Multiple organizations under same client EHR source id

[wangr...@gmail.com]

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)]

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]

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]

Hi Fenil,

Any update on above question?

Rui

[Fenil Desani (Cerner)]

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]

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