PA Harmonization Proposal Encounter Types

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Recommendation for HL7 RIM Change and/or Vocabulary changes	RECOMMENDATION ID:
Sponsored by: Patient Administration work group	Approval date by sponsor: 15 July 2009
Revision (# and date): #1 15 July 2009	Date submitted:
Editor/Author: Gregg Seppala	Sponsor Status: Approved
PROPOSALNAME: Encounter Type Value Sets

Summary of Vocabulary changes

REQUIRED - fill in the numbers in the rightmost three columns that total the number of vocabulary changes in the proposal. This is used to cross-check the accuracy of capturing and applying the requested changes

Abbrev.	Description	# to Add	# to Remove	# to Change
D	Concept Domains	0	0	0
S	Code Systems	0	0	0
C	Concept codes in a code system	0	0	1
V	Value sets	7	0	1
B	Context Bindings	0	0	0

Position of Concerned Organizations

REQUIRED - This table should contain one row for each organization/WG affected by the recommendation.

ORG.NAME	RECOMMENDATION APPROVAL STATUS	AFFECTED ENTITIES OF INTEREST TO ORG
Patient Administration WG	Approved	Encounter.code
WG/Organization 2	Unknown/Reviewed/Approved	List model elements of interest to WG/Organization

Issue

Patient Administration has identified different associations and constraints for different types of encounters (e.g., inpatient vs. home health) so we need to constrain encounter models to specific encounter types. Since this requires constraining the code attribute we need to add a set of single-value Value Sets for the encounter type.

This proposal also corrects an error that defines the ActMedicalServiceCode code set as a child of ActEncouterCode instead of as a sibling code set. The current placement permits selecting medical service codes (e.g., Pediatrics, Oncology) as an encounter type.

Recommendation Details

Vocabulary Recommendation(s)

1. CODE SYSTEM CHANGES

• Promote _ActMedicalServiceCode from a child of _ActEncounterCode to be its sibling (i.e., a child of _ActCareProvisionCode)

2. VALUE SET ADDITIONS Add six new value sets:

• v:ActAmbulatoryEncounterCode - 1 code from c:ActCode = AMB (ambulatory)
• v:ActEmergencyEncounterCode - 1 code from c:ActCode = EMER (emergency)
• v:ActFieldEncounterCode - 1 code from c:ActCode = FLD (field)
• v:ActHomeHealthEncounterCode - 1 code from c:ActCode = HH (home health)
• v:ActShortStayEncounterCode - 1 code from c:ActCode = SS (short stay)
• v:ActVirtualEncounterCode - 1 code from c:ActCode = VR (virtual)

Use the code definitions for the value sets.

3. VALUE SET CHANGE TO v:ActEncounterCode

• Remove Union with v:ActMedicalServiceCode
• Add Union with six value sets defined above
• Retain existing union with v:ActInpatientEncounterCode

4. VALUE SET CHANGE TO v:ActCareProvisionCode

• Add Union with v:ActMedicalServiceCode

Rationale

This use case was previously supported by defining encounter type (Encounter.code) as a fixed value. The recent changes in how terminology is handled outlaws this solution (cannot bind code to a CD data type.

Recommended Action Items

• MnM to implement the proposed solution

Resolution

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