Status: DRAFT: For Review

Introduction

This profile sets out the expectations for the interweave EpisodeOfCare resource. We use the EpisodeOfCare structure definition as a base to this profile.

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.

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.

EpisodeOfCare vs. Encounter

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.

Mandatory fields

The following fields are mandatory:

• patient - The patient who is the focus of this episode of care.

• status - this is mandatory in FHIR, with a short list of codes provided.

Must Support fields

In addition, the following fields are "Must Support" - i.e. they must be populated if relevant and known:

• Identifier - a Local Id should be provided, such that could be quoted if manually getting in touch to find out more

• statusHistory - The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource).

• Diagnosis - Link to a Condition diagnosed as a result of the episodeOfCare. Can obviously be provided only if the Condition FHIR Resource is also being offered.

• ReferralRequest - A link to a ReferralRequest which initiated this Episode of Care resource.

• Period When the episodeOfCare occurred is vital to know. The start date/time is always mandatory, but as per the FHIR specification, the end date/time may be omitted if the episodeOfCare is ongoing

• careManager - This field can be used to provide a link to the practitioner delivering the service.

• team - Other practitioners facilitating this episode of care

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Optional fields to note include:

• Type - categorises the type of place where the episodeOfcare took place. Care providers do not operate in isolation. Primary, secondary, tertiary and community care are intended to act as a single, integrated care system. Patients are passed from one provider to another as appropriate, for example when a GP refers a patient to a specialist in secondary care.

The diagram below summarises the above each with a specific purpose or specialism.

​

• managingOrganization - The organization that has assumed the specific responsibilities for the specified duration.

Discouraged or Removed fields

• Account - Removed. for billing purposes, not relevant.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from EpisodeOfCare

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare		0..*	EpisodeOfCare	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
identifier	S	0..*	Identifier	Business Identifier(s) relevant for this EpisodeOfCare
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	S	1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error
statusHistory	S	0..*	BackboneElement	Past list of status codes (the current status may be included to cover the start date of the status)
type		0..1	CodeableConcept	PrimaryCare | SecondaryCare | TertiaryCare | CommunityHealth Binding: InterweaveEpisodeOfCareType (preferred)
diagnosis	S	0..*	BackboneElement	The list of diagnosis relevant to this episode of care
patient	S	1..1	Reference(InterweavePatient)	The patient who is the focus of this episode of care
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
period	S	0..1	Period	Interval during responsibility is assumed
start	S	1..1	dateTime	Starting time with inclusive boundary
referralRequest	S	0..*	Reference(ServiceRequest)	Originating Referral Request(s)
careManager	S	0..1	Reference(Practitioner | PractitionerRole)	Care manager/care coordinator for the patient
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
team	S	0..*	Reference(CareTeam)	Other practitioners facilitating this episode of care
account		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
EpisodeOfCare.type	preferred	InterweaveEpisodeOfCareType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-EpisodeOfCareType from this IG

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare		0..*	EpisodeOfCare	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Business Identifier(s) relevant for this EpisodeOfCare
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
statusHistory	S	0..*	BackboneElement	Past list of status codes (the current status may be included to cover the start date of the status)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
period		1..1	Period	Duration the EpisodeOfCare was in the specified status
type	Σ	0..1	CodeableConcept	PrimaryCare | SecondaryCare | TertiaryCare | CommunityHealth Binding: InterweaveEpisodeOfCareType (preferred)
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this episode of care
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition)	Conditions/problems/diagnoses this episode of care is for
patient	SΣ	1..1	Reference(InterweavePatient)	The patient who is the focus of this episode of care
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
period	SΣ	0..1	Period	Interval during responsibility is assumed
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
referralRequest	S	0..*	Reference(ServiceRequest)	Originating Referral Request(s)
careManager	S	0..1	Reference(Practitioner | PractitionerRole)	Care manager/care coordinator for the patient
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
team	S	0..*	Reference(CareTeam)	Other practitioners facilitating this episode of care
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
EpisodeOfCare.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
EpisodeOfCare.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
EpisodeOfCare.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
EpisodeOfCare.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.statusHistory.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.type	preferred	InterweaveEpisodeOfCareType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-EpisodeOfCareType from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	EpisodeOfCare	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare		0..*	EpisodeOfCare	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Business Identifier(s) relevant for this EpisodeOfCare
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
statusHistory	S	0..*	BackboneElement	Past list of status codes (the current status may be included to cover the start date of the status)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
period		1..1	Period	Duration the EpisodeOfCare was in the specified status
type	Σ	0..1	CodeableConcept	PrimaryCare | SecondaryCare | TertiaryCare | CommunityHealth Binding: InterweaveEpisodeOfCareType (preferred)
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this episode of care
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition)	Conditions/problems/diagnoses this episode of care is for
role	Σ	0..1	CodeableConcept	Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank	Σ	0..1	positiveInt	Ranking of the diagnosis (for each role type)
patient	SΣ	1..1	Reference(InterweavePatient)	The patient who is the focus of this episode of care
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
managingOrganization	Σ	0..1	Reference(Organization)	Organization that assumes care
period	SΣ	0..1	Period	Interval during responsibility is assumed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
referralRequest	S	0..*	Reference(ServiceRequest)	Originating Referral Request(s)
careManager	S	0..1	Reference(Practitioner | PractitionerRole)	Care manager/care coordinator for the patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
team	S	0..*	Reference(CareTeam)	Other practitioners facilitating this episode of care
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
EpisodeOfCare.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
EpisodeOfCare.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
EpisodeOfCare.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
EpisodeOfCare.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
EpisodeOfCare.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.statusHistory.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.type	preferred	InterweaveEpisodeOfCareType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-EpisodeOfCareType from this IG
EpisodeOfCare.diagnosis.role	preferred	DiagnosisRole http://hl7.org/fhir/ValueSet/diagnosis-role from the FHIR Standard
EpisodeOfCare.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
EpisodeOfCare.careManager.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	EpisodeOfCare	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from EpisodeOfCare

