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This page is intended to capture the discussions and design work around the re-design of how these resources are connected, and ranked across the many use cases that they are done in.

Contributors: Brian PostlethwaiteCooper ThompsonMichelle Miller

Once the initial use cases are documented and ready for further review this will be scheduled on a joint conference call between Patient Administration and Patient Care sometime at the end of June (likely 28th).

The resources involved in the design are Encounter, EpisodeOfCare, Condition, Procedure, Claim, ExplanationOfBenefit, Account, ChargeItem


GF#16147  2018-May Core - In Person Claude
GF#20483 Add Encounter.diagnoses elements to Condition In Person
GF#16148 Encounter.reason and Encounter.diagnosis (PA) In Person
GF#18829Make element naming and modeling more consistent for Appointment/Encounter reason - STU #27
GF#13668Remove reference to Procedure as an option in Encounter/diagnosis

FHIR-16148 - Getting issue details... STATUS

FHIR-22764 - Getting issue details... STATUS

FHIR-22797 - Getting issue details... STATUS

FHIR-22850 - Getting issue details... STATUS

FHIR-28188 - Getting issue details... STATUS

FHIR-19285 - Getting issue details... STATUS

This has been discussed previously in (at least) two WGMs and a few conference calls:


Resource References

May 2019

Sept 2019

September 2020 Virtual WGM Monday 4:00 PM - 5:30 PM ET

Input for joined session with PC, CQI and CDS



This email is going to the following 8 HL7 groups to request a combined meeting (perhaps some sort of Birds-of-a-Feather or 2-hour session during the upcoming virtual HL7 WGM. The issue came up because of differences in the way a Claim or an Encounter diagnosis might represent a primary diagnosis, a principal diagnosis, and how to represent Claim and Encounter diagnosis in a harmonized manner.  They are currently different as shown in the attached slide deck.  I apologize in advance if I mis-represented anything in the deck. I am trying to get a good handle on how HL7 can manage this encounter-related diagnosis issue consistently.  This issue arose when considering how CQI creates QI-Core to address an Encounter.diagnosis with rank (or sequence).

If we can all align on a common meeting time or 2 or 3 separate meeting times to discuss, that would be very helpful. 

I look forward to learning when we can meet.

  1. Patient Administration: Alexander de Leon, Brian Postlethwaite, Irma Jongeneel-de Haas, Line Saele
  2. Financial Management: Kathleen Connor, Mary Kay McDaniel, Andy Stechishin, Paul Knapp, Benoit Schoeffler
  3. Patient Care: Stephen Chu, Emma Jones, Michelle Miller, Michael Tan, Laura Heermann Langford, Jay Lyle, Michael Padula
  4. Vocabulary: Reuben Daniels, Robert Hausam, Carol Macumber, Heather Grain, Ted Klein, Rob McClure
  5. CARIN Alliance: Amol Vyas, Pat Taylor, Lisa Nelson
  6. US Core: Brett Marquard, Eric Haas
  7. CGP Co-chairs: Floyd Eisenberg (me), Jean Duteau
  8. CQI Co-chairs: Floyd Eisenberg (me), Juliet Rubini, Paul Denning, Patty Craig, Yan Heras

Thank you all very much in advance – I understand timing is difficult since we include folks in New Zealand, Australia, Europe, England, US, Canada and perhaps some countries I missed.

Best Regards,


Movement Resource Design notes

Orders and Observations considered creating a complete resource that would capture a more complete set of metadata around these events.

Task profile?

Conditions under which the movement took place - environmental

From a patient administrative perspective this could include other requirements for the movement to occur, such as wheelchairs, PPE, ...

Patient Transport could also fit into this space to transfer between facilities

Sept WGM Design Notes

Encounter modification proposal

reason (codablereference)

   reference(condition) – should this also support coded only (i.e. use codeablereference)
   codeableconcept(use) (billing/admitting/etc)
   int rank (within the use - if required)

procedure to be performed

   reference(procedure) (v2: PR1-14)
   codeableconcept(use) (billing/admitting/etc) – is this even needed here? Maybe quality measures?
   int rank (within the use - if required) (v2: PR1-14)

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