Scope and Usage

The Finnish Core Encounter profile is intended to encapsulate the most common and basic data model of encounters in Finnish healthcare systems. The profile also defines encounter’s relation to the Kanta registry. As such the profile should be usable in most Finnish contexts.

Relation to Finnish palvelutapahtuma

Kanta is the Finnish national central registry of health and social welfare information. It has a specification for Palvelutapahtuma, this is typically translated as service-event or encompassing encounter.

The scope of palvelutapahtuma is described in Kanta-documentation (in finnish). It’s scope is not always the same as encounter’s. Encounter and palvelutapahtuma will overlap as concepts (depending on implementation). Some encounters clearly align with palvelutapahtuma while others don’t. Palvelutapahtuma may contain multiple encounters. For example a series of treatments is considered to be a singular palvelutapahtuma, but systems most likely want to express each visit as a separate encounter (see kanta doc for the description of “hoitosarja”, there are other examples too).

For deeper techical details, se Kanta HL7 V3 Medical Records specification (this again in finnish).

Why does encounter need this information?

Kanta HL7 V3 Medical Records specification requires that both queries and archivals transmit palvelutapahtuma’s OID identifier on each request. A client application that is integrated to a patient administration system (one that masters the data of encounters) often needs to create and query Kanta Medical records. Encounter is the best “vessel” we have to transmit this information.

For example a laboratory information system may have it’s own Kanta Medical Records capabilities and will archive lab results directly to Kanta. It receives encounter id in SMART App Launch context. Laboratory system can resolve palvelutapahtuma’s OID identifier by fetching the encounter resource.

How to communicate palvelutapahtuma via FHIR encounter?

First thing is to identify the appropriate aggregation level of encounter. If encounter is not representing a palvelutapahtuma, but is a lower level encounter (some systems call these prosessitapahtuma), parentOf -should be used to point to upper level encounter (up until palvelutapahtuma -level is reached).

Palvelutapahtuma -encounter is identified by identifier. When encounter has identifier with use=official it SHOULD be considered as palvelutapahtuma and that identifier should be the OID of palvelutapahtuma.

Other levels of encounter that are not palvelutapahtuma, MUST NOT contain use=official identifier.

Organizational responsibility

The unit responsible for the encounter should be communicated using the serviceProvider property.

