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  1. FHIR Specification Feedback
  2. FHIR-40547

Provide guidance re: convention for differentiating admission from arrival time

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US QI Core (FHIR)
    • current
    • Clinical Quality Information
    • QICore Encounter
    • Hide

      Add specific guidance to QDM-to-QI-Core mapping section [9.12.1 EncounterTiming|[qdm-to-qicore.html]:|https://build.fhir.org/ig/HL7/fhir-qi-core/qdm-to-qicore.html#encounter-timing]

      "Encounter.period provides the start and stop times of an encounter. Some measures require specific reference to encounter admissionTime while others require reference to a concept called arrivalTime. The meaning of Encounter.period start cannot reference both timings. Therefore, by convention and based on previous discussions with various HL7 workgroups, Encounter.period startTime represents admissionTime for hospitalizations. Therefore, to reference arrivalTime QDM and QI-Core use Encounter.location to indicate the physical place where the initial encounter services occur, and Encounter.location.period to indicate the arrivalTime and the departureTime. Thus, the measure query can differentiate between admissionTime used to determine length of stay and arrivalTime used to indicate when the patient presented for care at the location which is prior to the formal completion of the admission process."

      Further, create an example for Emergency Department Arrival Time.

      Show
      Add specific guidance to QDM-to-QI-Core mapping section [9.12.1 EncounterTiming| [qdm-to-qicore.html] :|https://build.fhir.org/ig/HL7/fhir-qi-core/qdm-to-qicore.html#encounter-timing] "Encounter.period provides the start and stop times of an encounter. Some measures require specific reference to encounter admissionTime while others require reference to a concept called  arrivalTime . The meaning of Encounter.period start cannot reference both timings. Therefore, by convention and based on previous discussions with various HL7 workgroups, Encounter.period  startTime represents  admissionTime for hospitalizations. Therefore, to reference arrivalTime QDM and QI-Core use Encounter.location to indicate the physical place where the initial encounter services occur, and Encounter.location.period to indicate the arrivalTime and the departureTime . Thus, the measure query can differentiate between  admissionTime used to determine length of stay and  arrivalTime used to indicate when the patient presented for care at the location which is prior to the formal completion of the admission process." Further, create an example for Emergency Department Arrival Time.
    • Floyd Eisenberg/Michelle Curie: 24-0-0
    • Clarification
    • Non-substantive

    Description

      QI-Core Encounter.location (location) includes an extension for location period (qdm-to-qicore.html

      The rationale is to continue a convention that the start/stop time for Encounter.period is admission to discharge time. This is distinct from arrivalTime which some inpatient measures need to determine time of a specific intervention after arrival. An effectiveTime cannot be both arrival and admission since there is no way to distinguish between these concepts. Therefore, measures have used a convention that Encounter.period addresses admission to discharge and that works for lengthOfStay. The convention uses location.period to indicate arrival to departure time.  The challenge is that base FHIR and US Core do not have a specific concept for location.period.  

      Suggest that QI-Core provide guidance and an example of how to define arrivalTime versus admission time.  Perhaps add an explanatory statement in the QDM to QI-Core table for Encounter.location.period row explaining the location period defines arrival and departure time for the location since the Encounter.period defines the admission to discharge time.

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            jen_seeman Jennifer Seeman
            feisenberg Floyd Eisenberg
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              Updated:
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