterReasonCodes
Encounter.diagnosis.usepreferredDiagnosisRole
Encounter.hospitalization.admitSourcepreferredAdmitSource
Encounter.hospitalization.reAdmissionexampleHl7VSReAdmissionIndicator
Encounter.hospitalization.dietPreferenceexampleDiet
Encounter.hospitalization.specialCourtesypreferredSpecialCourtesy
Encounter.hospitalization.specialArrangementpreferredSpecialArrangements
Encounter.hospitalization.dischargeDispositionexampleDischargeDisposition
Encounter.location.statusrequiredEncounterLocationStatus
Encounter.location.physicalTypeexampleLocationType

Notes:

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

  1. SHALL support searching for all encounters, including re-assessment timepoints, that are children of another encounter using the part-of search parameter:

    GET [base]/Encounter?part-of={Type/}[id]

    Example:

    1. GET [base]/Encounter?part-of=encounter1

    Implementation Notes: Fetches a bundle of all Encounter resources, including Re-Assessment Timepoint Encounter resources, that are children of the specified encounter (how to search by reference)

  2. SHALL support searching for encounters, including re-assessment timepoints, using the combination of the part-of and date search parameters:
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Encounter?date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}&part-of={Type/}[id]

    Example:

    1. GET [base]/Encounter?part-of=encounter1&date=ge2019-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Encounter resources, including Re-Assessment Timepoint Encounter resources, matching the specified date and parent Encounter (how to search by date and how to search by reference)

  3. SHALL support searching for all encounters, including re-assessment timepoint encounters, for a patient using the patient search parameter:

    GET [base]/Encounter?patient={Type/}[id]

    Example:

    1. GET [base]/Encounter?patient=1137192

    Implementation Notes: Fetches a bundle of all Encounter resources, including Re-Assessment Timepoint Encounter resources, for the specified patient ([how to search by reference])

  4. SHALL support searching for encounters, including re-assessment timepoints, using the combination of the patient and date search parameters:
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Encounter?date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}&patient={Type/}[id]

    Example:

    1. GET [base]/Encounter?patient=example1&date=ge2019-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Encounter resources, including Re-Assessment Timepoint Encounter resources, matching the specified date and patient (how to search by date and how to search by reference)

  5. SHALL support fetching a re-assessment timepoint using the _id search parameter:

    GET [base]/Encounter[id]

    Example:

    1. GET [base]/Encounter/12354
    2. GET [base]/Encounter?_id=12354

    Implementation Notes: Fetches a single Re-Assessment Timepoint Encounter resource (how to search by the logical id of the resource)

  6. SHALL support searching for all encounters, including re-assessment timepoints, using the combination of the date and patient search parameters:
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Encounter?date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}&patient={Type/}[id]

    Example:

    1. GET [base]/Encounter?patient=example1&date=ge2019-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Encounter resources, including Re-Assessment Timepoint Encounter resources, matching the specified date and patient (how to search by date and how to search by reference)

  7. SHALL support searching for all encounters, including re-assessment timepoints, using the date search parameter:
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/Encounter?date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/Encounter?date=ge2019-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all Encounter resources, including Re-Assessment Timepoints, matching the specified date (how to search by date)

  8. SHALL support searching for all encounters, including re-assessment timepoints, using the episode-of-care search parameter: GET [base]/Encounter?episode-of-care={Type/}[id]

    Example:

    1. GET [base]/Encounter?episode-of-care=episode1

    Implementation Notes: Fetches a bundle of all Encounter resources, including Re-Assessment Timepoint Encounter resources, that are children of the episode of care (how to search by reference)

Optional Search Parameters:

The following search parameters SHOULD be supported. In addition, search parameters which are supported individually SHOULD also be supported in combination with any set of other individually supported search parameters.

  1. SHOULD support searching for all encounters, including re-assessment timepoints, using the based-on search parameter:

    GET [base]/Encounter?based-on={Type/}[id]

    Example:

    1. GET [base]/Encounter?based-on=ClinicalImpression/impression1
    2. Get [base]/Encounter?based-on=ServiceRequest/request1

    Implementation Notes: Fetches a bundle containing any Encounter resources, including Re-Assessment Timepoint Encounter resources, referencing the ClinicalImpression or ServiceRequest instance (how to search by reference)

  2. SHOULD support searching for all encounters, including re-assessment timepoints, using the diagnosis search parameter:

    GET [base]/Encounter?diagnosis={Type/}[id]

    Example:

    1. GET [base]/Encounter?diagnosis=Condition/condition1
    2. GET [base]/Encounter?diagnosis=Procedure/procedure1

    Implementation Notes: Fetches a bundle containing any Encounter resources, including Re-Assessment Timepoint Encounter resources, referencing the Condition or Procedure instance (how to search by reference)

  3. SHOULD support searching for all encounters, including re-assessment timepoints, using the reason-reference search parameter:

    GET [base]/Encounter?reason-reference={Type/}[id]

    Example:

    1. GET [base]/Encounter?reason-reference=Condition/condition1
    2. GET [base]/Encounter?reason-reference=Procedure/procedure1
    3. GET [base]/Encounter?reason-reference=Observation/observation1

    Implementation Notes: Fetches a bundle containing any Encounter resources, including Re-Assessment Timepoint Encounter resources, referencing the Condition, Procedure, or Observation instance (how to search by reference)

  4. SHOULD support searching for all encounters, including re-assessment timepoints, using the service-provider search parameter:

    GET [base]/Encounter?service-provider={Type/}[id]

    Example:

    1. GET [base]/Encounter?service-provider=Organization/org1

    Implementation Notes: Fetches a bundle containing any Encounter resources, including Re-Assessment Timepoint Encounter resources, referencing the Organization instance (how to search by reference)

  5. SHOULD support searching for all encounters, including re-assessment timepoints, using the status search parameter:

    GET [base]/Encounter?status={Type/}[id]

    Example:

    1. GET [base]/Encounter?status=finished

    Implementation Notes: Fetches a bundle containing any Encounter resources, including Re-Assessment Timepoint Encounter resources, matching the status (how to search by token)