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  1. FHIR Specification Feedback
  2. FHIR-22726

Suggesting guidance regarding Encounter Period start and stop times

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    Details

    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Medium
    • Resolution: Persuasive
    • Specification:
      FHIR Core (FHIR)
    • Raised in Version:
      STU3
    • Work Group:
      Patient Administration
    • Related Artifact(s):
      Encounter
    • Resolution Description:
      Hide

      Where admissions are relevant:

      The Encounter.period.start is the admission date

      The Encounter.period.end is the discharge date

      An additional status will be added to the Encounter Status ValueSet

      http://build.fhir.org/valueset-encounter-status.html

      code "discharged"

      display "Discharged"

      definition:

      "The Encounter has been clinically completed, the patient has been discharged from the facility or the visit has ended, and the patient may have departed (refer to subjectStatus). While the encounter is in this status, administrative activities are usually performed, collating all required documentation and charge information before being released for billing, at which point the status will move to completed."

      canonical status: (none match)

      An additional note will be added to the Encounter Status Management section to further describe this scenario.

       

      Show
      Where admissions are relevant: The Encounter.period.start is the admission date The Encounter.period.end is the discharge date An additional status will be added to the Encounter Status ValueSet http://build.fhir.org/valueset-encounter-status.html code "discharged" display "Discharged" definition: "The Encounter has been clinically completed, the patient has been discharged from the facility or the visit has ended, and the patient may have departed (refer to subjectStatus). While the encounter is in this status, administrative activities are usually performed, collating all required documentation and charge information before being released for billing, at which point the status will move to completed." canonical status: (none match) An additional note will be added to the Encounter Status Management section to further describe this scenario.  
    • Resolution Vote:
      Brian Postlethwaite/Mary Kay McDaniel: 19-0-0
    • Change Category:
      Enhancement
    • Change Impact:
      Compatible, substantive
    • Applied for Version:
      R5

      Description

      The Encounter resource includes some guidance (8.11.2 Boundaries and Relationships) to help implementers understand how to apply status and Encounter.period (i.e., actual start and stop times). It may be helpful to consider some text explaining other confounding issues about Encounter.period. Administrative (billing) software may indicate a start based on patient check-in or initiation of clinician-patient interaction and stop based on patient check-out or end of clinician-patient interaction. However, clinical software may require that clinicians "close out" the encounter when all related documentation is completed. And, in the real-world, such documentation completion may take 48, 72 or more hours so the Encounter is left in "open" status and the clinical software could identify the Encounter.period as 72 hours for a 15-minute actual encounter. Such timings are significant especially when evaluating clinical workflow and when comparing the time from the end of one activity until the initiation of another activity. It has surfaced as an issue in calculating quality measures. Some general guidance about actual intent Vs interpretation would be helpful in the FHIR Encounter resource "boundaries and relationships" section.

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              Assignee:
              brian.postlethwaite Brian Postlethwaite
              Reporter:
              feisenberg Floyd Eisenberg
              Watchers:
              3 Start watching this issue

                Dates

                Created:
                Updated:
                Resolved:
                Vote Date: