This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

5.17 Resource EpisodeOfCare - Content

This resource maintained by the Patient Administration Work Group

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.

5.17.1 Scope and Usage

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
Encounter: Visit, Contact

5.17.2 Boundaries and Relationships

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 Enounters together for a specific problem/issue.
The Example scenarios below give some good examples as to when you might want to be using an EpisodeOfCare.

5.17.3 Background and Context

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 Episode Of Care 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, healthcare provider 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.

5.17.3.1 Expected Imlementations

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)

This resource is referenced by [Encounter]

Structure

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare			DomainResource	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
identifier		0..*	Identifier	Identifier(s) by which this EpisodeOfCare is known
currentStatus	Σ	1..1	code	planned \| active \| onhold \| finished \| withdrawn \| other EpisodeOfCareStatus (Required)
statusHistory		0..*	Element	The status history for the EpisodeOfCare
status		1..1	code	planned \| active \| onhold \| finished \| withdrawn \| other EpisodeOfCareStatus (Required)
period		1..1	Period	The period during this episodeofcare that the specific status applied
type	Σ	0..*	CodeableConcept	Specific type of EpisodeOfcare
patient	Σ	1..1	Patient	The patient that this episodeofcare applies to
managingOrganization	Σ	0..1	Organization	The organization that has assumed the specific responsibilities for the specified duration
period	Σ	0..1	Period	The interval during which the managing organization assumes the defined responsibility
condition		0..*	Condition	A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for
referralRequest		0..1	ReferralRequest	A Referral Request that this EpisodeOfCare manages activities within
careManager		0..1	Practitioner	The practitioner that is the care manager/care co-ordinator for this patient
careTeam		0..*	Element	The list of practitioners that may be facilitating this episode of care for specific purposes
member		0..1	Practitioner	The practitioner within the team
role		0..*	CodeableConcept	The role that this team member is taking within this episode of care
period		0..1	Period	The period of time that this practitioner is performing some role within the episode of care

UML Diagram

XML Template

<EpisodeOfCare xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this EpisodeOfCare is known --></identifier>
 <currentStatus value="[code]"/><!-- 1..1 planned | active | onhold | finished | withdrawn | other -->
 <statusHistory>  <!-- 0..* The status history for the EpisodeOfCare -->
  <status value="[code]"/><!-- 1..1 planned | active | onhold | finished | withdrawn | other -->
  <period><!-- 1..1 Period 
      The period during this episodeofcare that the specific status applied --></period>
 </statusHistory>
 <type><!-- 0..* CodeableConcept Specific type of EpisodeOfcare --></type>
 <patient><!-- 1..1 Reference(Patient) The patient that this episodeofcare applies to --></patient>
 <managingOrganization><!-- 0..1 Reference(Organization) 
     The organization that has assumed the specific responsibilities for the specified duration --></managingOrganization>
 <period><!-- 0..1 Period 
     The interval during which the managing organization assumes the defined responsibility --></period>
 <condition><!-- 0..* Reference(Condition) 
     A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for --></condition>
 <referralRequest><!-- 0..1 Reference(ReferralRequest) 
     A Referral Request that this EpisodeOfCare manages activities within --></referralRequest>
 <careManager><!-- 0..1 Reference(Practitioner) 
     The practitioner that is the care manager/care co-ordinator for this patient --></careManager>
 <careTeam>  <!-- 0..* The list of practitioners that may be facilitating this episode of care for specific purposes -->
  <member><!-- 0..1 Reference(Practitioner) The practitioner within the team --></member>
  <role><!-- 0..* CodeableConcept 
      The role that this team member is taking within this episode of care --></role>
  <period><!-- 0..1 Period 
      The period of time that this practitioner is performing some role within the episode of care --></period>
 </careTeam>
</EpisodeOfCare>

JSON Template

{
  "resourceType" : "EpisodeOfCare",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this EpisodeOfCare is known
  "currentStatus" : "<code>", // R! planned | active | onhold | finished | withdrawn | other
  "statusHistory" : [{ // The status history for the EpisodeOfCare
    "status" : "<code>", // R! planned | active | onhold | finished | withdrawn | other
    "period" : { Period } // R! 
      The period during this episodeofcare that the specific status applied
  }],
  "type" : [{ CodeableConcept }], // Specific type of EpisodeOfcare
  "patient" : { Reference(Patient) }, // R! The patient that this episodeofcare applies to
  "managingOrganization" : { Reference(Organization) }, // 
     The organization that has assumed the specific responsibilities for the specified duration
  "period" : { Period }, // 
     The interval during which the managing organization assumes the defined responsibility
  "condition" : [{ Reference(Condition) }], // 
     A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for
  "referralRequest" : { Reference(ReferralRequest) }, // 
     A Referral Request that this EpisodeOfCare manages activities within
  "careManager" : { Reference(Practitioner) }, // 
     The practitioner that is the care manager/care co-ordinator for this patient
  "careTeam" : [{ // 
     The list of practitioners that may be facilitating this episode of care for specific purposes
    "member" : { Reference(Practitioner) }, // The practitioner within the team
    "role" : [{ CodeableConcept }], // 
      The role that this team member is taking within this episode of care
    "period" : { Period } // 
      The period of time that this practitioner is performing some role within the episode of care
  }]
}

