Scope and usage

klgateway-children-encounter is used whenever a child with or without family members meet the health nurse (sundhedsplejerske) in a Danish municipality context. The CommonCareSocialEncounters are e.g.

• Home visits in citizens homes by health nurses
• Open consultations
• Specialized service for specific groups

The Encounter.type.coding attribute is used to classify the type of activities that occur at the encounter. The encounters have been classified according to the guidance document from the Health Authorities (Sundhedsstyrelsen).

• Forebyggelseskontakt af småbørnssundhedsplejen
  • Graviditetsbesøg
  • Barselsbesøg
  • Etableringsbesøg
  • Andet besøg i barnets første levemåned
  • Besøg ved det ca. 2 måneder gamle barn
  • Besøg ved det 4-6 måneder gamle barn
  • Besøg ved det 8-11 måneder gamle barn
• Behovsbesøg af småbørnssundhedsplejen
• Anden kontakt med småbørnssundhedsplejen ifm den almindelige forebyggende småbørnsindsats
  • Kontakt med sundhedsplejen i åben konsultation
  • Kontakt med sundhedsplejen ifm. gruppeaktivitet”
• Forebyggelseskontakt i skolesundhedsplejen
  • Indskolingsundersøgelse
  • første klasses undersøgelse
  • Undersøgelse i mellemtrin, med måling
  • Udskolingsundersøgelse
• Behovsbaseret kontakt med skolesundhedsplejersken”
• Anden kontakt med skolesundhedsplejersken ifm den almindelige forebyggende skolebørnsindsats”

Sometimes, it might be difficult to apply the correct type to an encounter. The following guiding principles exists:

• The encounter in which most of the activities of a certain visit or examination (as described in the guidance document) is carried out, is classified as that type of visit or examination. This holds true even if the guidance document describes this enconter or examination for a child of a certain age, and the child examined is in fact younger or older. (fx hvis man besøger et 12 måneder gammelt barn, og udfører de ting sundhedsstyrelsen vejledning beskriver for ‘besøg ved det 8-11 måneder gamle barn’, så klassificeres det som ‘besøg ved det 8-11 måneder gamle barn’.)
• If certain mandatory activites are not carried out, and another encounter is planned and completed to account for this, classify this secondary encounter as ‘Forebyggelsekontakt i småbørnssundhedsplejen’/’Forebyggelseskontakt i skolesundhedsplejen’.
• If local encounter types exists, report them as the most specific type which is still true. Be especially aware if the reason for the encounter is prevention, or a specific need in the family. E.g. a municipality may have a specific encountertype to help mothers that have problems with breastfeeding. These should be reported as ‘Behovsbesøg af småbørnssundhedsplejen’. If the municipality has regular extra visits with all children in the 3rd month, they should be reported af ‘Forebyggelseskontakt af småbørnssundhedsplejen’.

In the context of the children database, only encounters actually carried out should be documented. Consequently, for most intends and purposes the encounter.status should be ‘finished’. However, if errors have been repported use the ‘entered-in-error’ status as described by the FHIR-documentation.

Encounter.class is mandatory in FHIR. In Danish municipalities the values are used as follows.

• Visits in citizens homes have the code ‘HH’ home health, the code is also used for services that are not strictly health related e.g. help with cleaning. This code is also used, even if the activities stretch outside the citizens residence e.g. a physiotherapist that want to see a citizen walk outside, or a social worker helping with shpping activities.
• Sessions where the citizens visit municipality facilities e.g. for training or health prevention have the code “AMB” ambulatory.
• For telehealth/telecare encounters, where the patient is contacted by telephone, by teleconference or e-mail, the code is ‘VR’ virtual.

The time of the encounter is documented in Encounter.period.start, and is mandatory. The endtime is not mandatory.

Encounter.subject relates to the subject that the encounter is about. In the context of the childrens database, only the childrens encounters are documented. This should be respected even though many visits are directed at the family as a whole.

Conversions between Danish information model and FHIR-profile

Nedenstående tabel oversætter mellem de attributter der er defineret i den fælleskommunale informationsmodel (FKI), definerer kort den enkelte attribut på dansk og specificere hvilke af FHIR-profilens atributter der skal bruges til specifikation af indholdet

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

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter			Encounter
identifier		0..0
status		1..1	code	[DK] kontaktstatus
statusHistory		0..0
class		1..1	Coding	[DK] kontaktklasse
version		0..0
display		0..0
userSelected		0..0
classHistory		0..0
type		0..*	CodeableConcept	Specific type of encounter Binding: EncounterTypes (required)
coding		1..*	Coding	[DK] kontakttype
version		0..0
userSelected		0..0
text		0..0
serviceType		0..0
priority		0..0
subject		1..1	Reference(KLGatewayChildrenCitizen) {b}	[DK] kontaktsubjekt
episodeOfCare		0..0
basedOn		0..0
participant		0..0
appointment		0..0
period		1..1	Period	The start and end time of the encounter
start		1..1	dateTime	[DK] kontaktstart
end		0..1	dateTime	[DK] kontaktslut
length		0..0
reasonCode		0..0
reasonReference		0..0
diagnosis		0..0
account		0..0
hospitalization		0..0
location		0..0
serviceProvider		0..0
partOf		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Encounter.type	required	EncounterTypes

