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).
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.