Stream: implementers
Topic: Patient / Case / Stay Hierarchy
André Sander (Mar 20 2019 at 13:22):
In Germany we name a patients stay in a hospital a "case" and if the patient moves from ward to ward during his stay we call this a "stay". So, the hierarchy for a patient in a hospital from admission to discharge is "1 patient has 1 case has n stays". Now my question: how would I model the case: with an EpisodeOfCare or with an Encounter?
Documentation of EpisodeOfCare says that it would be known as "case" in exisiting systems but 8.10.3.1. Expected Implementations reads a bit different as there are more generic categories are listed.
So, what is a case in a hospital?
Thanks!
Leonid Toporkov (Mar 21 2019 at 17:03):
i would say encounter fits best for you. I might be used as a container for all events while patient stays in hospital
Brendan Keeler (Mar 21 2019 at 18:33):
Igor, stays are interesting... Are wards/departments so segmented that there's a separate concept? Is that because they're generally on different systems?
Brendan Keeler (Mar 21 2019 at 18:35):
Neither the US nor the NL has analogous concepts to my knowledge. US has admissions that are bucketed into financial accounts or grouped into episodes (for care over many admissions) but in terms of a distinct container for each department's piece of an admission...that'd just a transfer within the admission. NL has admissions (opnames) linked by episodes (zorgtrajecten) in some capacity.
Sebastiaan van Sandijk (Mar 21 2019 at 19:58):
As Leonid says, Encounter fits best for you. If the patient moves from ward to ward, for whatever reason, you most likely would use locations within the overarching hospital Encounter. So your 'stays' corresponds to hospital 'locations', while the case, from admission to discharge, is an Encounter. There can be one or more episodes of care associated with the hospital stay/case, but these are to be associated with the clinical pathway(s) (clusters of Encounters around a specific specialism / diagnosis) that emerge from the admission, both in terms of inpatient and outpatient care. An admission / encounter can also be part of an existing episode of care that started with a previous admission or an outpatient Encounter.
René Spronk (Mar 22 2019 at 07:57):
See also https://chat.fhir.org/#narrow/stream/179166-implementers/topic/Encounter.20Hierarchy where this very same topic (or something quite like it) was discussed.
André Sander (Mar 22 2019 at 10:23):
Thank you very much for your replies. I think the difference are mainly based in the fact that a "case" is a "billing unit" and not medical driven. Unfortunately, we tend to organize everything around billing and not about the patient... So, for now I will use Encounter to map a "case" to FHIR. Thanks for your help - really appreciate this community!
Simone Heckmann (Mar 22 2019 at 16:06):
@Igor Zaus You may want to discuss this issue with the german FHIR community over at https://chat.fhir.org/#narrow/stream/179183-german-(d-a-ch) ;-)
Last updated: Apr 12 2022 at 19:14 UTC