For instance, there’s a detailed example with explanations how to fetch patients in a ward.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
class	Σ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!Σ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory		0..*	BackboneElement	List of past encounter statuses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period		1..1	Period	The time that the episode was in the specified status
class	Σ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
classHistory		0..*	BackboneElement	List of past encounter classes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
class		1..1	Coding	inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period		1..1	Period	The time that the episode was in the specified class
type	Σ	0..*	CodeableConcept	Specific type of encounter Binding: EncounterType (example): The type of encounter.
serviceType	Σ	0..1	CodeableConcept	Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
priority		0..1	CodeableConcept	Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject	Σ	0..1	Reference(Patient | Group)	The patient or group present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	Σ	0..*	BackboneElement	List of participants involved in the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..*	CodeableConcept	Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner | PractitionerRole | RelatedPerson)	Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	Σ	0..*	CodeableConcept	Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	Σ	0..*	Reference(Condition | Procedure | Observation | ImmunizationRecommendation)	Reason the encounter takes place (reference)
diagnosis	Σ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition | Procedure)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank		0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization		0..1	BackboneElement	Details about the admission to a healthcare service
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location | Organization)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination		0..1	Reference(Location | Organization)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: DischargeDisposition (example): Discharge Disposition.
location		0..*	BackboneElement	List of locations where the patient has been
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location		1..1	Reference(Location)	Location the encounter takes place
status		0..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	example	EncounterType
Encounter.serviceType	example	ServiceType
Encounter.priority	example	ActPriority
Encounter.participant.type	extensible	ParticipantType
Encounter.reasonCode	preferred	EncounterReasonCodes
Encounter.diagnosis.use	preferred	DiagnosisRole
Encounter.hospitalization.admitSource	preferred	AdmitSource
Encounter.hospitalization.reAdmission	example	Hl7VSReAdmissionIndicator
Encounter.hospitalization.dietPreference	example	Diet
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	example	DischargeDisposition
Encounter.location.status	required	EncounterLocationStatus
Encounter.location.physicalType	example	LocationType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
class	Σ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Encounter	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Encounter	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Encounter	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Encounter	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Encounter		0..*	Encounter	An interaction during which services are provided to the patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Identifier(s) by which this encounter is known
status	?!Σ	1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
statusHistory		0..*	BackboneElement	List of past encounter statuses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
status		1..1	code	planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter.
period		1..1	Period	The time that the episode was in the specified status
class	Σ	1..1	Coding	Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter.
classHistory		0..*	BackboneElement	List of past encounter classes
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
class		1..1	Coding	inpatient | outpatient | ambulatory | emergency + Binding: ActEncounterCode (extensible): Classification of the encounter.
period		1..1	Period	The time that the episode was in the specified class
type	Σ	0..*	CodeableConcept	Specific type of encounter Binding: EncounterType (example): The type of encounter.
serviceType	Σ	0..1	CodeableConcept	Specific type of service Binding: ServiceType (example): Broad categorization of the service that is to be provided.
priority		0..1	CodeableConcept	Indicates the urgency of the encounter Binding: ActPriority (example): Indicates the urgency of the encounter.
subject	Σ	0..1	Reference(Patient | Group)	The patient or group present at the encounter
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	Episode(s) of care that this encounter should be recorded against
basedOn		0..*	Reference(ServiceRequest)	The ServiceRequest that initiated this encounter
participant	Σ	0..*	BackboneElement	List of participants involved in the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..*	CodeableConcept	Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter.
period		0..1	Period	Period of time during the encounter that the participant participated
individual	Σ	0..1	Reference(Practitioner | PractitionerRole | RelatedPerson)	Persons involved in the encounter other than the patient
appointment	Σ	0..*	Reference(Appointment)	The appointment that scheduled this encounter
period		0..1	Period	The start and end time of the encounter
length		0..1	Duration	Quantity of time the encounter lasted (less time absent)
reasonCode	Σ	0..*	CodeableConcept	Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place.
reasonReference	Σ	0..*	Reference(Condition | Procedure | Observation | ImmunizationRecommendation)	Reason the encounter takes place (reference)
diagnosis	Σ	0..*	BackboneElement	The list of diagnosis relevant to this encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
condition	Σ	1..1	Reference(Condition | Procedure)	The diagnosis or procedure relevant to the encounter
use		0..1	CodeableConcept	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents.
rank		0..1	positiveInt	Ranking of the diagnosis (for each role type)
account		0..*	Reference(Account)	The set of accounts that may be used for billing for this Encounter
hospitalization		0..1	BackboneElement	Details about the admission to a healthcare service
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
preAdmissionIdentifier		0..1	Identifier	Pre-admission identifier
origin		0..1	Reference(Location | Organization)	The location/organization from which the patient came before admission
admitSource		0..1	CodeableConcept	From where patient was admitted (physician referral, transfer) Binding: AdmitSource (preferred): From where the patient was admitted.
reAdmission		0..1	CodeableConcept	The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Binding: hl7VS-re-admissionIndicator (example): The reason for re-admission of this hospitalization encounter.
dietPreference		0..*	CodeableConcept	Diet preferences reported by the patient Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
specialCourtesy		0..*	CodeableConcept	Special courtesies (VIP, board member) Binding: SpecialCourtesy (preferred): Special courtesies.
specialArrangement		0..*	CodeableConcept	Wheelchair, translator, stretcher, etc. Binding: SpecialArrangements (preferred): Special arrangements.
destination		0..1	Reference(Location | Organization)	Location/organization to which the patient is discharged
dischargeDisposition		0..1	CodeableConcept	Category or kind of location after discharge Binding: DischargeDisposition (example): Discharge Disposition.
location		0..*	BackboneElement	List of locations where the patient has been
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
location		1..1	Reference(Location)	Location the encounter takes place
status		0..1	code	planned | active | reserved | completed Binding: EncounterLocationStatus (required): The status of the location.
physicalType		0..1	CodeableConcept	The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Binding: LocationType (example): Physical form of the location.
period		0..1	Period	Time period during which the patient was present at the location
serviceProvider		0..1	Reference(Organization)	The organization (facility) responsible for this encounter
partOf		0..1	Reference(Encounter)	Another Encounter this encounter is part of
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	example	EncounterType
Encounter.serviceType	example	ServiceType
Encounter.priority	example	ActPriority
Encounter.participant.type	extensible	ParticipantType
Encounter.reasonCode	preferred	EncounterReasonCodes
Encounter.diagnosis.use	preferred	DiagnosisRole
Encounter.hospitalization.admitSource	preferred	AdmitSource
Encounter.hospitalization.reAdmission	example	Hl7VSReAdmissionIndicator
Encounter.hospitalization.dietPreference	example	Diet
Encounter.hospitalization.specialCourtesy	preferred	SpecialCourtesy
Encounter.hospitalization.specialArrangement	preferred	SpecialArrangements
Encounter.hospitalization.dischargeDisposition	example	DischargeDisposition
Encounter.location.status	required	EncounterLocationStatus
Encounter.location.physicalType	example	LocationType

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Encounter

Summary