Ambulance - Tabular View

EncompassingEncounter Tabular View

EncompassingEncounter

In most but not all cases the Encompassing Encounter template covers an episode of care.
An episode of care for the purpose of this specification is defined as:-
A continuous period of care (including assessment for care) for a PERSON for an illness or condition involving health and possibly other agencies which has been nationally targeted and prioritised as requiring an organised and cohesive programme or regime of care. Overall management and coordination of the care will be the solely led responsibility of a specific Health Care Provider, or in the case of equally shared responsibility, the jointly led responsibility of two or more Health Care Providers. Actual treatment associated with the programme or regime of care may be delivered by the responsible Health Care Provider or by other Health Care Providers.

This class represents the setting of the clinical encounter during which the documented act(s) or service event occurred. Documents are not necessarily generated during an encounter, such as when a clinician, in response to an abnormal lab result, attempts to contact the patient but can't, and writes a Progress Note.

In some cases, the setting of the encounter is inherent in the ClinicalDocument.code, such as where ClinicalDocument.code is "Diabetes Clinic Progress Note". The setting of an encounter can also be transmitted in the HealthCareFacility.code attribute. If HealthCareFacility.code is sent, it should be equivalent to or further specialize the value inherent in the ClinicalDocument.code. Such as where the ClinicalDocument.code is simply "Clinic Progress Note" and the value of HealthCareFacility.code is "cardiology clinic"). HealthCareFacility.code shall not conflict with the value inherent in the ClinicalDocument.code, as such a conflict would constitute an ambiguous situation.

The following notes are recommendations for the use of this template:

The same instance of an encompassing encounter can appear in multiple documents, document sets and documents types.

The id (UUID) has to be the same for it to be the same encounter

The information carried in the encounter should not be changed unless the id (UUID) is changed but more information may be added for example:

The start time in all instances must be the same (it may be missing in the early instances and added in later instances)

The end time in all instances must be the same (it may be missing in early instances and added in later instances)

The EncompassingEncounter code must be the same type in all instances but can be further refined ( consultation can be refined to telephone consultation for example)

The location cannot be changed but more information maybe added

Participants can be added but should not be removed, participant time should be used to indicate when the person's/organisations were involved

Responsible party can only be changed when the person or organisation responsible changes. A responsible organisation can be refined to be a named person within that organisation

Used by:

[1..1] [M] classCode (CS { CNE: ActClass } )
{ Fixed="ENC" }

Model Attribute Description

The HL7 attribute classCode uses a code to describe this class as an encounter.

Implementation in XML Instance

The XML attribute classCode is fixed to " ENC".

[1..1] [M] moodCode (CS { CNE: ActMood } )
{ Fixed="EVN" }

Model Attribute Description

The HL7 attribute moodCode uses a code to describe this class as an encounter event

Implementation in XML Instance

The XML attribute moodCode is fixed to " EVN".

[1..1] [M] code (CD { CWE:CodedEntryCode } )

Model Attribute Description

The HL7 attribute code uses a SNOMED CT code from the CDAEncounterSnCT vocabulary to describe the type of encompassing encounter.

Implementation in XML Instance

The Coded Value (CV) data type shall be used to carry this information in the XML element code as follows:

The XML attribute code shall contain a code from the subset stated in CDAEncounterSnCT vocabulary
The XML attribute codeSystem shall contain the OID "2.16.840.1.113883.2.1.3.2.4.15"
The XML attribute displayName shall carry a description associated with the code in the subset stated in the CDAEncounterSnCT vocabulary. It is recommended that the preferred term is used to populate this attribute
The XML attribute originalText may be used if required to carry the text or phrase used as the basis for the coding

[1..1] [R] dischargeDispositionCode (CE { CWE:CodedEntryCode } )

Model Attribute Description

The HL7 attribute dischargeDispositioncode uses a SNOMED CT code from the EncounterDispositionSnCT vocabulary to describe how the encompassing encounter ended. This attribute should only be used when there is a business concept of discharge else it should be nulled.

Implementation in XML Instance

The Coded with Equivalents (CE) data type shall be used to carry this information in the XML element dischargeDispositioncode as follows:

The XML attribute code shall contain a code from the subset stated in EncounterDispositionSnCT vocabulary
The XML attribute codeSystem shall contain the OID "2.16.840.1.113883.2.1.3.2.4.15"
The XML attribute displayName shall carry a description associated with the code in the subset stated in the EncounterDispositionSnCT vocabulary. It is recommended that the preferred term is used to populate this attribute
The XML attribute originalText may be used if required to carry the text or phrase used as the basis for the coding

The use of the SNOMED CT terms in this subset are for guidance purposes only. Codes outside this subset may be used at clinical discretion.

When this element is nulled then:

The XML attribute nullFlavor of the XML element dischargeDispositioncode shall contain the value "NA".

[1..1] [M] effectiveTime (IVL<TS>)

Model Attribute Description

The HL7 attribute effectiveTime uses low (start), high (end) and center (point in time) to detail time associated with / relevant to the encounter.

