FHIR Encounter

Return to PA Resource Development

Encounter scope and definition

Overview of the definition

If we look up Encounter in a dictionary, we find something along these lines: A meeting with a person or thing, especially a casual, unexpected, or brief meeting: "Our running into each other was merely a chance encounter"

However, in the context of Healthcare IT, an Encounter is a mostly planned, non-casual, longer running event: Situation on the uninterrupted course of which one or more health care professionals delivers health care services to a subject of care (from: EN13940:2001, Health informatics -- System of concepts to support continuity of care)

The full scope of Encounter only becomes clear in the definition shared by CCDA and ASTM CCR:

An Encounter is an interaction, regardless of the setting, between a patient and a practitioner who is vested with primary responsibility for diagnosing, evaluating, or treating the patient's condition. It may include visits, appointments, as well as non face-to-face interactions. It is also a contact between a patient and a practitioner who has primary responsibility for assessing and treating the patient at a given contact, exercising independent judgment. (from CCDA, section 4.11).

The "regardless of the setting" is elaborated upon elsewhere in the ASTM CCR document:

An Encounter can be a hospitalization (acute, rehab, nursing facility, or longterm care), office or clinic visit, emergency room visit, home health visit, or any treatment or therapy (physical, occupational, respiratory, or other), or any interaction, even non face-toface, between the patient and the healthcare system or a healthcare provider.

and this is echoed by the current definition from the PA Wiki: An interaction between a patient and healthcare participant(s) for the purpose of providing patient service(s) or assessing the health status of a patient. For example, outpatient visit to multiple departments, home health support (including physical therapy), inpatient hospital stay, emergency room visit, field visit (e.g., traffic accident), office visit, occupational therapy, telephone call.

These "settings" are not necessarily mutually exclusive and can take place at the same time: as an Encounter seems to include longer running hospitalizations, "treatment" settings and face-to-face interactions, multiple "encounters" may be active at the same time.

It should be clear that these are not the only possible definitions, take for example, this one from Microsoft's Connected Health Framework: A consultation, examination, or treatment provided by a care professional typically at a single session or appointment. (from Microsoft Connected Health Framework - Part 2 - Business Framework) or openEHR, where an Encounter is a kind of "Composition", a unit of modification of the EHR, more specifically described as a "record of encounter as a progress note", and "for use to record when a person and clinician interact".

Questions

• The definitions found on Encounter define its scope as ranging from short home visits to long-term care. Most seem to agree that outpatient visits and inpatient stays are all Encouters. Do we retain this definition?
• Is Encounter mainly a administrative or logistic concept, or does it include responsibility?
• Encounters, according to this definition, overlap in time and scope. How do we relate them, e.g. Do we wish to see a doctor visiting an inpatient as an encounter within an encounter? Does moving a patient from a medium-care ward to an intensive-care ward start a new encounter? What about referring a patient to another specialty for consultation? What about an outpatient visiting multiple facilities?