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	[DK] kontaktstatus Binding: EncounterStatus (required): Current state of the encounter.
class	Σ	1..1	Coding	[DK] kontaktklasse Binding: ActEncounterCode (extensible): Classification of the encounter.
type	Σ	0..*	CodeableConcept	Specific type of encounter Binding: EncounterTypes (required)
coding	Σ	1..*	Coding	[DK] kontakttype
subject	Σ	1..1	Reference(KLGatewayChildrenCitizen) {b}	[DK] kontaktsubjekt
period		1..1	Period	The start and end time of the encounter
start	ΣC	1..1	dateTime	[DK] kontaktstart
end	ΣC	0..1	dateTime	[DK] kontaktslut
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	required	EncounterTypes

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
status	?!Σ	1..1	code	[DK] kontaktstatus Binding: EncounterStatus (required): Current state of the encounter.
class	Σ	1..1	Coding	[DK] kontaktklasse Binding: ActEncounterCode (extensible): Classification of the encounter.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
code	Σ	0..1	code	Symbol in syntax defined by the system
type	Σ	0..*	CodeableConcept	Specific type of encounter Binding: EncounterTypes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	[DK] kontakttype
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
subject	Σ	1..1	Reference(KLGatewayChildrenCitizen) {b}	[DK] kontaktsubjekt
period		1..1	Period	The start and end time of the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	[DK] kontaktstart
end	ΣC	0..1	dateTime	[DK] kontaktslut
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	required	EncounterTypes
Encounter.participant.type	extensible	ParticipantType
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
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()

Differential View

This structure is derived from Encounter

Name	Flags	Card.	Type	Description & Constraints
Encounter			Encounter
identifier		0..0
status		1..1	code	[DK] kontaktstatus
statusHistory		0..0
class		1..1	Coding	[DK] kontaktklasse
version		0..0
display		0..0
userSelected		0..0
classHistory		0..0
type		0..*	CodeableConcept	Specific type of encounter Binding: EncounterTypes (required)
coding		1..*	Coding	[DK] kontakttype
version		0..0
userSelected		0..0
text		0..0
serviceType		0..0
priority		0..0
subject		1..1	Reference(KLGatewayChildrenCitizen) {b}	[DK] kontaktsubjekt
episodeOfCare		0..0
basedOn		0..0
participant		0..0
appointment		0..0
period		1..1	Period	The start and end time of the encounter
start		1..1	dateTime	[DK] kontaktstart
end		0..1	dateTime	[DK] kontaktslut
length		0..0
reasonCode		0..0
reasonReference		0..0
diagnosis		0..0
account		0..0
hospitalization		0..0
location		0..0
serviceProvider		0..0
partOf		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Encounter.type	required	EncounterTypes

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	[DK] kontaktstatus Binding: EncounterStatus (required): Current state of the encounter.
class	Σ	1..1	Coding	[DK] kontaktklasse Binding: ActEncounterCode (extensible): Classification of the encounter.
type	Σ	0..*	CodeableConcept	Specific type of encounter Binding: EncounterTypes (required)
coding	Σ	1..*	Coding	[DK] kontakttype
subject	Σ	1..1	Reference(KLGatewayChildrenCitizen) {b}	[DK] kontaktsubjekt
period		1..1	Period	The start and end time of the encounter
start	ΣC	1..1	dateTime	[DK] kontaktstart
end	ΣC	0..1	dateTime	[DK] kontaktslut
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Encounter.status	required	EncounterStatus
Encounter.statusHistory.status	required	EncounterStatus
Encounter.class	extensible	ActEncounterCode
Encounter.classHistory.class	extensible	ActEncounterCode
Encounter.type	required	EncounterTypes

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
status	?!Σ	1..1	code	[DK] kontaktstatus Binding: EncounterStatus (required): Current state of the encounter.
class	Σ	1..1	Coding	[DK] kontaktklasse Binding: ActEncounterCode (extensible): Classification of the encounter.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
code	Σ	0..1	code	Symbol in syntax defined by the system
type	Σ	0..*	CodeableConcept	Specific type of encounter Binding: EncounterTypes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	[DK] kontakttype
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
subject	Σ	1..1	Reference(KLGatewayChildrenCitizen) {b}	[DK] kontaktsubjekt
period		1..1	Period	The start and end time of the encounter
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	[DK] kontaktstart
end	ΣC	0..1	dateTime	[DK] kontaktslut
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	required	EncounterTypes
Encounter.participant.type	extensible	ParticipantType
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
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()

This structure is derived from Encounter

Summary

Mandatory: 3 elements (1 nested mandatory element)
Prohibited: 24 elements

Structures

This structure refers to these other structures:

• KLGatewayChildrenCitizen (http://fhir.kl.dk/children/StructureDefinition/klgateway-children-citizen)