{"type":"doc","content":[{"type":"bodiedExtension","attrs":{"layout":"default","extensionType":"com.atlassian.confluence.macro.core","extensionKey":"excerpt","parameters":{"macroParams":{},"macroMetadata":{"macroId":{"value":"426e7126-ff58-4d6d-b5af-49dd3637767b"},"schemaVersion":{"value":"1"},"title":"Excerpt"}},"localId":"6e3f29d2-ffbb-4e28-b29b-5a2653a68b19"},"content":[{"type":"paragraph","content":[{"text":"Technical description of how to enrol a patient in an episode of care.","type":"text"}]}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"Use Case: ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://docs.ehealth.sundhed.dk/latest-released/sparx/EARoot/EA2/EA2/EA25.htm"}},{"text":" ","type":"text"}]}]},{"type":"extension","attrs":{"layout":"default","extensionType":"com.atlassian.confluence.macro.core","extensionKey":"toc","parameters":{"macroParams":{},"macroMetadata":{"macroId":{"value":"07735b73-f71e-47dc-a8bc-e1b032cd0686"},"schemaVersion":{"value":"1"},"title":"org.randombits.confluence.toc.toc.label"}},"localId":"9356c4e0-a0ae-4dda-8f91-d7e06ac07a64"}},{"type":"heading","attrs":{"level":1},"content":[{"text":"Establishing a Citizen as a Patient","type":"text"}]},{"type":"paragraph","content":[{"text":"The ","type":"text"},{"text":"Patient","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-patient.html"}}]},{"text":" resource is a central resource in the eHealth Infrastructure. It plays several different roles:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Conveys basic information about the patient (name, address, birth date, gender, civil registration number, demographics information, etc.)","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Conveys extended information about the patient","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Contact information","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Language / Need for an interpreter","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Temporary addresses","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"General practitioner","type":"text"}]}]}]}]}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"A Patient is considered a 'singleton' in the eHealth Infrastructure. The patient is primarily a container for demographic information. While it is allowed according to the FHIR specification to have multiple different logical Patients for the same person, it does not fit the case for the infrastructure and the Danish modelling of patient information. As such, the patient resource is shared across different episodes of care and other clinical resources.","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Ensuring a Match Between CRN and Citizen","type":"text"}]},{"type":"paragraph","content":[{"text":"To verify the correspondence between the Citizen name and CRN, a lookup can be made with a ","type":"text"},{"text":"Person name lookup","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/OperationDefinition-ehealth-person-match.html"}}]},{"text":", based on the CRN given in the input Person resource.","type":"text"}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Establishing the Patient","type":"text"}]},{"type":"expand","attrs":{"title":"Example Create Patient Request in HAPI FHIR Client Framework"},"content":[{"type":"codeBlock","attrs":{"language":"java"},"content":[{"text":"Parameters in = new Parameters().addParameter()\n .setName(\"crn\").setValue(new Identifier().setSystem(\"urn:oid:1.2.208.176.1.2\").setValue(\"2810887020\"));\nParameters result = client.operation().onType(Patient.class).named(\"createPatient\").withParameters(in).execute();","type":"text"}]},{"type":"paragraph"}]},{"type":"expand","attrs":{"title":"Example Create Patient HTTP Request and Response"},"content":[{"type":"codeBlock","attrs":{"language":"xml"},"content":[{"text":"POST /Patient/$createPatient\nContent-Type: text/xml; extended-operation-type\nAccept: */*\nHost: localhost:8080\naccept-encoding: gzip, deflate\ncontent-length: 689\n\n \n \n \n \n \n \n \n","type":"text"}]},{"type":"paragraph","content":[{"text":"Example HTTP Response:","type":"text"}]},{"type":"codeBlock","attrs":{"language":"xml"},"content":[{"text":"HTTP/1.1 200\nstatus: 200\nDate: Wed, 20 Feb 2019 09:00:35 GMT\nX-Powered-By: Trifork\nContent-Type: application/fhir+xml;charset=utf-8\nContent-Encoding: gzip\nTransfer-Encoding: chunked\nServer: Jetty(9.4.14.v20181114)\n\n \n \n \n \n \n \n \n \n \n ...\n \n \n \n \n \n \n \n \n \n \n

\n \n \n \n \n \n \n

\n                    \n                    \n                    \n                    \n                    \n                    \n

