Episode of Care Definitions

Episode of Care Definitions

HCI3’s Episode of Care definitions

When using HCI3‘s Episode of Care definitions, it is important to understand the difference in file types and which one best suits your needs. Although the definitions need logic applied to make them applicable for implementation, these free files provide a pivotal foundation for new payment models or performance analysis.

Before downloading the files, we recommend you familiarize yourself with An Introduction to ECRs (the title refers to a previous name for the definitions—ECRs—and will soon be updated; the substantive content remains valid) to better understand the principles and guidelines, as well as boundaries and sub-types rationale, that were followed in order to create these definitions.

Summary Descriptions
The Episode of Care Definition Summary Descriptions, listed in the table below, are available for all users interested in understanding the scope and boundaries of a specific episode. These summary descriptions are not the full machine-readable files and therefore, additional information and logic needs to be considered and applied through an analytical system in order to fit the user’s needs for which the metadata files are more useful.

Summary Description Limitations
When using these definition summaries, it is important to understand the distinction between the clinical logic of an episode system and the service assignment and other rules associated to the construction of episodes. These rules have been defined by HCI3 as part of the PROMETHEUS Analytics® system, which is available from certified third parties.

Metadata Files
The HCI3 Episode of Care Definition metadata files are machine-readable versions of all the definitions in detail. They are accessible via an API—a publicly available MySQL database—or can be downloaded as XML files. The definitions are available to anyone who accepts our user agreement, and are useful for those considering payment reform programs or cost and quality analysis implementations.

Metadata File Limitations
While these files are more comprehensive than the summary descriptions, methodological decisions on service assignments, triggers and episode construction still need to be addressed as the files describe the clinical boundaries of episodes but not the rules for analyzing claims based on those limits. However, these rules have been defined by HCI3 and embedded in the complete PROMETHEUS Analytics® system, which is available for license from certified third parties.

To download the XML metadata files, accept this user agreement.

To access the API, accept this user agreement.

Name 5.4.005
Accidental Falls (SRF) Definition
Acute CHF / pulm edema (SRF) Definition
Acute Myocardial Infarction Definition
Acute Renal Failure (SRF) Definition
Adverse effects of drugs (SRF) Definition
Allergic Rhinitis/Chronic Sinusitis Definition
Arrhythmia / Heart Block / Condn Dis Definition
Arterial thromboembolism (SRF) Definition
Aspiration Pneumonia (SRF) Definition
Asthma Definition
Attention Deficit / Oppositional Definition
Bariatric Surgery Definition
Bipolar Disorder Definition
Breast Biopsy Definition
Breast Cancer Definition
C-Difficile Infection (SRF) Definition
C-Section Definition
CABG &/or Valve Procedures Definition
Cataract Surgery Definition
Catheter Associated UTIs (SRF) Definition
Cellulitis, Skin Infection (SRF) Definition
Central Venous Catheter Infn (SRF) Definition
Chronic Obstructive Pulmonary Disease Definition
Colon Cancer Definition
Colonoscopy Definition
Colorectal Resection Definition
Coma, persistent veg. state (SRF) Definition
Complication of Implanted device SRF Definition
Complication surgical procedures SRF Definition
Coronary Angioplasty Definition
Coronary Artery Disease Definition
Crohn’s Disease Definition
Decubitus Ulcer (SRF) Definition
Deep Vein Throm/Pulm Embolism (SRF) Definition
Delirium, Encephalopathy (SRF) Definition
Depression & Anxiety Definition
Dermatitis, Urticaria (SRF) Definition
Diabetes Definition
Diabetes, poor control (SRF) Definition
Diverticulitis Definition
Fluid Electrolyte Imbalance (SRF) Definition
Gall Bladder Surgery Definition
Gastro-Esophageal Reflux Disease Definition
GI Bleed (SRF) Definition
Glaucoma Definition
Gynecological Cancers Definition
Healthcare Acquired Pneumonia Definition
Heart Failure Definition
Hepatitis (SRF) Definition
Hepatitis C Definition
Hip Replacement & Hip Revision Definition
Hip/Pelvic Fracture Definition
Hypertension Definition
Hypotension / Syncope (SRF) Definition
Hysterectomy Definition
Infections (SRF) Definition
Intestinal Obstruction (SRF) Definition
Knee Arthroscopy Definition
Knee Replacement & Knee Revision Definition
Low Back Pain Definition
Lumbar Laminectomy Definition
Lumbar Spine Fusion Definition
Lung Cancer Definition
Lung Resection Definition
Malignant Hypertension (SRF) Definition
Mastectomy Definition
Meningitis / Encephalitis (SRF) Definition
MRSA, Drug Resistant Infections (SRF) Definition
Newborn Definition
Nutritional Deficiency (SRF) Definition
Osteoarthritis Definition
Pacemaker / Defibrillator Definition
Pancreatitis (SRF) Definition
Pneumonia Definition
Poisoning (SRF) Definition
Pregnancy Definition
Preventive Care Definition
Prostate Cancer Definition
Prostatectomy Definition
Rectal Cancer Definition
Respiratory Failure (SRF) Definition
Routine Sick Care Definition
Schizophrenia Definition
Sepsis (SRF) Definition
Shock / Cardiac Arrest (SRF) Definition
Shoulder Replacement Definition
Stroke Definition
Substance Use Disorder Definition
Tonsillectomy Definition
Transfusion related complications SRF Definition
Transurethral resection prostate Definition
Trauma & Stressors Disorders Definition
Ulcerative Colitis Definition
Upper GI Endoscopy Definition
Upper Respiratory Infection Definition
Urinary Tract Infection (SRF) Definition
Vaginal Delivery Definition