EpisodeOfCare FHIR Resource Proposal

EpisodeOfCare

Owning committee name

Patient Administration

Contributing or Reviewing Work Groups

• Patient Care
• Financial Management

FHIR Resource Development Project Insight ID

pending

Scope of coverage

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.

This may include information such as:

• Organization
• Practitioners (and roles)
• Problem/Condition/Diagnosis
• Care Team
• Care Manager/Care co-ordinator
• Funding Sources (Government Agencies/Health Insurers/Individual payers/Guarantors)
• Contact information
• Period
• Status information
• Referral source
• Consent?
• other episodes of care

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.

Note: 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.

These resources are typically known in existing systems as:

• EpisodeOfCare: Case, Program, Problem
• Encounter: Visit, Contact

RIM scope

TBD.

Resource appropriateness

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.

Expected implementations

This resource is likely to be implemented by applications:

• 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)

Content sources

We will refer to the HL7 v2, v3 and OpenEHR messages and models.

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.

Resource Relationships

This resource is expected to reference Patient, Location, Organization and Practitioner.

Resources that are expected to reference the EpisodeOfCare are: Appointment, Encounter, Coverage and CarePlan.

Other draft resources such as Claim and Invoice may also reference the EpisodeOfCare resource.

Timelines

We are hoping that this resource will be ready for inclusion in the next Ballot (expecting September 2014).

gForge Users

brian_pos