Patient Resource Query not following HL7 spec

[Medent Interface]

Hello,

We are attempting to connect to the Cerner Sandbox from the MEDENT EMR application.  We are starting with the patient resource query.  We noticed that the query parameters are different from the EPIC parameters, and don't follow the HL7 spec either.

Example:

cerner patient query paramenters:   http://fhir.cerner.com/may2015/patient/ 

name = "A portion of either family or given name of the patient. Example: Peters"

while hl7: http://hl7.org/fhir/datatypes.html#HumanName 

has no name field and has "family = Family name (often called 'Surname')" and "given = Given names (not always 'first'). Includes middle names"

This makes it difficult to program to as it seems there are discrepancies between different sandboxes and neither are adhering completely to the HL7 standard spec.  Is this something you are aware of and working on?  Or are you programmed to a different standard/spec for all Cerner applications?  

Any insight you can provide will be very helpful.

Thanks,

MEDENT

[Michele Mottini]

FHIR search parameters do not necessarily correspond to resource fields. 

'name' is indeed a valid Patient search parameter - see http://hl7.org/fhir/patient.html#search fort the complete list.

  - Michele

  CareEvolution Inc

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[Medent Interface]

Hi Michele,

Thanks that is helpful.  The issue we're running into then is the fact that unless we use exactly the 'name' parameter for Cerner then we don't get any data back.  Ideally you would be able to accept all parameters in this list as we are using valid search parameters as well.  Is that something that would be considered?  It's not ideal to have different systems expect different parameters for every query... it kind of defeats the purpose of having the standard if it's custom for each platform right?

Thanks

On Friday, October 28, 2016 at 11:21:39 AM UTC-4, Michele Mottini wrote:

FHIR search parameters do not necessarily correspond to resource fields. 

'name' is indeed a valid Patient search parameter - see http://hl7.org/fhir/patient.html#search fort the complete list.

  - Michele

  CareEvolution Inc

On Fri, Oct 28, 2016 at 11:13 AM, Medent Interface <mede...@gmail.com> wrote:

Hello,

We are attempting to connect to the Cerner Sandbox from the MEDENT EMR application.  We are starting with the patient resource query.  We noticed that the query parameters are different from the EPIC parameters, and don't follow the HL7 spec either.

Example:

cerner patient query paramenters:   http://fhir.cerner.com/may2015/patient/ 

name = "A portion of either family or given name of the patient. Example: Peters"

while hl7: http://hl7.org/fhir/datatypes.html#HumanName 

has no name field and has "family = Family name (often called 'Surname')" and "given = Given names (not always 'first'). Includes middle names"

This makes it difficult to program to as it seems there are discrepancies between different sandboxes and neither are adhering completely to the HL7 standard spec.  Is this something you are aware of and working on?  Or are you programmed to a different standard/spec for all Cerner applications?  

Any insight you can provide will be very helpful.

Thanks,

MEDENT

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[Kevin Shekleton]

Hi Medent team,

FHIR, while a standard, is designed for optionality nearly everywhere. This is intentional as FHIR is trying to get adoption by disparate systems, from different regions across the world, each with their own data models, workflows, and paradigms. As you've made the sober realization, this makes FHIR interoperability challenging for developers.

On a positive note, we're trying to address this with things like the Argonaut project (a joint venture from many vendors -- Cerner and Epic included) to define US centric FHIR profiles. See http://argonautwiki.hl7.org/index.php?title=Implementation_Guide for this work. Other similar profile efforts are underway for other regions. This work is still in development and we have not completed the profiles nor implemented them completely yet.

As much as I wish this weren't the case, writing a robust, truly vendor agnostic healthcare application will not be trivial. It will require adoption and understanding of profiles, the FHIR server's conformance document, etc.

Best,

Kevin

[Kevin Shekleton]

Medent team,

I did some searching and read more about what your team is doing. Sounds like you all are working on some great stuff. Given that you have your own EHR, have you all created your own FHIR server yet? I'd love to code against and play against it if it's available.

If you have it, can you send me a link to information on how I can call it?

Thanks!

Kevin

[Medent Interface]

Hi Kevin,

Thanks for the reply... it is an issue and hopefully it can be resolved over time... it's almost impossible to develop to all the "differences" we're seeing out there.

In regards to the Argonaut project you referenced, do you know of any Sandbox or base URL that we can start developing against?  We're currently using the Cerner sandbox, EPIC Sandbox, and the HSPC Sandbox.  They all behave a little differently so we're having trouble making a lot of progress.  Any info on a potential Argonaut Sandbox would be great.

Thanks again.

[Mark Gidman]

One additional insight...

The May 2015 version of FHIR is on it's way out. Cerner just hasn't updated the doc pages yet. Use this version instead http://fhir.cerner.com/dstu2/

[Jenni Syed]

Just to add to this: we have (recently) updated our documentation. May2015 is documented as deprecated now, and links to our documentation now direct to the DSTU 2 endpoint as the current version.

[Medent Interface]

Hi Jenni,

Yes thank you... we are currently pointed to that environment.  

Do you have any further information on the Argonaut project or if there is any open server Sandbox we can use for testing?

Thanks,

Andrew

[Jenni Syed]

Our sandbox (listed here) is the same server we used for Argonaut testing. Similarly, I believe the other servers out there reused existing servers/sandboxes for testing the profiles defined by Argonaut.

All servers used in the re-sprints are here: https://docs.google.com/spreadsheets/d/17Tqtl_1iO-zhRfBHpQY7eU0kU_9oHvOx08CGDZIpKUc/edit#gid=0

Re-sprint schedules/target functionality: https://github.com/argonautproject/implementation-program/wiki

For Patient, servers are expected to support 2 of the following parameters: name, gender, and/or birthdate. Our server supports name and birthdate, though as mentioned in our documentation, the search is incorrectly "fuzzy" right now - closer to how a user would expect it to work to account for typos/etc. This fuzziness will be going away in a future update, but the parameters themselves should still return results. Are you not seeing support for name across all the Argonaut servers?

~ Jenni

[Medent Interface]

Hi Jenni,

Thanks for the feedback again.  The problem we're running into with the Cerner sandbox specifically is that all others support the "Family" and "Given" parameters, while yours just does "Name".  Does Cerner plan on supporting the additional parameters for a patient query or will it always be "Name"?  Supporting the Family and Given parameters would be very useful as all other sandboxes we have developed with use these, or at least support that query.  Any insight would be very much appreciated.

Thanks,

Andrew

[Medent Interface]

Hi All,

Any update or insight on this?  We'd like to continue but it would be great if more parameters were accepted for patient matching.  

Thanks,

Andrew

[Jenni Syed]

Hi Andrew,

The current project is just to fix the existing parameters, and bring it in line with the Argonaut profile stating that the "name" parameter is supported. 

~ Jenni