Introduction

The CareTeam includes all the people and organizations who plan to participate in the coordination and delivery of care for a patient. A CareTeam can be constructed for a single patient but typically handles more patients.

Scope and Usage

In the eHealth Infrastructure, a CareTeam has a lifecycle independent of Patients and consists of a group of Practitioners. Typically the group of Practitioners are affiliated with a real-world organizational unit such as a hospital department/care unit, but a CareTeam can also be representing a "virtual" unit comprised of
Practitioners from more sectors or several real-world organizational units.

The core FHIR CareTeam has subject and context which can reference a Patient and EpisodeOfCare, respectively, which when used ties a CareTeam to a Patient context. Similarly, use of element reasonReference would indirectly tie the CareTeam to a Patient. As this is not used in the eHealth Infrastructure and to prevent such tying, these elements have been set to 0..0.

Instead CareTeam is intended to be referenced from CarePlan and EpisodeOfCare. A CareTeam can be referenced from a single CarePlan but the typical scenario is that it is referenced by multiple CarePlan and/or EpisodeOfCare instances crossing multiple Patient instances.

The eHealth profile of CareTeam has the following extensions:

• ehealth-useContext which defines the context(s) in which the CareTeam is intended and expected to be used (non-exclusively)

Composition of CareTeams

In the eHealth Infrastructure, the possibility to add CareTeam participant members other than Practitioner is not used, but the other types (Organization, CareTeam etc) have been retained for possible future use.

There are currently no restrictions on the composition of CareTeams. The intended usage is to establish a few layers of CareTeams, but it is important to make sure that the CareTem member graph contains no cycles.

CareTeam Identifier

At least one identifier for the CareTeam shall use system set to urn:ietf:rfc:3986 and contain a value which is a UUID.

Condition types handled by the CareTeam

In order to ease selection of CareTeam appropriate for a given CarePlan, at least one Condition type handled by a CareTeam must be stated in reasonCode. This is used as criteria for suggesting CareTeams in the operation suggest-care-teams.

UseContext

The element useContext.code has binding to the ValueSet http://hl7.org/fhir/ValueSet/use-context (see https://hl7.org/fhir/R4/valueset-use-context.html). It is, however, validated against the eHealth ValueSet http://ehealth.sundhed.dk/vs/ehealth-usage-context-type (see https://ehealth.sundhed.dk/fhir/ValueSet-ehealth-usage-context-type.html). This validation includes that the value in useContext.valueCodeableConcept is acceptable in the ValueSet described for useContext.code. Do not use code 'focus'. Conditions must be added to the reasonCode property.

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

Name	Flags	Card.	Type	Description & Constraints
CareTeam		0..*	CareTeam	Planned participants in the coordination and delivery of care for a patient or group dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
useContext		0..*	UsageContext	The context that the content is intended to support URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-useContext ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!Σ	1..1	code	proposed | active | suspended | inactive | entered-in-error Binding: CareTeamStatus (required): Indicates the status of the care team. ele-1: All FHIR elements must have a @value or children
category	Σ	0..*	CodeableConcept	Type of team Binding: CareTeam Category (required) ele-1: All FHIR elements must have a @value or children
name	Σ	1..1	string	Name of the team, such as crisis assessment team ele-1: All FHIR elements must have a @value or children
reasonCode		1..*	CodeableConcept	Why the care team exists Binding: Conditions (required) ele-1: All FHIR elements must have a @value or children
managingOrganization	Σ	0..*	Reference(ehealth-organization) {r}	Organization responsible for the care team ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CareTeam.status	required	CareTeamStatus http://hl7.org/fhir/ValueSet/care-team-status|4.0.1 from the FHIR Standard
CareTeam.category	required	CareTeamCategory (a valid code from CareTeam Category) http://ehealth.sundhed.dk/vs/careteam-category from this IG
CareTeam.reasonCode	required	Conditions http://ehealth.sundhed.dk/vs/conditions from this IG

This structure is derived from CareTeam

Name	Flags	Card.	Type	Description & Constraints
CareTeam			CareTeam
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
useContext		0..*	UsageContext	The context that the content is intended to support URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-useContext
status		1..1	code	proposed | active | suspended | inactive | entered-in-error
category		0..*	CodeableConcept	Type of team Binding: CareTeam Category (required)
name		1..1	string	Name of the team, such as crisis assessment team
subject		0..0
participant
role		1..*	CodeableConcept	Type of involvement Binding: CareTeam Participant Role (required)
member		1..1	Reference(ehealth-practitioner | ehealth-practitionerrole | ehealth-relatedperson | ehealth-patient | ehealth-organization | ehealth-careteam) {r}	Who is involved
onBehalfOf		0..1	Reference(ehealth-organization) {r}	Organization of the practitioner
reasonCode		1..*	CodeableConcept	Why the care team exists Binding: Conditions (required)
reasonReference		0..0
managingOrganization		0..*	Reference(ehealth-organization) {r}	Organization responsible for the care team
telecom
value		1..1	string	The actual contact point details
note
Slices for author[x]		0..1	Reference(Practitioner | Patient | RelatedPerson | Organization), string	Individual responsible for the annotation Slice: Unordered, Open by type:$this
author[x]:authorReference		0..1	Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)	Individual responsible for the annotation
author[x]:authorString		0..1	string	Individual responsible for the annotation
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CareTeam.category	required	CareTeamCategory (a valid code from CareTeam Category) http://ehealth.sundhed.dk/vs/careteam-category from this IG
CareTeam.participant.role	required	CareTeamParticipantRole (a valid code from CareTeam Participant Role) http://ehealth.sundhed.dk/vs/careteam-participant-role from this IG
CareTeam.reasonCode	required	Conditions http://ehealth.sundhed.dk/vs/conditions from this IG

