Episode of Care Definitions

When using 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, 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 as part of the PROMETHEUS Analytics system, which is available from certified third parties.

Metadata Files
The 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 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.