xCaliber healthCare Data Mesh

CareTeam

Overview

The CareTeam API empowers healthcare developers to seamlessly organize and manage interdisciplinary care teams, fostering collaborative patient care and enhancing communication among healthcare professionals within clinical workflows. By integrating this API, developers can optimize care coordination, improve information sharing, and ensure a cohesive and patient-centered approach to healthcare delivery.

Use Cases

  • Care Coordination - Define patient care teams across healthcare settings and use cases.
  • Condition Management - Build specialty care teams based on expertise needed for a condition.
  • Referrals Management - Coordinate referrals amongst internal and external care team members.
  • Care Transition - Notify new care teams to ensure continuity of care when patients transfer.
  • Contact Lists - Maintain contact details on all care team members for improved communication.
  • Patient Attribution - Attribute and assign patient panels to appropriate care teams.​
  • Resource Management - Analyze care team composition and identify resource gaps.
  • Value-based Care - Track care team performance against quality metrics for incentives.
  • Patient Engagement - Share care team details with patients for coordinated access.
  • Clinical Workflows - Integrate care team assignments into workflows.

EHR Data Model

EHRSupported?Mapped Source Object
AthenaCare Team
ElationN/A
EpicN/A

Object Definition

{
  "resourceType": "CareTeam",
  "id": "example",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Care Team</div>"
  },
  "contained": [
    {
      "resourceType": "Practitioner",
      "id": "pr1",
      "name": [
        {
          "family": "Dietician",
          "given": [
            "Dorothy"
          ]
        }
      ]
    }
  ],
  "identifier": [
    {
      "value": "12345"
    }
  ],
  "status": "active",
  "category": [
    {
      "coding": [
        {
          "system": "http://loinc.org",
          "code": "LA27976-2",
          "display": "Encounter-focused care team"
        }
      ]
    }
  ],
  "name": "Peter James Charlmers Care Plan for Inpatient Encounter",
  "subject": {
    "reference": "Patient/example",
    "display": "Peter James Chalmers"
  },
  "encounter": {
    "reference": "Encounter/example"
  },
  "period": {
    "end": "2013-01-01"
  },
  "participant": [
    {
      "role": [
        {
          "text": "responsiblePerson"
        }
      ],
      "member": {
        "reference": "Patient/example",
        "display": "Peter James Chalmers"
      }
    },
    {
      "role": [
        {
          "text": "adviser"
        }
      ],
      "member": {
        "reference": "#pr1",
        "display": "Dorothy Dietition"
      },
      "onBehalfOf": {
        "reference": "Organization/f001"
      },
      "period": {
        "end": "2013-01-01"
      }
    }
  ],
  "managingOrganization": [
    {
      "reference": "Organization/f001"
    }
  ],
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}

Data Fields

Data FieldTypeDescription
resourceTypeCareTeamThis is a CareTeam resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedBackboneElementThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionExtensionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionExtensionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierIdentifierBusiness identifiers assigned to this care team by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
statuscodeIndicates the current state of the care team.
categoryCodeableConceptIdentifies what kind of team. This is to support differentiation between multiple co-existing teams, such as care plan team, episode of care team, longitudinal care team.
namestringA label for human use intended to distinguish like teams. E.g. the "red" vs. "green" trauma teams.
subjectReferenceIdentifies the patient or group whose intended care is handled by the team.
encounterReferenceThe Encounter during which this CareTeam was created or to which the creation of this record is tightly associated.
periodPeriodIndicates when the team did (or is intended to) come into effect and end.
participantBackboneElementIdentifies all people and organizations who are expected to be involved in the care team.
participant.idstringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
participant.extensionExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
participant.modifierExtensionExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
participant.roleCodeableConceptIndicates specific responsibility of an individual within the care team, such as "Primary care physician", "Trained social worker counselor", "Caregiver", etc.
participant.memberReferenceThe specific person or organization who is participating/expected to participate in the care team.
participant.onBehalfOfReferenceThe organization of the practitioner.
participant.periodPeriodIndicates when the specific member or organization did (or is intended to) come into effect and end.
reasonCodeCodeableConceptDescribes why the care team exists.
reasonReferenceReferenceCondition(s) that this care team addresses.
managingOrganizationReferenceThe organization responsible for the care team.
telecomContactPointA central contact detail for the care team (that applies to all members).
noteAnnotationComments made about the CareTeam.

Extensions

NameURL

Operations & APIs

CareTeam-GET

CareTeam-POST

CareTeam ID-GET

CareTeam ID-PUT

CareTeam ID-DELETE