Encounter HMO Data - alignment to HL7 FHIR resources

Encounter HMO data: Encounter data is detailed data generated by health care providers, such as doctors and hospitals, that documents both the clinical conditions they diagnose as well as the services and items delivered to beneficiaries to treat these conditions. The Centers for Medicare & Medicaid Services (CMS) began collecting encounter data from Medicare Advantage plans in 2012.

We are looking to bring in Encounter HMO data, a brief description above provided by one of the business stakeholders. Any feedback on the resources this would closely align to would really be appreciated!

Thank you!

Typically for CMS, this information would come in as claims data and would use the Claim resource - it would include the billing codes for performed procedures and supplied devices and substances. It would also include the diagnoses and information about who performed the services (clinicians and organizations) and the start and end dates for the encounter.

That said, in the U.S., regulations mandate that all claims are transmitted using X12, so you won’t typically see this information shared or exposed as FHIR.

You could of course send all of this same information in considerably more clinical detail using Encounter, Condition, Observation, Procedure, MedicationAdministration, and various other resources.