Encounter (QDM)

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The HL7 CQI Workgroup reviewed the content on this page in April 2018 referencing QDM version 5.3. There are no changes to the QDM Encounter category in QDM 5.4.

QDM defines Encounter as an identifiable grouping of healthcare-related activities characterized by the entity relationship between the subject of care and a healthcare provider; such a grouping is determined by the healthcare provider. A patient encounter represents interaction between a healthcare provider and a patient with a face-to-face patient visit to a clinician’s office, or any electronically remote interaction with a clinician for any form of diagnostic treatment or therapeutic event. Encounters can be billable events but are not limited to billable interactions. Each encounter has an associated location or modality within which it occurred (such as an office, home, electronic methods, phone encounter, or telemedicine methods). The encounter location is the patient’s location at the time of measurement. Different levels of interaction can be specified in the value associated with the element while modes of interaction (e.g., telephone) may be modeled using the data flow attribute. QDM defines three contexts for Encounter: Encounter, Order; Encounter, Performed; Encounter, Recommended. Note: Encounter, Performed; Encounter, Order; and Encounter, Recommended do not include a clear mechanism to address urgent, emergent or routine (scheduled) encounters. QDM is evaluating the possibility of adding Encounter,priority to address these issues. See the QDM Known Issues site to review the request and to link to the ONC Jira QDM Issues page to join in the discussion in consideration of the next version of QDM (5.5) [1].

Encounter, Order

QDM Attribute	QI Core Metadata Element	Comment
Encounter, Order	ReferralRequest.intent - FHIR STU 4.0 updating to ServiceRequest.intent	Referral Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. For QDM datatypes with the context "order" the ReferralRequest.intent value shall be constrained to "order"
FacilityLocation	ReferralRequest.context	QDM matched to QI Core / FHIR
Negation Rationale	ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)	Modeled as a procedure request - there is no Encounter request in QI Core. Note FHIR STU 4.0 is updating ReferralRequest to Service.Request. See FHIR Tracker Item 15940 for negation rationale for ServiceRequest.
Reason	ReferralRequest.reasonCode	QDM matched to QI Core / FHIR
Author dateTime	ReferralRequest.authoredOn	Note - ProcedureRequest.occurrence[x] defines a dateTime when the event should occur - not addressed in QDM
Code	ReferralRequest.type	See also, Observation.category
id	ReferralRequest.id	QDM matched to QI Core / FHIR
Source	ReferralRequest.requester	Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf - the organization on whose behalf the device or practitioner was acting

Encounter, Recommended

QDM Attribute	QI Core Metadata Element	Comment
Encounter, Recommended	ReferralRequest.intent	Referral Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. For QDM datatypes with the context "recommended" the ReferralRequest.intent value shall be constrained to "order"
FacilityLocation	ReferralRequest.context	QDM matched to QI Core / FHIR
Negation Rationale	ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)	Modeled as a procedure request - there is no Encounter request in QI Core. Note FHIR STU 4.0 is updating ReferralRequest to Service.Request. See FHIR Tracker Item 15940 for negation rationale for ServiceRequest.
Reason	ReferralRequest.reasonCode	QDM matched to QI Core / FHIR
Author dateTime	ReferralRequest.authoredOn	Note - ProcedureRequest.occurrence[x] defines a dateTime when the event should occur - not addressed in QDM
Code	ReferralRequest.type	See also, Observation.category
id	ReferralRequest.id	QDM matched to QI Core / FHIR
Source	ReferralRequest.requester	Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf - the organization on whose behalf the device or practitioner was acting

Encounter, Performed

QDM Attribute	QI Core Metadata Element	Comment
Encounter, Performed	Encounter (the .status metadata allows conformance to the specific QDM datatype context)	Constrained to status consistent with in-progress or finished.
Relevant Period	Encounter.period	QDM matched to QI Core / FHIR
Admission Source	Encounter.hospitalization.admitSource	QDM matched to QI Core / FHIR
Diagnosis	Encounter.diagnosis	QDM matched to QI Core / FHIR
Discharge Disposition	Encounter.hospitalization.dischargeDisposition	QDM matched to QI Core / FHIR
Length of Stay	Encounter.length	QDM matched to QI Core / FHIR
Negation Rationale	Encounter.extension (http://hl7.org/fhir/StructureDefinition/encounter-reasonCancelled)	Only applies to an encounter that was cancelled, not an encounter that was never planned for a specific reason.
Principal Diagnosis	Encounter.diagnosis.role Encounter.diagnosis.rank	Constrain Encounter.diagnosis.role to "Billing Diagnosis" and require Encounter.diagnosis.rank =1. See FHIR Tracker Request 15944 requesting addition of Principal Diagnosis reference in US Core that is consistent with this QDM to QI Core mapping
Author dateTime	FHIR.provenance.recorded	FHIR references authorDatetime as part of the provenance resource for all resources. Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html). The FHIR Encounter resource does not reference an author dateTime; hence the QDM mapping references FHIR.provenance.
Code	Encounter.type	Encounter.type fits best with the type of encounter. The Encounter.type value set includes codes from SNOMED CT decending from 308335008 patient encounter procedure (procedure) and codes from the Current Procedure and Terminology designated for Evaluation and Management (99200 – 99607) (subscription to AMA Required). Code systems included: http://snomed.info/sct http://www.ama-assn.org/go/cpt Encounter.type indicates: The codes SHALL be taken from US Core Encounter Type; other codes may be used where these codes are not suitable
FacilityLocations	Encounter.location	QDM matched to QI Core / FHIR
FacilityLocations code	Location.type	QDM matched to QI Core / FHIR
FacilityLocations location period	Location.period	QDM matched to QI Core / FHIR
id	Encounter.id	QDM matched to QI Core / FHIR