ZD EpisodeOfCare
Resources conforming to this profile are requested by ZorgDomein when populating the referral letter or request form with data from the source information system.
Queries on the https://[FHIRServerUrl]/EpisodeOfCare endpoint may include the following query parameters:
patient=[PatientID]:[PatientID]refers to the patient ID as provided in the Task resource that is requested by ZorgDomein during SSO._sort=-date: indicates that the resources in the search result must be sorted by date, descending.
The canonical URL for this profile is:
http://zorgdomein.nl/fhir/StructureDefinition/zd-episodeofcare
This profile builds on EpisodeOfCare.
| EpisodeOfCare | S I | EpisodeOfCare | Element Id
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 Alternate namesCase Program Problem DefinitionAn 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.
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| id | S Σ | 1..1 | id |
There are no (further) constraints on this element Element Id
EpisodeOfCare.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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| extension | I | 0..* | Extension | Element Id
EpisodeOfCare.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Constraints
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| zd-classification-code | S I | 0..* | Extension(CodeableConcept) | Element Id
EpisodeOfCare.extension:zd-classification-code Classification code(s) for the episode Alternate namesextensions, user content DefinitionOptional Extension Element - found in all resources. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. http://zorgdomein.nl/fhir/StructureDefinition/zd-classification-code Constraints
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| url | 1..1 | uriFixed Value |
There are no (further) constraints on this element Element Id
EpisodeOfCare.extension:zd-classification-code.url identifies the meaning of the extension DefinitionSource of the definition for the extension code - a logical name or a URL. The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
http://zorgdomein.nl/fhir/StructureDefinition/zd-classification-code
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| valueCodeableConcept | 0..1 | CodeableConcept | Element Id
EpisodeOfCare.extension:zd-classification-code.valueCodeableConcept:valueCodeableConcept Classification code for the episode DefinitionValue of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
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| coding | Σ | 0..* | Coding | Element Id
EpisodeOfCare.extension:zd-classification-code.valueCodeableConcept:valueCodeableConcept.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Unordered, Open, by system(Value) Constraints
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| ICPC | Σ | 0..1 | Coding | Element Id
EpisodeOfCare.extension:zd-classification-code.valueCodeableConcept:valueCodeableConcept.coding:ICPC ICPC code DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| system | Σ | 1..1 | uriFixed Value | Element Id
EpisodeOfCare.extension:zd-classification-code.valueCodeableConcept:valueCodeableConcept.coding:ICPC.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.
http://hl7.org/fhir/sid/icpc-1-nl
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| version | Σ | 0..1 | string |
There are no (further) constraints on this element Element Id
EpisodeOfCare.extension:zd-classification-code.value[x]:valueCodeableConcept.coding:ICPC.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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| code | Σ | 1..1 | code | Element Id
EpisodeOfCare.extension:zd-classification-code.valueCodeableConcept:valueCodeableConcept.coding:ICPC.code Actual ICPC code DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
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| display | Σ | 0..1 | string |
There are no (further) constraints on this element Element Id
EpisodeOfCare.extension:zd-classification-code.value[x]:valueCodeableConcept.coding:ICPC.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
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| userSelected | Σ | 0..1 | boolean |
There are no (further) constraints on this element Element Id
EpisodeOfCare.extension:zd-classification-code.value[x]:valueCodeableConcept.coding:ICPC.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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| text | Σ | 0..1 | string |
There are no (further) constraints on this element Element Id
EpisodeOfCare.extension:zd-classification-code.value[x]:valueCodeableConcept.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings.
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| identifier | 0..* | Identifier |
There are no (further) constraints on this element Element Id
EpisodeOfCare.identifier Business Identifier(s) relevant for this EpisodeOfCare DefinitionThe EpisodeOfCare may be known by different identifiers for different contexts of use, such as when an external agency is tracking the Episode for funding purposes.
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| status | Σ ?! | 1..1 | codeBinding |
There are no (further) constraints on this element Element Id
EpisodeOfCare.status planned | waitlist | active | onhold | finished | cancelled | entered-in-error Definitionplanned | waitlist | active | onhold | finished | cancelled. This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid.
The status of the episode of care. EpisodeOfCareStatus (required)Constraints
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| statusHistory | 0..* | BackboneElement |
There are no (further) constraints on this element Element Id
EpisodeOfCare.statusHistory Past list of status codes (the current status may be included to cover the start date of the status) DefinitionThe history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource).