Name	Flags	Card.	Type	Description & Constraints
CareTeam		0..*	CareTeam	Planned participants in the coordination and delivery of care for a patient or group
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
useContext		0..*	UsageContext	The context that the content is intended to support URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-useContext
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this team
status	?!Σ	1..1	code	proposed | active | suspended | inactive | entered-in-error Binding: CareTeamStatus (required): Indicates the status of the care team.
category	Σ	0..*	CodeableConcept	Type of team Binding: CareTeam Category (required)
name	Σ	1..1	string	Name of the team, such as crisis assessment team
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
period	Σ	0..1	Period	Time period team covers
participant	C	0..*	BackboneElement	Members of the team ctm-1: CareTeam.participant.onBehalfOf can only be populated when CareTeam.participant.member is a Practitioner
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
role	Σ	1..*	CodeableConcept	Type of involvement Binding: CareTeam Participant Role (required)
member	Σ	1..1	Reference(ehealth-practitioner | ehealth-practitionerrole | ehealth-relatedperson | ehealth-patient | ehealth-organization | ehealth-careteam) {r}	Who is involved
onBehalfOf	Σ	0..1	Reference(ehealth-organization) {r}	Organization of the practitioner
period		0..1	Period	Time period of participant
reasonCode		1..*	CodeableConcept	Why the care team exists Binding: Conditions (required)
managingOrganization	Σ	0..*	Reference(ehealth-organization) {r}	Organization responsible for the care team
telecom		0..*	ContactPoint	A contact detail for the care team (that applies to all members)
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	ΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	Σ	1..1	string	The actual contact point details
use	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
note		0..*	Annotation	Comments made about the CareTeam
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for author[x]	Σ	0..1		Individual responsible for the annotation Slice: Unordered, Closed by type:$this
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
author[x]:authorReference	Σ	0..1	Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)	Individual responsible for the annotation
author[x]:authorString	Σ	0..1	string	Individual responsible for the annotation
time	Σ	0..1	dateTime	When the annotation was made
text	Σ	1..1	markdown	The annotation - text content (as markdown)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CareTeam.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CareTeam.status	required	CareTeamStatus http://hl7.org/fhir/ValueSet/care-team-status|4.0.1 from the FHIR Standard
CareTeam.category	required	CareTeamCategory (a valid code from CareTeam Category) http://ehealth.sundhed.dk/vs/careteam-category from this IG
CareTeam.participant.role	required	CareTeamParticipantRole (a valid code from CareTeam Participant Role) http://ehealth.sundhed.dk/vs/careteam-participant-role from this IG
CareTeam.reasonCode	required	Conditions http://ehealth.sundhed.dk/vs/conditions from this IG
CareTeam.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
CareTeam.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
CareTeam		0..*	CareTeam	Planned participants in the coordination and delivery of care for a patient or group dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
useContext		0..*	UsageContext	The context that the content is intended to support URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-useContext ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!Σ	1..1	code	proposed | active | suspended | inactive | entered-in-error Binding: CareTeamStatus (required): Indicates the status of the care team. ele-1: All FHIR elements must have a @value or children
category	Σ	0..*	CodeableConcept	Type of team Binding: CareTeam Category (required) ele-1: All FHIR elements must have a @value or children
name	Σ	1..1	string	Name of the team, such as crisis assessment team ele-1: All FHIR elements must have a @value or children
reasonCode		1..*	CodeableConcept	Why the care team exists Binding: Conditions (required) ele-1: All FHIR elements must have a @value or children
managingOrganization	Σ	0..*	Reference(ehealth-organization) {r}	Organization responsible for the care team ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CareTeam.status	required	CareTeamStatus http://hl7.org/fhir/ValueSet/care-team-status|4.0.1 from the FHIR Standard
CareTeam.category	required	CareTeamCategory (a valid code from CareTeam Category) http://ehealth.sundhed.dk/vs/careteam-category from this IG
CareTeam.reasonCode	required	Conditions http://ehealth.sundhed.dk/vs/conditions from this IG