Implementation in XML Instance

The XML attribute value of the XML elements low, center and high, shall be populated (when used in the instance) with a time stamp in the format yyyymmddhhmmss[+|-ZZzz] where:

yyyy is the year
mm is the month
dd is the day
hh is the hour
mm is the minutes
ss is the seconds
[+|-ZZzz] is the time zone offset in hours and minutes

Sections from the right of this representation may be left off when the sending system does not record to this level of accuracy. When hours are present, the time zone offset must also be present.

The XML attribute value of the XML elements low, center and high should be populated to the level of detail that is available on the sending system.

The actual use of the XML element effectiveTime in an instance will vary from domain to domain. The following guidance has been issued for existing domains on how to populate the XML element effectiveTime and sub elements.

Admissions domain

The XML attribute value of the XML element low should be used to indicate when the patient was admitted and should be equal to the XML attribute value of the XML element low on the Encompassing Encounter on any discharge document for the admission (same inpatient stay)
The element center should NOT be used
The element high should NOT be used

Discharge domain

The XML attribute value of the XML element low should be used to indicate when the patient was admitted and should be equal to the XML attribute value of the XML element low on the Encompassing Encounter on the admission document for the inpatient stay
The XML element center should NOT be used
The XML attribute value of the XML element high shall be used to indicate when the patient was discharged

Ambulance domain

The XML attribute value of the XML element low should be used to indicate when the ambulance arrived
The XML attribute center should not normally be used
The XML attribute value of the XML element high should be used to indicate when the patient left the care of the ambulance personnel

Diagnostic Imaging domain

The XML attribute value of the XML element low should be used to indicate when the consultation started
The XML attribute center should not normally be used
The XML attribute value of the XML element high should be used to indicate when the consultation ended which maybe after the patient left the department

Emergency Department domain

The XML attribute value of the XML element low should be used to indicate when Emergency Department event started
The XML element center should not normally be used
The XML attribute value of the XML element high should be used to indicate when the patient left the care of the Emergency Department personnel

Assessments

The XML attribute value of the XML element low should be used to indicate when the assessment event started
The XML element center should not normally be used
The XML attribute value of the XML element high should be used to indicate when the assessment event ended

Care plans

The XML attribute value of the XML element low should be used to indicate when the care planning event started
The XML element center should not be used
The XML attribute value of the XML element high should be used to indicate when the care planning event ended

Out of Hours domain

The XML attribute value of the XML element low should be used to indicate when patient first contacts Out of Hours
The XML element center should not normally be used
The XML attribute value of the XML element high should be used to indicate when the Out of Hours encounter ended

Outpatients domain

The XML attribute value of the XML element low should be used to indicate when patient first arrives in the outpatient department
The XML element center should not normally be used
The XML attribute value of the XML element high should be used to indicate when the patient leaves the Outpatients department

Consultations (any domain) including telephone consultations

The XML attribute value of the XML element low should be used to indicate when Consultation started
The XML element center should not normally be used
The XML attribute value of the XML element high should be used to indicate when the Consultation ended

General guidance

If a single point in time is to be carried the Date or Time Point data type flavour shall be used:

The XML attribute value of the XML element center shall contain the date

If both a start date and an end date are present the Date or Time Interval Complete data type flavour shall be used:

The XML attribute value of the XML element low shall contain the start date
The XML attribute value of the XML element high shall contain the end date

If only a start date is present the Date or Time Interval After data type flavour shall be used:

The XML attribute value of the XML element low shall contain the start date

If only an end date is present the Date or Time Interval Before data type shall be used:

The XML attribute value of the XML element high shall contain the end date

[1..1] [M] id (II)

Model Attribute Description

The HL7 attribute id uses an identifier to identify each unique instance of an encompassing encounter.

Implementation in XML Instance

The Identifier Global data type flavour is used to carry the identifier in the XML element id as follows:

The XML attribute root shall contain a DCE UUID

[1..1] [M] templateId (II)
{ Fixed="COCD_TP146360GB01#EncompassingEncounter" }

Model Attribute Description

The HL7 attribute templateId provides a unique identifier for the template and the class name within that template. This is used to identify how the CDA standard has been constrained for NHS use.

Implementation in XML Instance

The Identifier External data type flavour is used to carry this information in the XML element templateId as follows:

The XML attribute root is fixed to the OID "2.16.840.1.113883.2.1.3.2.4.18.2"
The XML attribute extension is fixed to "COCD_TP146360GB01#EncompassingEncounter"

[0..*] encounterParticipant

A class which holds details of how the various people and organisations were involved in the encompassing encounter.

[1..1] [M] typeCode (CS { CNE:x_EncounterParticipant } )

Model Attribute Description

The HL7 attribute typeCode uses a code from the HL7 vocabulary x_EncounterParticipant to describe the type of participation.

Implementation in XML Instance

The XML attribute typeCode shall contain a value from the x_EncounterParticipant vocabulary.

The recommended codes for populating the XML attribute typeCode are listed below:

code	Display name	Definition
ADM	admitter	The practitioner who is responsible for admitting a patient to a hospital stay.
ATND	attender	The attending practitioner that has responsibility for a patient's care during a hospital stay.
CON	consultant	An advisor participating in the service by performing evaluations and making recommendations.
DIS	discharger	The practitioner who is responsible for the discharge of a patient from a hospital stay.
REF	referrer	A person having referred the subject of the service to the performer (referring physician). Typically, a referring physician will receive a report.