Structure

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare			DomainResource	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
identifier		0..*	Identifier	Identifier(s) by which this EpisodeOfCare is known
currentStatus	Σ	1..1	code	planned \| active \| onhold \| finished \| withdrawn \| other EpisodeOfCareStatus (Required)
statusHistory		0..*	Element	The status history for the EpisodeOfCare
status		1..1	code	planned \| active \| onhold \| finished \| withdrawn \| other EpisodeOfCareStatus (Required)
period		1..1	Period	The period during this episodeofcare that the specific status applied
type	Σ	0..*	CodeableConcept	Specific type of EpisodeOfcare
patient	Σ	1..1	Patient	The patient that this episodeofcare applies to
managingOrganization	Σ	0..1	Organization	The organization that has assumed the specific responsibilities for the specified duration
period	Σ	0..1	Period	The interval during which the managing organization assumes the defined responsibility
condition		0..*	Condition	A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for
referralRequest		0..1	ReferralRequest	A Referral Request that this EpisodeOfCare manages activities within
careManager		0..1	Practitioner	The practitioner that is the care manager/care co-ordinator for this patient
careTeam		0..*	Element	The list of practitioners that may be facilitating this episode of care for specific purposes
member		0..1	Practitioner	The practitioner within the team
role		0..*	CodeableConcept	The role that this team member is taking within this episode of care
period		0..1	Period	The period of time that this practitioner is performing some role within the episode of care

UML Diagram

XML Template

<EpisodeOfCare xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifier(s) by which this EpisodeOfCare is known --></identifier>
 <currentStatus value="[code]"/><!-- 1..1 planned | active | onhold | finished | withdrawn | other -->
 <statusHistory>  <!-- 0..* The status history for the EpisodeOfCare -->
  <status value="[code]"/><!-- 1..1 planned | active | onhold | finished | withdrawn | other -->
  <period><!-- 1..1 Period 
      The period during this episodeofcare that the specific status applied --></period>
 </statusHistory>
 <type><!-- 0..* CodeableConcept Specific type of EpisodeOfcare --></type>
 <patient><!-- 1..1 Reference(Patient) The patient that this episodeofcare applies to --></patient>
 <managingOrganization><!-- 0..1 Reference(Organization) 
     The organization that has assumed the specific responsibilities for the specified duration --></managingOrganization>
 <period><!-- 0..1 Period 
     The interval during which the managing organization assumes the defined responsibility --></period>
 <condition><!-- 0..* Reference(Condition) 
     A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for --></condition>
 <referralRequest><!-- 0..1 Reference(ReferralRequest) 
     A Referral Request that this EpisodeOfCare manages activities within --></referralRequest>
 <careManager><!-- 0..1 Reference(Practitioner) 
     The practitioner that is the care manager/care co-ordinator for this patient --></careManager>
 <careTeam>  <!-- 0..* The list of practitioners that may be facilitating this episode of care for specific purposes -->
  <member><!-- 0..1 Reference(Practitioner) The practitioner within the team --></member>
  <role><!-- 0..* CodeableConcept 
      The role that this team member is taking within this episode of care --></role>
  <period><!-- 0..1 Period 
      The period of time that this practitioner is performing some role within the episode of care --></period>
 </careTeam>
</EpisodeOfCare>

JSON Template

{
  "resourceType" : "EpisodeOfCare",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifier(s) by which this EpisodeOfCare is known
  "currentStatus" : "<code>", // R! planned | active | onhold | finished | withdrawn | other
  "statusHistory" : [{ // The status history for the EpisodeOfCare
    "status" : "<code>", // R! planned | active | onhold | finished | withdrawn | other
    "period" : { Period } // R! 
      The period during this episodeofcare that the specific status applied
  }],
  "type" : [{ CodeableConcept }], // Specific type of EpisodeOfcare
  "patient" : { Reference(Patient) }, // R! The patient that this episodeofcare applies to
  "managingOrganization" : { Reference(Organization) }, // 
     The organization that has assumed the specific responsibilities for the specified duration
  "period" : { Period }, // 
     The interval during which the managing organization assumes the defined responsibility
  "condition" : [{ Reference(Condition) }], // 
     A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for
  "referralRequest" : { Reference(ReferralRequest) }, // 
     A Referral Request that this EpisodeOfCare manages activities within
  "careManager" : { Reference(Practitioner) }, // 
     The practitioner that is the care manager/care co-ordinator for this patient
  "careTeam" : [{ // 
     The list of practitioners that may be facilitating this episode of care for specific purposes
    "member" : { Reference(Practitioner) }, // The practitioner within the team
    "role" : [{ CodeableConcept }], // 
      The role that this team member is taking within this episode of care
    "period" : { Period } // 
      The period of time that this practitioner is performing some role within the episode of care
  }]
}

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

5.17.4.1 Terminology Bindings

Path	Definition	Type	Reference
EpisodeOfCare.currentStatus EpisodeOfCare.statusHistory.status	The status of the encounter	Fixed	http://hl7.org/fhir/episode-of-care-status

Path

Definition

Type

Reference

EpisodeOfCare.currentStatus
EpisodeOfCare.statusHistory.status

The status of the encounter

Fixed

http://hl7.org/fhir/episode-of-care-status

5.17.5 Example Scenarios

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 Episode Of Care enables him 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

5.17.6 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Paths
care-manager	reference	The practitioner that is the care manager/care co-ordinator for this patient	EpisodeOfCare.careManager (Practitioner)
condition	reference	A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for	EpisodeOfCare.condition (Condition)
date	date	The interval during which the managing organization assumes the defined responsibility	EpisodeOfCare.period
identifier	token	Identifier(s) by which this EpisodeOfCare is known	EpisodeOfCare.identifier
organization	reference	The organization that has assumed the specific responsibilities for the specified duration	EpisodeOfCare.managingOrganization (Organization)
patient	reference	The patient that this episodeofcare applies to	EpisodeOfCare.patient (Patient)
referral	reference	A Referral Request that this EpisodeOfCare manages activities within	EpisodeOfCare.referralRequest (ReferralRequest)
status	token	planned \| active \| onhold \| finished \| withdrawn \| other	EpisodeOfCare.currentStatus
type	token	Specific type of EpisodeOfcare	EpisodeOfCare.type