Episodes of Care

Background

During the OpenMRS Implementers meeting in 2009, we designed a way to expand on single-form encounters into the notions of visits and episodes of care. Encounters become a representation of a clinical transaction (a combination of orders, observations, notes, and/or metadata collected at a point in time) and are grouped within visits (e.g., clinic visit, hospitalization, emergency room visit, etc.). Episodes of Care are a grouping of encounters and/or visits related to a single topic (e.g., all encounters relating to a pregnancy).

Definitions

	Description	Examples
Encounter	A clinical transaction. One or more providers generating a set of data (orders, labs, notes, and/or observations) for a patient at a point in time.	An encounter form entered during a patient visit A doctor writes some orders and a note in one "ordering session" during a hospitalization A set of lab results delivered to the EMR
Visit	A group of one or more encounters that typically occur within a contiguous span of time.	A clinic vist A hospitalization
Episode of Care	A collection of visits and/or individual encounters that a related to a condition or treatment plan.	A pregnancy Treatment of hepatitis over 1 hospitalization and multiple clinic visits

Designing Episodes of Care

Per the notes taken during the implementers meeting 2009, the episode table would be designed as:

episode

column	description
episode_id	internal primary key
patient_id	patient to whom episode applies (is this redundant, since we're grouping visits & encounters which already link to patient?)
episode_topic	defines the type of episode, probably a link to a concept (e.g., pregnancy)
start_date	date on which episode began (could be earlier than first encounter/visit)
end_date	date on which episode ended (could be later than last encounter/visit)
voided	true if episode voided
voided_by	who voided episode
date_voided	date episode was voided
creator	who created this row
date_created	when row was created

episode_visit

column	description
episode_id	link to an episode
visit_id	link to a visit that is within the linked episode

We would link visits to an episode only when all encounter(s) within the visit are part of the episode.

episode_encounter

column	description
episode_id	link to an episode
encounter_id	link to an encounter that is within the linked episode

We would link encounters to episodes when other encounters in the same visit are not part of the episode.

Relationship to programs

There is a similarity to programs, which track programs of care. Episodes of care differ in that they only represent a grouping of encounters & visits -- i.e., episodes do not have to be part of a patient program of care and episodes would not reference study protocols, workflows/states, etc. Once episodes of care are realized within OpenMRS, then programs could link to episodes to define the set of encounters/visits that are part of the program of care.