\n                \n                    \n                \n

\n \n \n

","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Adding a Related Person","type":"text"}]},{"type":"heading","attrs":{"level":1},"content":[{"text":"Creating and Maintaining an EpisodeOfCare","type":"text"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"See ","type":"text"},{"text":"EpisodeOfCare","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-episodeofcare.html"}}]},{"text":" for an introduction to use and elements.","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Creating the EpisodeOfCare","type":"text"}]},{"type":"paragraph","content":[{"text":"The EpisodeOfCare is created by invoking ","type":"text"},{"text":"$create-episode-of-care","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/OperationDefinition--s-create-episode-of-care.html"}}]},{"text":" on the CarePlan Service.","type":"text"}]},{"type":"heading","attrs":{"level":3},"content":[{"text":"Preparing Conditions","type":"text"}]},{"type":"paragraph","content":[{"text":"An EpisodeOfCare relates to one or more conditions. These must be created as part of the ","type":"text"},{"text":"$create-episode-of-care","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/OperationDefinition--s-create-episode-of-care.html"}}]},{"text":" operation by including them in the input bundle.","type":"text"}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Creating a Consent","type":"text"}]},{"type":"paragraph","content":[{"text":"Prerequisite to activating the EpisodeOfCare, the citizen’s consent to undergo/be enrolled to the EpisodeOfCare and comprised CarePlan resources must be registered in a Consent. The Consent is created through Consent Create and must contain details as described in the ","type":"text"},{"text":"Consent","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-consent.html"}}]},{"text":" introduction.","type":"text"}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Activating the EpisodeOfCare","type":"text"}]},{"type":"paragraph","content":[{"text":"An EpisodeOfCare is activated by: ","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Setting the ","type":"text"},{"text":"status","type":"text","marks":[{"type":"code"}]},{"text":" to ","type":"text"},{"text":"active","type":"text","marks":[{"type":"code"}]},{"text":" through an EpisodeOfCare HTTP-Patch.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Setting a status change to ","type":"text"},{"text":"active","type":"text","marks":[{"type":"code"}]},{"text":" in the ","type":"text"},{"text":"EpisodeOfCare.ehealth-statusschedule","type":"text","marks":[{"type":"code"}]},{"text":" resulting in an automatic status change in the future.","type":"text"}]}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Maintaining EpisodeOfCare Status","type":"text"}]},{"type":"paragraph","content":[{"text":"EpisodeOfCare.status","type":"text","marks":[{"type":"code"}]},{"text":" can be adjusted in two ways through the use of EpisodeOfCare HTTP-Patch (Update is not exposed):","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Setting ","type":"text"},{"text":"EpisodeOfCare.status","type":"text","marks":[{"type":"code"}]},{"text":" directly","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Setting a scheduled status change by updating ","type":"text"},{"text":"EpisodeOfCare.ehealth-statusschedule","type":"text","marks":[{"type":"code"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"scheduled changes are applied when the ApplyPlannedChangesJob is run. (see ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2550661140#AutomatedProcessing-AutomatedApplicationofPlannedChanges(EpisodeOfCare,CarePlanandServiceRequest)"}},{"text":" )","type":"text"}]}]}]}]}]},{"type":"paragraph","content":[{"text":"Allowed status changes:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"From ","type":"text"},{"text":"planned","type":"text","marks":[{"type":"code"}]},{"text":" to ","type":"text"},{"text":"active","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"waitlist","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"cancelled","type":"text","marks":[{"type":"code"}]},{"text":", or ","type":"text"},{"text":"entered-in-error","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"From ","type":"text"},{"text":"active ","type":"text","marks":[{"type":"code"}]},{"text":"to ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"finished","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"cancelled","type":"text","marks":[{"type":"code"}]},{"text":", or ","type":"text"},{"text":"entered-in-error","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"From ","type":"text"},{"text":"waitlist","type":"text","marks":[{"type":"code"}]},{"text":" to ","type":"text"},{"text":"planned","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"active","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"cancelled,","type":"text","marks":[{"type":"code"}]},{"text":" or ","type":"text"},{"text":"entered-in-error","type":"text","marks":[{"type":"code"}]},{"text":" ","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"From ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]},{"text":" to ","type":"text"},{"text":"active","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"finished","type":"text","marks":[{"type":"code"}]},{"text":", ","type":"text"},{"text":"cancelled","type":"text","marks":[{"type":"code"}]},{"text":", or ","type":"text"},{"text":"entered-in-error","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"From ","type":"text"},{"text":"finished","type":"text","marks":[{"type":"code"}]},{"text":" to ","type":"text"},{"text":"entered-in-error","type":"text","marks":[{"type":"code"}]},{"text":" or ","type":"text"},{"text":"active","type":"text","marks":[{"type":"code"}]}]}]}]},{"type":"paragraph","content":[{"text":"See implementation guide: ","type":"text"},{"text":"EpisodeOfCare.status","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/StructureDefinition-ehealth-episodeofcare-definitions.html#EpisodeOfCare.status"}}]},{"text":" ","type":"text"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"Enforced