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare		0..*	EpisodeOfCare	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
identifier	S	0..*	Identifier	Business Identifier(s) relevant for this EpisodeOfCare
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	S	1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error
statusHistory	S	0..*	BackboneElement	Past list of status codes (the current status may be included to cover the start date of the status)
type		0..1	CodeableConcept	PrimaryCare | SecondaryCare | TertiaryCare | CommunityHealth Binding: InterweaveEpisodeOfCareType (preferred)
diagnosis	S	0..*	BackboneElement	The list of diagnosis relevant to this episode of care
patient	S	1..1	Reference(InterweavePatient)	The patient who is the focus of this episode of care
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
period	S	0..1	Period	Interval during responsibility is assumed
start	S	1..1	dateTime	Starting time with inclusive boundary
referralRequest	S	0..*	Reference(ServiceRequest)	Originating Referral Request(s)
careManager	S	0..1	Reference(Practitioner | PractitionerRole)	Care manager/care coordinator for the patient
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
team	S	0..*	Reference(CareTeam)	Other practitioners facilitating this episode of care
account		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
EpisodeOfCare.type	preferred	InterweaveEpisodeOfCareType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-EpisodeOfCareType from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare		0..*	EpisodeOfCare	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Business Identifier(s) relevant for this EpisodeOfCare
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
statusHistory	S	0..*	BackboneElement	Past list of status codes (the current status may be included to cover the start date of the status)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
period		1..1	Period	Duration the EpisodeOfCare was in the specified status
type	Σ	0..1	CodeableConcept	PrimaryCare | SecondaryCare | TertiaryCare | CommunityHealth Binding: InterweaveEpisodeOfCareType (preferred)
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this episode of care
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition)	Conditions/problems/diagnoses this episode of care is for
patient	SΣ	1..1	Reference(InterweavePatient)	The patient who is the focus of this episode of care
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
period	SΣ	0..1	Period	Interval during responsibility is assumed
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
referralRequest	S	0..*	Reference(ServiceRequest)	Originating Referral Request(s)
careManager	S	0..1	Reference(Practitioner | PractitionerRole)	Care manager/care coordinator for the patient
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
team	S	0..*	Reference(CareTeam)	Other practitioners facilitating this episode of care
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
EpisodeOfCare.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
EpisodeOfCare.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
EpisodeOfCare.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
EpisodeOfCare.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.statusHistory.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.type	preferred	InterweaveEpisodeOfCareType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-EpisodeOfCareType from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	EpisodeOfCare	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
EpisodeOfCare		0..*	EpisodeOfCare	An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	0..*	Identifier	Business Identifier(s) relevant for this EpisodeOfCare
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
statusHistory	S	0..*	BackboneElement	Past list of status codes (the current status may be included to cover the start date of the status)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | waitlist | active | onhold | finished | cancelled | entered-in-error Binding: EpisodeOfCareStatus (required): The status of the episode of care.
period		1..1	Period	Duration the EpisodeOfCare was in the specified status
type	Σ	0..1	CodeableConcept	PrimaryCare | SecondaryCare | TertiaryCare | CommunityHealth Binding: InterweaveEpisodeOfCareType (preferred)
diagnosis	SΣ	0..*	BackboneElement	The list of diagnosis relevant to this episode of care
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition)	Conditions/problems/diagnoses this episode of care is for
role	Σ	0..1	CodeableConcept	Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank	Σ	0..1	positiveInt	Ranking of the diagnosis (for each role type)
patient	SΣ	1..1	Reference(InterweavePatient)	The patient who is the focus of this episode of care
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
managingOrganization	Σ	0..1	Reference(Organization)	Organization that assumes care
period	SΣ	0..1	Period	Interval during responsibility is assumed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
referralRequest	S	0..*	Reference(ServiceRequest)	Originating Referral Request(s)
careManager	S	0..1	Reference(Practitioner | PractitionerRole)	Care manager/care coordinator for the patient
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
team	S	0..*	Reference(CareTeam)	Other practitioners facilitating this episode of care
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
EpisodeOfCare.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
EpisodeOfCare.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
EpisodeOfCare.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
EpisodeOfCare.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
EpisodeOfCare.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
EpisodeOfCare.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.statusHistory.status	required	EpisodeOfCareStatus http://hl7.org/fhir/ValueSet/episode-of-care-status|4.0.1 from the FHIR Standard
EpisodeOfCare.type	preferred	InterweaveEpisodeOfCareType https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-EpisodeOfCareType from this IG
EpisodeOfCare.diagnosis.role	preferred	DiagnosisRole http://hl7.org/fhir/ValueSet/diagnosis-role from the FHIR Standard
EpisodeOfCare.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
EpisodeOfCare.careManager.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	EpisodeOfCare	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	EpisodeOfCare	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	EpisodeOfCare	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from EpisodeOfCare

Summary

Mandatory: 2 elements(9 nested mandatory elements)
Must-Support: 20 elements
Fixed: 2 elements
Prohibited: 6 elements

Structures

This structure refers to these other structures:

• InterweaveOrganization (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Organization)
• InterweavePatient (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Patient)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of EpisodeOfCare.meta.tag

Differences between Interweave STU3 and R4 profiles

Graphical relationship diagram