Encounter

An encounter is an interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient. An Encounter resource encompasses the lifecycle from pre-admission (the actual encounter for ambulatory encounters), through admission, stay, and discharge (for inpatient encounters). During the encounter the patient may move from practitioner to practitioner and location to location.

A patient encounter is further characterized by the setting in which it takes place. Among them are ambulatory, emergency, home health, inpatient, and virtual encounters.

The class element describes the setting (e.g., inpatient, outpatient) in which the encounter took place. This is important for interpreting the context of the encounter, so choosing the appropriate business rules for enforcement and management of the process is required.

Because of the broad scope of the Encounter resource, not all elements are relevant in all settings. For this reason, admission/discharge related information is kept in a separate Hospitalization component within Encounter. The class element is used to distinguish between these settings.

An Associated Encounter extension should be used to reference an encounter where no property defines this association on the resource.

Appointment versus Encounter

An Appointment resource is normally used for the planning stage of an appointment: searching, locating an available time, then making the appointment. Once this process is completed and the appointment is about to start, the Appointment resource is marked as fulfilled and linked to the newly created encounter. This new encounter may start in an arrived status when the patient is admitted at a location of the facility, and will move to the ward where another partOf encounter may begin.

Encounters can be aggregated or grouped under other Encounters using the partOf element. The Hospitalization component is intended to store the extended information relating to a hospitalization event. It is always expected to be the same period as the encounter itself. Where the period is different, another encounter instance should be used to capture this information as a partOf this encounter instance.

Encounter instances may exist before the actual encounter takes place to convey pre-admission information, including using Encounters elements to reflect the planned start date or planned encounter locations. In this case the status element is set to planned. An encounter with a planned status is not identical to the appointment that scheduled it, but it is the encounter prior to its actual occurrence, with the expectation that encounter will be updated as it progresses to completion.

The Appointment resource is intended to be used to store appointment information; the Encounter resource should not be used for this.

In many systems, outpatient encounters (which are in scope for the Encounter resource) and the Appointment resource are used concurrently. In FHIR, Appointment is used for establishing a date for the encounter, while Encounter is used for information about the actual Encounter (i.e., the patient showing up).

Related Resources

The Procedure and encounter have references to each other, and these should be to different procedures; one for the procedure that was performed during the encounter (stored in Procedure.encounter), and another for cases where an encounter is a result of another procedure (stored in Encounter.indication) such as a follow-up encounter to resolve complications from an earlier procedure.

The Encounter resource is referenced by these resources:

A-C	D-M	M-V
AdverseEvent	DeviceRequest	MedicationDispense
AllergyIntolerance	DiagnosticReport	MedicationRequest
CarePlan	DocumentReference	MedicationStatement
CareTeam	Encounter (itself)	NutritionOrder
ChargeItem	ExplanationOfBenefit	Observation
Claim	Flag	Procedure
ClinicalImpression	GuidanceResponse	QuestionnaireResponse
Communication	ImagingStudy	RequestGroup
CommunicationRequest	Immunization	RiskAssessment
Composition	List	ServiceRequest
Condition	Media	Task
Contract	MedicationAdministration	VisionPrescription

For More Information

• FHIR R4 Encounter (8.11) resource.
• Detailed Descriptions (8.11.8) for the elements in the Encounter resource
• Terminology Bindings (8.11.3.1) for the Encounter resource
• Search Parameters (8.11.6) for the Encounter resource
• US Core Encounter (4.3.10) resource profile
• US Core Structure Definition (3.11.1) for the Encounter resource profile
• US Core Detailed Descriptions (3.11.0.1) for the Encounter resource profile