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| status | 1..1 | codeBinding |
There are no (further) constraints on this element Element Id
EpisodeOfCare.statusHistory.status planned | waitlist | active | onhold | finished | cancelled | entered-in-error Definitionplanned | waitlist | active | onhold | finished | cancelled. Note that FHIR strings may not exceed 1MB in size
The status of the episode of care. EpisodeOfCareStatus (required)Constraints
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| period | I | 1..1 | Period |
There are no (further) constraints on this element Element Id
EpisodeOfCare.statusHistory.period Duration the EpisodeOfCare was in the specified status DefinitionThe period during this EpisodeOfCare that the specific status applied. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| type | S Σ | 0..* | CodeableConcept | Element Id
EpisodeOfCare.type Type/class - e.g. specialist referral, disease management DefinitionA classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. The type can be very important in processing as this could be used in determining if the EpisodeOfCare is relevant to specific government reporting, or other types of classifications. Unordered, Open, by coding.code(Value) Binding
The type of the episode of care EpisodeOfCareType (example)Constraints
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| flaggedEpisode | Σ | 0..1 | CodeableConcept | Element Id
EpisodeOfCare.type:flaggedEpisode Use coding.code = "flagged-episode" if the episode should be flagged as an episode with attention value DefinitionA classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care. The type can be very important in processing as this could be used in determining if the EpisodeOfCare is relevant to specific government reporting, or other types of classifications.
The type of the episode of care EpisodeOfCareType (example)Constraints
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| coding | Σ | 1..1 | Coding |
There are no (further) constraints on this element Element Id
EpisodeOfCare.type:flaggedEpisode.coding Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
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| system | Σ | 0..1 | uri |
There are no (further) constraints on this element Element Id
EpisodeOfCare.type:flaggedEpisode.coding.system Identity of the terminology system DefinitionThe identification of the code system that defines the meaning of the symbol in the code. Need to be unambiguous about the source of the definition of the symbol. The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.
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| version | Σ | 0..1 | string |
There are no (further) constraints on this element Element Id
EpisodeOfCare.type:flaggedEpisode.coding.version Version of the system - if relevant DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
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| code | Σ | 1..1 | codeFixed Value | Element Id
EpisodeOfCare.type:flaggedEpisode.coding.code Symbol in syntax defined by the system DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Need to refer to a particular code in the system. Note that FHIR strings may not exceed 1MB in size
flagged-episode
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| display | Σ | 0..1 | stringFixed Value | Element Id
EpisodeOfCare.type:flaggedEpisode.coding.display Representation defined by the system DefinitionA representation of the meaning of the code in the system, following the rules of the system. Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Note that FHIR strings may not exceed 1MB in size
Episode met attentiewaarde
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| userSelected | Σ | 0..1 | boolean |
There are no (further) constraints on this element Element Id
EpisodeOfCare.type:flaggedEpisode.coding.userSelected If this coding was chosen directly by the user DefinitionIndicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
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| text | Σ | 0..1 | string |
There are no (further) constraints on this element Element Id
EpisodeOfCare.type:flaggedEpisode.text Plain text representation of the concept DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Very often the text is the same as a displayName of one of the codings.
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| diagnosis | S Σ | 1..* | BackboneElement |
There are no (further) constraints on this element Element Id
EpisodeOfCare.diagnosis The list of diagnosis relevant to this episode of care DefinitionThe list of diagnosis relevant to this episode of care.
