EpisodeOfCare — detail: longitudinal care
Longitudinal management of a patient around a care programme: ALD diabetes, pregnancy follow-up, chemo, palliative care. Narrative container spanning encounters.
EpisodeOfCare vs Encounter
An Encounter = a stay, a consultation: temporal extent bounded by the
walls of a facility and the flow of care.
An EpisodeOfCare = longitudinal care, cross-Encounter, possibly lasting
several years (French ALD, onco programme). Multiple Encounters can belong to the same
EpisodeOfCare via Encounter.episodeOfCare.
Key fields
| Field | Cardinality | Role |
|---|---|---|
status | 1..1 | Lifecycle (see below). |
type | 0..* | Type of management. |
reason | 0..* | Reason for the care (R5 new reason backbone). |
diagnosis | 0..* | Diagnoses carried by the episode, with condition and use. |
patient | 1..1 | Patient concerned. |
managingOrganization | 0..1 | Pivot organisation. |
period | 0..1 | Episode period. |
careManager | 0..1 | Designated care manager. |
team | 0..* | Associated CareTeams. |
Status lifecycle
EpisodeOfCare goes through planned -> waitlist ->
active -> onhold -> finished | cancelled
| entered-in-error. statusHistory tracks transitions.
Example: ALD diabetes
{
"resourceType": "EpisodeOfCare",
"id": "ald-diabetes-001",
"identifier": [{ "system": "urn:oid:1.2.250.1.213.2.7", "value": "ALD8-202604123" }],
"status": "active",
"type": [{
"coding": [{
"system": "http://terminology.hl7.org/CodeSystem/episodeofcare-type",
"code": "hacc",
"display": "Home and Community Care"
}]
}],
"reason": [{
"use": [{ "coding": [{ "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role", "code": "AD", "display": "Admission diagnosis" }] }],
"value": [{ "concept": { "coding": [{
"system": "http://hl7.org/fhir/sid/icd-10",
"code": "E11",
"display": "Type 2 diabetes mellitus"
}] } }]
}],
"patient": { "reference": "Patient/marie-dupont" },
"managingOrganization": { "reference": "Organization/cpam-paris" },
"period": { "start": "2024-09-15" },
"careManager": { "reference": "Practitioner/dr-leclerc" }
}Common pitfalls
- Confusion with CarePlan — EpisodeOfCare is the administrative container, CarePlan is the operational plan. They coexist.
- No coded
type— an EpisodeOfCare withouttypeis unintelligible to payers. - diagnosis without
use— specifyAD(admission),CC(chief complaint),DD(discharge), or prioritisation breaks. - Encounter without backlink — each Encounter in the longitudinal care must point to the EpisodeOfCare via
Encounter.episodeOfCare.