EpisodeOfCare

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.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Business Identifier(s) relevant for this EpisodeOfCare Details The EpisodeOfCare may be known by different identifiers for different contexts of use, such as when an external agency is tracking the Episode for funding purposes.
status	✓	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Details planned | waitlist | active | onhold | finished | cancelled. This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid.
statusHistory		EpisodeOfCareStatusHistory[]	Past list of status codes (the current status may be included to cover the start date of the status) Details The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource).
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
status	✓	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Details planned | waitlist | active | onhold | finished | cancelled.
period	✓	Period	Duration the EpisodeOfCare was in the specified status Details The period during this EpisodeOfCare that the specific status applied.
type		CodeableConcept[]	Type/class - e.g. specialist referral, disease management Details A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. The type can be very important in processing as this could be used in determining if the EpisodeOfCare is relevant to specific government reporting, or other types of classifications.
diagnosis		EpisodeOfCareDiagnosis[]	The list of diagnosis relevant to this episode of care Details The list of diagnosis relevant to this episode of care.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
condition	✓	Reference<Condition>	Conditions/problems/diagnoses this episode of care is for Details A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for.
role		CodeableConcept	Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) Details Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …).
rank		positiveInt	Ranking of the diagnosis (for each role type) Details Ranking of the diagnosis (for each role type).
patient	✓	Reference<Patient>	The patient who is the focus of this episode of care Details The patient who is the focus of this episode of care.
managingOrganization		Reference<Organization>	Organization that assumes care Details The organization that has assumed the specific responsibilities for the specified duration.
period		Period	Interval during responsibility is assumed Details The interval during which the managing organization assumes the defined responsibility.
referralRequest		Reference<ServiceRequest>[]	Originating Referral Request(s) Details Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals.
careManager		Reference<Practitioner | PractitionerRole>	Care manager/care coordinator for the patient Details The practitioner that is the care manager/care coordinator for this patient.
team		Reference<CareTeam>[]	Other practitioners facilitating this episode of care Details The list of practitioners that may be facilitating this episode of care for specific purposes.
account		Reference<Account>[]	The set of accounts that may be used for billing for this EpisodeOfCare Details The set of accounts that may be used for billing for this EpisodeOfCare. The billing system may choose to allocate billable items associated with the EpisodeOfCare to different referenced Accounts based on internal business rules.

Search Parameters

Name	Type	Description	Expression
date	date	The provided date search value falls within the episode of care's period	EpisodeOfCare.period
identifier	token	Business Identifier(s) relevant for this EpisodeOfCare	EpisodeOfCare.identifier
patient	reference	The patient who is the focus of this episode of care	EpisodeOfCare.patient
type	token	Type/class - e.g. specialist referral, disease management	EpisodeOfCare.type
care-manager	reference	Care manager/care coordinator for the patient	EpisodeOfCare.careManager.where(resolve() is Practitioner)
condition	reference	Conditions/problems/diagnoses this episode of care is for	EpisodeOfCare.diagnosis.condition
incoming-referral	reference	Incoming Referral Request	EpisodeOfCare.referralRequest
organization	reference	The organization that has assumed the specific responsibilities of this EpisodeOfCare	EpisodeOfCare.managingOrganization
status	token	The current status of the Episode of Care as provided (does not check the status history collection)	EpisodeOfCare.status

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
text		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
contained		Resource[]	Contained, inline Resources Details These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored Details May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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, Episode
• Encounter: Visit, Contact

Multiple Organizations and Transfer of Care

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.

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 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.

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 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.

Expected Implementations

• 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)

Referenced By

• ChargeItem
• Contract
• DocumentReference
• Encounter
• MedicationAdministration
• MedicationDispense
• MedicationStatement