Differential View

This structure is derived from CareTeam

Name	Flags	Card.	Type	Description & Constraints
CareTeam			CareTeam
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
useContext		0..*	UsageContext	The context that the content is intended to support URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-useContext
status		1..1	code	proposed | active | suspended | inactive | entered-in-error
category		0..*	CodeableConcept	Type of team Binding: CareTeam Category (required)
name		1..1	string	Name of the team, such as crisis assessment team
subject		0..0
participant
role		1..*	CodeableConcept	Type of involvement Binding: CareTeam Participant Role (required)
member		1..1	Reference(ehealth-practitioner | ehealth-practitionerrole | ehealth-relatedperson | ehealth-patient | ehealth-organization | ehealth-careteam) {r}	Who is involved
onBehalfOf		0..1	Reference(ehealth-organization) {r}	Organization of the practitioner
reasonCode		1..*	CodeableConcept	Why the care team exists Binding: Conditions (required)
reasonReference		0..0
managingOrganization		0..*	Reference(ehealth-organization) {r}	Organization responsible for the care team
telecom
value		1..1	string	The actual contact point details
note
Slices for author[x]		0..1	Reference(Practitioner | Patient | RelatedPerson | Organization), string	Individual responsible for the annotation Slice: Unordered, Open by type:$this
author[x]:authorReference		0..1	Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)	Individual responsible for the annotation
author[x]:authorString		0..1	string	Individual responsible for the annotation
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CareTeam.category	required	CareTeamCategory (a valid code from CareTeam Category) http://ehealth.sundhed.dk/vs/careteam-category from this IG
CareTeam.participant.role	required	CareTeamParticipantRole (a valid code from CareTeam Participant Role) http://ehealth.sundhed.dk/vs/careteam-participant-role from this IG
CareTeam.reasonCode	required	Conditions http://ehealth.sundhed.dk/vs/conditions from this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
CareTeam		0..*	CareTeam	Planned participants in the coordination and delivery of care for a patient or group
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
useContext		0..*	UsageContext	The context that the content is intended to support URL: http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-useContext
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this team
status	?!Σ	1..1	code	proposed | active | suspended | inactive | entered-in-error Binding: CareTeamStatus (required): Indicates the status of the care team.
category	Σ	0..*	CodeableConcept	Type of team Binding: CareTeam Category (required)
name	Σ	1..1	string	Name of the team, such as crisis assessment team
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
period	Σ	0..1	Period	Time period team covers
participant	C	0..*	BackboneElement	Members of the team ctm-1: CareTeam.participant.onBehalfOf can only be populated when CareTeam.participant.member is a Practitioner
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
role	Σ	1..*	CodeableConcept	Type of involvement Binding: CareTeam Participant Role (required)
member	Σ	1..1	Reference(ehealth-practitioner | ehealth-practitionerrole | ehealth-relatedperson | ehealth-patient | ehealth-organization | ehealth-careteam) {r}	Who is involved
onBehalfOf	Σ	0..1	Reference(ehealth-organization) {r}	Organization of the practitioner
period		0..1	Period	Time period of participant
reasonCode		1..*	CodeableConcept	Why the care team exists Binding: Conditions (required)
managingOrganization	Σ	0..*	Reference(ehealth-organization) {r}	Organization responsible for the care team
telecom		0..*	ContactPoint	A contact detail for the care team (that applies to all members)
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	ΣC	0..1	code	phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point.
value	Σ	1..1	string	The actual contact point details
use	?!Σ	0..1	code	home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point.
rank	Σ	0..1	positiveInt	Specify preferred order of use (1 = highest)
period	Σ	0..1	Period	Time period when the contact point was/is in use
note		0..*	Annotation	Comments made about the CareTeam
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for author[x]	Σ	0..1		Individual responsible for the annotation Slice: Unordered, Closed by type:$this
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
author[x]:authorReference	Σ	0..1	Reference(ehealth-practitioner | ehealth-patient | ehealth-relatedperson)	Individual responsible for the annotation
author[x]:authorString	Σ	0..1	string	Individual responsible for the annotation
time	Σ	0..1	dateTime	When the annotation was made
text	Σ	1..1	markdown	The annotation - text content (as markdown)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
CareTeam.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CareTeam.status	required	CareTeamStatus http://hl7.org/fhir/ValueSet/care-team-status|4.0.1 from the FHIR Standard
CareTeam.category	required	CareTeamCategory (a valid code from CareTeam Category) http://ehealth.sundhed.dk/vs/careteam-category from this IG
CareTeam.participant.role	required	CareTeamParticipantRole (a valid code from CareTeam Participant Role) http://ehealth.sundhed.dk/vs/careteam-participant-role from this IG
CareTeam.reasonCode	required	Conditions http://ehealth.sundhed.dk/vs/conditions from this IG
CareTeam.telecom.system	required	ContactPointSystem http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1 from the FHIR Standard
CareTeam.telecom.use	required	ContactPointUse http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1 from the FHIR Standard

This structure is derived from CareTeam

Summary

Mandatory: 3 elements(3 nested mandatory elements)
Prohibited: 2 elements

Structures

This structure refers to these other structures:

• ehealth-practitioner (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-practitioner)
• ehealth-practitionerrole (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-practitionerrole)
• ehealth-relatedperson (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-relatedperson)
• ehealth-patient (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-patient)
• ehealth-organization (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-organization)
• ehealth-careteam (http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-careteam)

Extensions

This structure refers to these extensions:

• http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-useContext

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CareTeam.note.author[x]