Multiple organizations under same client EHR source id

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Assigned to Fenil....@cerner.com by me

wangr...@gmail.com

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May 27, 2021, 5:51:07 PM5/27/21
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Hi Team,
We have a customer who has set up one EHR source id but have different organizations sharing the same EHR source id.
So for example, they have organization A and organization B. Org A has organization id 111, and org B has organization id 222 . Each org has a unique MRN pool(oid:urn:A and oid:urn:B). 
I have a few questions on the above set up and hope you can help me understand that:
(1) When we call patient create via FHIR,  how does FHIR know which MRN to be generated for the new patient? Is it via this identifier -> assigner field? So if I pass in Organization/111, a patient will be created with MRN (oid:urn:A) assigned? 
Or will it always create the patient with two MRNs assigned?

(2) If a patient has visited and has record created in both org A and B, will FHIR patient.search return one FHIR patient with two MRNs or will it return two FHIR patients and each has a unique MRN?

Thanks,
Rui

Fenil Desani (Cerner)

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May 30, 2021, 11:01:54 AM5/30/21
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Hello,

1) Correct. The MRN will be created based on the OrganizationId provided.
2) Correct. Patient can have multiple MRNs associated with different Organizations returned in the FHIR response.

Thanks,
Fenil (Cerner)

Rui Wang

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May 31, 2021, 10:24:02 AM5/31/21
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Hi Fenil,

Thanks for the info. Having some follow up questions as I'm a little confused how FHIR keep in sync with Cerner records: 

(1) If a patient already exists in org A, but not org B, FHIR search will return the patient with only org A MRN available at this point, is that right?
(2) Then If I create the same patient in org B with Organization/222 via FHIR, what's the expected result here? Will FHIR.create automatically assign an org B MRN to the existing FHIR patient in (1) and the create call will return the same FHIR id as (1)? So now if I do another PatientSearch, it will return one patient with two MRNs. Is that how it works? 

Thanks,
Rui

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wangr...@gmail.com

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Jun 2, 2021, 10:02:23 AM6/2/21
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Hi Fenil,

Any update on above question?

Rui

Fenil Desani (Cerner)

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Jun 3, 2021, 1:02:30 AM6/3/21
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1) If a patient already exists in org A, but not org B, FHIR search will return the patient with only org A MRN available at this point, is that right?
  • Correct.
(2) Then If I create the same patient in org B with Organization/222 via FHIR, what's the expected result here? Will FHIR.create automatically assign an org B MRN to the existing FHIR patient in (1) and the create call will return the same FHIR id as (1)? So now if I do another PatientSearch, it will return one patient with two MRNs. Is that how it works? 
  • If you create a new patient (same demographics as patient 1)with org/222, this would create the a duplicate of patient 1, with only org B MRN.
  • Now If you search by demographics, it will return two identical patients each having Org A MRN and org B MRN respectively.

wangr...@gmail.com

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Jun 3, 2021, 9:49:00 AM6/3/21
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So Fenil,
 
1. is this very normal cases that will happen in FHIR - where a same patient having multiple FHIR records each having their own MRN? Or is this considered as duplicates that I should avoid doing so?
2. In what situation the patient will just have only one FHIR record with multiple MRNs associated to it? 
3. What will happen in this scenario?
 A brand new patient checks into Org A via registration area, he gets a record created with Org A MRN assigned in Cerner millennium on this visit. Then he checks into Org B on a second visit, will he gets a new record created with Org B MRN assigned which in turn results in two FHIR records? Or will Cerner millennium has a way for user to figure out this patient already exist in Org A and will just assign a Org B MRN to existing record which will in turn result in one FHIR record with two MRNs associated to it?

Thanks,
Rui
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