Generated Narrative: StructureDefinition kenya-core-encounter Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Encounter 0..* Encounter An interaction during which services are provided to the patient #xD; id S 1..1 id Logical id of this artifact #xD; meta S 1..1 Meta Metadata about the resource #xD; profile 1..* canonical(StructureDefinition) Profiles this resource claims to conform to Fixed Value: https://fhir.sha.go.ke/fhir/StructureDefinition/kenya-core-encounter|1.0.0 #xD; status S 1..1 code planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: Encounter Status Value Set (required) #xD; class S 1..1 Coding Classification of patient encounter Binding: ActEncounterCode (required) #xD; type 0..* CodeableConcept Specific type of encounter Binding: Encounter Type Value Set (required) #xD; subject S 1..1 Reference(KenyaCore Patient Profile) The patient or group present at the encounter #xD; participant #xD; individual S 1..1 Reference(Practitioner | PractitionerRole | RelatedPerson) Persons involved in the encounter other than the patient #xD; diagnosis S 0..* BackboneElement The list of diagnosis relevant to this encounter #xD; location S 0..* BackboneElement List of locations where the patient has been #xD; location 1..1 Reference(Kenya Core Location Profile) Location the encounter takes place #xD; serviceProvider S 0..1 Reference(KenyaCore Organization Profile) The organization (facility) responsible for this encounter #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
Kenya Core FHIR profile for Encounter resource, aligned with Kenya Core specifications.
An interaction during which services are provided to the patient
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
The 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.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. 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 can 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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
When the resource last changed - e.g. when the version changed.
This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R4/http.html#read) interaction.
Identifies where the resource comes from
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Profiles this resource claims to conform to
A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Security Labels applied to this resource
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Security Labels from the Healthcare Privacy and Security Classification System.
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifier(s) by which this encounter is known
Identifier(s) by which this encounter is known.
planned | arrived | triaged | in-progress | onleave | finished | cancelled +
planned | arrived | triaged | in-progress | onleave | finished | cancelled +.
Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
No clear equivalent in HL7 v2; active/finished could be inferred from PV1-44, PV1-45, PV2-24; inactive could be inferred from PV2-16
The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.
The current status is always found in the current version of the resource, not the status history.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The time that the episode was in the specified status
The time that the episode was in the specified status.
Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.
inpatient | outpatient | ambulatory | emergency +
inpatient | outpatient | ambulatory | emergency +.
The time that the episode was in the specified class
The time that the episode was in the specified class.
Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).
Since there are many ways to further classify encounters, this element is 0..*.
Broad categorization of the service that is to be provided (e.g. cardiology).
Broad categorization of the service that is to be provided.
The patient or group present at the encounter
The patient or group present at the encounter.
While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).
Episode(s) of care that this encounter should be recorded against
Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).
The ServiceRequest that initiated this encounter
The request this encounter satisfies (e.g. incoming referral or procedure request).
List of participants involved in the encounter
The list of people responsible for providing the service.
The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.
Period of time during the encounter that the participant participated
The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
Persons involved in the encounter other than the patient
Persons involved in the encounter other than the patient.
The appointment that scheduled this encounter
The appointment that scheduled this encounter.
.outboundRelationship[typeCode=FLFS].target[classCode=ENC, moodCode=APT]
The start and end time of the encounter.
If not (yet) known, the end of the Period may be omitted.
Quantity of time the encounter lasted (less time absent)
Quantity of time the encounter lasted. This excludes the time during leaves of absence.
May differ from the time the Encounter.period lasted because of leave of absence.
(PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations )
Reason the encounter takes place (reference)
The list of diagnosis relevant to this encounter
The list of diagnosis relevant to this encounter.
The diagnosis or procedure relevant to the encounter
Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.
Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively.
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).
The type of diagnosis this condition represents.
Ranking of the diagnosis (for each role type)
Ranking of the diagnosis (for each role type).
The set of accounts that may be used for billing for this Encounter
The set of accounts that may be used for billing for this Encounter.
The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
Details about the admission to a healthcare service
Details about the admission to a healthcare service.
An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.
.outboundRelationship[typeCode=COMP].target[classCode=ENC, moodCode=EVN]
The location/organization from which the patient came before admission
The location/organization from which the patient came before admission.
From where patient was admitted (physician referral, transfer)
From where patient was admitted (physician referral, transfer).
The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Whether this hospitalization is a readmission and why if known.
The reason for re-admission of this hospitalization encounter.
Diet preferences reported by the patient
Diet preferences reported by the patient.
For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.
Medical, cultural or ethical food preferences to help with catering requirements.
.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=EVN, code="diet"]
Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
Location/organization to which the patient is discharged
Location/organization to which the patient is discharged.
Category or kind of location after discharge
Category or kind of location after discharge.
List of locations where the patient has been
List of locations where the patient has been during this encounter.
Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".
The location where the encounter takes place.
The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.
When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.
The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.
This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query. There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.
Time period during which the patient was present at the location
Time period during which the patient was present at the location.
The organization (facility) responsible for this encounter
The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.
Another Encounter this encounter is part of
Another Encounter of which this encounter is a part of (administratively or in time).
This is also used for associating a child's encounter back to the mother's encounter. Refer to the Notes section in the Patient resource for further details.
.inboundRelationship[typeCode=COMP].source[classCode=COMP, moodCode=EVN]