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| condition | S Σ I | 1..1 | Reference(Condition) |
There are no (further) constraints on this element Element Id
EpisodeOfCare.diagnosis.condition Conditions/problems/diagnoses this episode of care is for DefinitionA list of conditions/problems/diagnoses that this episode of care is intended to be providing care for. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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| reference | Σ I | 0..1 | string |
There are no (further) constraints on this element Element Id
EpisodeOfCare.diagnosis.condition.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
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| identifier | Σ | 0..1 | Identifier |
There are no (further) constraints on this element Element Id
EpisodeOfCare.diagnosis.condition.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
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| display | S Σ | 1..1 | string |
There are no (further) constraints on this element Element Id
EpisodeOfCare.diagnosis.condition.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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| role | Σ | 0..1 | CodeableConceptBinding |
There are no (further) constraints on this element Element Id
EpisodeOfCare.diagnosis.role Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) DefinitionRole that this diagnosis has within the episode of care (e.g. admission, billing, discharge …). Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
The type of diagnosis this condition represents DiagnosisRole (preferred)Constraints
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| rank | Σ | 0..1 | positiveInt |
There are no (further) constraints on this element Element Id
EpisodeOfCare.diagnosis.rank Ranking of the diagnosis (for each role type) DefinitionRanking of the diagnosis (for each role type). 32 bit number; for values larger than this, use decimal
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| patient | S Σ I | 1..1 | Reference(ZD Patient) | Element Id
EpisodeOfCare.patient The patient who is the focus of this episode of care DefinitionThe patient who is the focus of this episode of care. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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| managingOrganization | Σ I | 0..1 | Reference(Organization) |
There are no (further) constraints on this element Element Id
EpisodeOfCare.managingOrganization Organization that assumes care DefinitionThe organization that has assumed the specific responsibilities for the specified duration. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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| period | S Σ I | 0..1 | Period |
There are no (further) constraints on this element Element Id
EpisodeOfCare.period Interval during responsibility is assumed DefinitionThe interval during which the managing organization assumes the defined responsibility. This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
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| referralRequest | I | 0..* | Reference(ReferralRequest) |
There are no (further) constraints on this element Element Id
EpisodeOfCare.referralRequest Originating Referral Request(s) DefinitionReferral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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| careManager | I | 0..1 | Reference(Practitioner) |
There are no (further) constraints on this element Element Id
EpisodeOfCare.careManager Care manager/care co-ordinator for the patient DefinitionThe practitioner that is the care manager/care co-ordinator for this patient. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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| team | I | 0..* | Reference(CareTeam) |
There are no (further) constraints on this element Element Id
EpisodeOfCare.team Other practitioners facilitating this episode of care Alternate namesCareTeam DefinitionThe list of practitioners that may be facilitating this episode of care for specific purposes. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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| account | I | 0..* | Reference(Account) |
There are no (further) constraints on this element Element Id
EpisodeOfCare.account The set of accounts that may be used for billing for this EpisodeOfCare DefinitionThe set of accounts that may be used for billing for this EpisodeOfCare. The billing system may choose to allocate billable items associated with the EpisodeOfCare to different referenced Accounts based on internal business rules.
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See the profile on simplifier.net for additional details.
Resource example
Below you find an example of an EpisodeOfCare resource that conforms to the ZD EpisodeOfCare profile.
{
"resourceType": "EpisodeOfCare",
"id": "10893",
"meta": {
"versionId": "1",
"lastUpdated": "2019-06-05T14:23:56.385+02:00",
"profile": [
"http://zorgdomein.nl/fhir/StructureDefinition/zd-episodeofcare"
]
},
"extension": [
{
"url": "http://zorgdomein.nl/fhir/StructureDefinition/zd-classification-code",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icpc-1-nl",
"code": "T90",
"display": "Diabetes mellitus"
}
]
}
}
],
"status": "active",
"type": [
{
"coding": {
"code": "flagged-episode",
"display": "Episode met attentiewaarde"
}
}
],
"diagnosis": [
{
"condition": {
"display": "Diabetes mellitus"
}
}
],
"patient": {
"reference": "Patient/10796"
},
"period": {
"start": "2017-02-14T00:00:00+01:00"
}
}
<EpisodeOfCare xmlns='http://hl7.org/fhir'>
<id value='10893'/>
<meta>
<versionId value='1'/>
<lastUpdated value='2019-06-05T14:23:56.385+02:00'/>
<profile value='http://zorgdomein.nl/fhir/StructureDefinition/zd-episodeofcare'/>
</meta>
<extension url='http://zorgdomein.nl/fhir/StructureDefinition/zd-classification-code'>
<valueCodeableConcept>
<coding>
<system value='http://hl7.org/fhir/sid/icpc-1-nl'/>
<code value='T90'/>
<display value='Diabetes mellitus'/>
</coding>
</valueCodeableConcept>
</extension>
<status value='active'/>
<type>
<coding>
<code value='flagged-episode'/>
<display value='Episode met attentiewaarde'/>
</coding>
</type>
<diagnosis>
<condition>
<display value='Diabetes mellitus'/>
</condition>
</diagnosis>
<patient>
<reference value='Patient/10796'/>
</patient>
<period>
<start value='2017-02-14T00:00:00+01:00'/>
</period>
</EpisodeOfCare>