[1..1] [M] contentId (II) { "NPFIT-000028#Role" }

Model Attribute Description

The HL7 (NHS localisation) attribute contentId, when valued in an instance, provides a unique forward pointing identifier for the template which constrains the classes and attributes which follow, for NHS use.

The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The contentId is populated at runtime with a value from the allowed list contained in the model.

Implementation in XML Instance

The Identifier External data type flavour is used to carry this information in the XML element contentId as follows:

The XML attribute root is fixed to the OID "2.16.840.1.113883.2.1.3.2.4.18.16"
The XML attribute extension shall contain one of the allowed template artefact identifiers

[1..1] [M] templateId (II)
{ Fixed="COCD_TP146360GB01#encounterParticipant" }

Model Attribute Description

The Identifier External data type flavour is used to carry this information in the XML element templateId as follows:

The XML attribute root is fixed to the OID "2.16.840.1.113883.2.1.3.2.4.18.2"
The XML attribute extension is fixed to "COCD_TP146360GB01#encounterParticipant"

[0..1] time (IVL<TS>)

Model Attribute Description

The HL7 attribute participation time is used to indicate when the person participated in the encompassing encounter.

Implementation in XML Instance

The date range shall be carried as follows:

The XML attribute value of the XML elements low, center and high, shall be populated ( when used) with a time stamp in the format yyyymmddhhmm where:

yyyy is the year
mm is the month
dd is the day
hh is the hour
mm is the minute

If a single point in time is to be carried the Date or Time Point data type shall be used. this is used when the time when or during which the person participated(was involved) is not fully known:

The XML attribute value of the XML element center shall contain the date

If both a start date and an end date are present the Date or Time Interval Complete data type shall be used, this is used when the start and end times of the person's participation (involvement) is known and the presence of an end date indicates that the person is no longer participating (no longer involved):

The XML attribute value of the XML element low shall contain the start date of the person's involvement
The XML attribute value of the XML element high shall contain the end date of the person's involvement

If only a start date is present the Date or Time Interval After data type shall be used, this is used when the person is still participating (is still involved):

The XML attribute value of the XML element low shall contain the start date of the person's involvement

If only an end date is present the Date or Time Interval Before data type shall be used, this is used when the person is no longer participating (involved) and the actual date they started participating is not known:

The XML attribute value of the XML element high shall contain the end date

[1..1] participant (ParticipantChoice)

A link to the choice of participant templates.

[1..1] [M] location

A class which holds details of the location where the Encompassing Encounter took place or is taking place if still ongoing.

[1..1] [M] typeCode (CS { CNE: ParticipationType } )
{ Fixed="LOC" }

Model Attribute Description

The HL7 attribute typeCode uses a code to describe this participation as a location.

Implementation in XML Instance

The XML attribute typeCode is fixed to " LOC".

[1..1] [R] contentId (II) { "NPFIT-000027#Role" }

Model Attribute Description

Implementation in XML Instance

The Identifier External data type flavour is used to carry this information in the XML element contentId as follows:

The XML attribute root is fixed to the OID "2.16.840.1.113883.2.1.3.2.4.18.16"
The XML attribute extension shall contain one of the allowed template artefact identifiers

[1..1] [M] templateId (II)
{ Fixed="COCD_TP146360GB01#location" }

Model Attribute Description

The Identifier External data type flavour is used to carry this information in the XML element templateId as follows:

The XML attribute root is fixed to the OID "2.16.840.1.113883.2.1.3.2.4.18.2"
The XML attribute extension is fixed to "COCD_TP146360GB01#location"

[1..1] [M] participant (HealthCareFacilityChoice)

A link to a choice of health care facility templates.

[0..1] responsibleParty

A class which holds details of how the person was responsible for the encompassing encounter.

Note this participation is required to be included if available on the sending system.

[1..1] [M] typeCode (CS { CNE: ParticipationType } )
{ Fixed="RESP" }

Model Attribute Description

The HL7 attribute typeCode uses a code to describe this class as a responsible party participation.

Implementation in XML Instance

The XML attribute classCode is fixed to " RESP".

[1..1] [M] contentId (II) { "NPFIT-000026#Role" }

Model Attribute Description

Implementation in XML Instance

The Identifier External data type flavour is used to carry this information in the XML element contentId as follows:

The XML attribute root is fixed to the OID "2.16.840.1.113883.2.1.3.2.4.18.16"
The XML attribute extension shall contain one of the allowed template artefact identifiers

[1..1] [M] templateId (II)
{ Fixed="COCD_TP146360GB01#responsibleParty" }

Model Attribute Description

The Identifier External data type flavour is used to carry this information in the XML element templateId as follows:

The XML attribute root is fixed to the OID "2.16.840.1.113883.2.1.3.2.4.18.2"
The XML attribute extension is fixed to "COCD_TP146360GB01#responsibleParty"