2009 Implementers Group Meeting Program Episodes of Care

Venue: Breakaway 1

Burke Mamlin / Darius Jazayeri :

Goals:
1) How to model episodes of care in the future

History: Encounters are a patient visit, aka, any time a patient interacts with the medical system. Encounters are tightly bound with forms. Each form is a visit form.
History: OpenMRS has Program enrollments, which is used in the TB program usecase. Encounters happen during programs, but are not tied to a program. It is difficult to figure out if an encounter happened within a certain state.

Future: Many to one for forms to an encounter. (other conversation)
Future: Interactions with the system are usually more than one "encounter".

Needs:
Hospital visits as one thing
Grouping of enocunters
lab tests, long running tests
attributes on an encounter
what are program/workflows?
how this interacts with remoteformentry
Clarify episode vs visit
how episodes relate to programs
outpatient and inpatient
how to even define episode

Should we use a hierarchy of encounters to model this?

We plan to have a way to have many forms for one encounter

Episode vs Visit vs Encounter:

Diagnosis' are longitudinal and can change over time.

Encounter is just one type of Visit. Episode of care is a span of time where some data was collected, orders places, encounters happened, etc.

Where does pregnancy fit?
The diagnosis of pregnancy is an observation.
The treatment of pregnancy is an episode of care.

Episodes can be concurrent. A diagnosis captured at a certain time doesn't necessarily apply to all episodes.

An encounter is an instant of creating data and why its 1 to 1 with forms
We could have a visit object above encounter and then episode above visit

An encounter being many to one with forms means its impossible to assign providers to a certain form. Do we need two levels of hierarchy?

How does hl7 handle pregnancy? It has a single set of oberservations is a message

When dealing with reporting, they only want to see certain bits of data.

Pathways of care: Certain patients get a certain workflow, aka TB gets initial visit, conversion visit, etc. HIV programs get cd4 counts every 6 months, etc

An episdoe of care is a program workflow. We create a new object called Visit for a hospital visit, etc, and encounter does get multiple forms as a possibility in care there are multiple forms (and potentially multiple providers)

Do we have a use-case for encounters being multi-level. Its a pain to code and people could abuse it.

If an outpaitent comes to a clinic for both an tb visit and hiv visit...is that two Visit entries or one?
It should be one visit and the patient is in two different episodes of care.

A visit happens from admission to discharge. For outpatient visits, the discharge happens automatically at the end of the day.

Roger was at the hospital the other day.

Time is important in a hospital stay.

Do visits have to have an episode of care?

Episode has start/stop. Visit has start/stop. Encounter has a single date.

Time.