constraints on the duration of scheduled status with value ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]},{"text":".","type":"text"}]},{"type":"paragraph","content":[{"text":"When setting scheduled status changes it is automatically enforced how long the EpisodeOfCare can be planned as paused (with ","type":"text"},{"text":"status","type":"text","marks":[{"type":"code"}]},{"text":" set to ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]},{"text":"). This is done to prevent patient plans from being forgotten in a paused state.","type":"text"}]},{"type":"paragraph","content":[{"text":"When setting ","type":"text"},{"text":"EpisodeOfCare.ehealth-statusschedule","type":"text","marks":[{"type":"code"}]},{"text":":","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"If no further status changes are planned by the user, then the infrastructure will automatically insert a planned change back to ","type":"text"},{"text":"active","type":"text","marks":[{"type":"code"}]},{"text":" 7 days after the start of ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The maximum duration of a planned ","type":"text"},{"text":"onhold","type":"text","marks":[{"type":"code"}]},{"text":" status is 30 days.","type":"text"}]}]}]}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"EpisodeOfCare automatically maintains a status history ","type":"text"},{"text":"EpiodeOfCare.statushistory","type":"text","marks":[{"type":"code"}]},{"text":":","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The status history is maintained as a list of ","type":"text"},{"text":"ehealth-statusHistory","type":"text","marks":[{"type":"link","attrs":{"href":"http://ehealth-documentation.s3-website-eu-west-1.amazonaws.com/latest/ig/StructureDefinition-ehealth-careplan-statusHistory.html"}}]},{"text":" objects each containing:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"A status.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The period the status was set.","type":"text"}]}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The history is automatically updated when the status is (regardless of whether the status is set manually or is a scheduled change):","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"A new entry is added with the new status and an open-ended period that started at the time of the status change.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The ","type":"text"},{"text":"Period.end","type":"text","marks":[{"type":"code"}]},{"text":" in the entry for the previous status is updated to be the same as the start of the new entry.","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"One should consider the period to be exclusive-end to avoid confusion as the ","type":"text"},{"text":"Period.end","type":"text","marks":[{"type":"code"}]},{"text":" of one historic status and the ","type":"text"},{"text":"Period.start","type":"text","marks":[{"type":"code"}]},{"text":" of the next have the same timestamp.","type":"text"}]}]}]}]}]}]}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Maintaining the set of CareTeam involved in the EpisodeOfCare","type":"text"}]},{"type":"paragraph","content":[{"text":"Over the lifecycle of an EpisodeOfCare, the set of CareTeam involved might change. Adjustment of CareTeam involved can be performed in several ways:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Through EpisodeOfCare Patch","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Setting the ","type":"text"},{"text":"EpisodeOfCare.team","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Setting the scheduled team changes in ","type":"text"},{"text":"EpisodeOfCare.ehealth-teamschedule","type":"text","marks":[{"type":"code"}]}]}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Through ","type":"text"},{"text":"EpisodeOfCare$update-care-teams","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/OperationDefinition-EpisodeOfCare-i-update-care-teams.html"}}]}]}]}]},{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","content":[{"text":"CareTeam Handover and Unhandled Tasks","type":"text"}]},{"type":"paragraph","content":[{"text":"The CareTeams involved in an EpisodeOfCare have access to the EpisodeOfCare, all CarePlan related to it, and all measurements related to ServiceRequest related to the CarePlan and so on (provided the appropriate Role-based access privileges are present for a user using the CareTeam). For Task resources currently created automatically by the infrastructure, the set of CareTeam involved in an EpisodeOfCare are not designated as Task responsible.","type":"text"}]},{"type":"paragraph","content":[{"text":"There might, however, still exist Tasks created by other means, for instance, Tasks created on user initiative in a solution. For these, it should be considered whether a change in the set of CareTeam involved in the EpisodeOfCare should also result in adjusting of ","type":"text"},{"text":"Task.taskResponsible","type":"text","marks":[{"type":"code"}]},{"text":" (by adding CareTeam added to the EpisodeOfCare).","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Adjusting the Period ","type":"text"}]},{"type":"paragraph","content":[{"text":"The period in which the EpisodeOfCare is applicable is reflected in the ","type":"text"},{"text":"EpisodeOfCare.period","type":"text","marks":[{"type":"code"}]},{"text":". Adjustment of ","type":"text"},{"text":"EpisodeOfCare.period","type":"text","marks":[{"type":"code"}]},{"text":" is performed through EpisodeOfCare Patch.","type":"text"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"The ","type":"text"},{"text":"EpisodeOfCare.status","type":"text","marks":[{"type":"code"}]},{"text":" and ","type":"text"},{"text":"EpisodeOfCare.period","type":"text","marks":[{"type":"code"}]},{"text":" are set independently. Setting either causes no automatic change of the other.","type":"text"}]}]}],"version":1}

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