CareTeam resource call not returning data for specific patient, non-prod

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Ralph Rostock

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Feb 10, 2023, 11:53:46 AM2/10/23
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Hello,
In our non prod environment, call to CareTeam resource is generally working and matching what is shown in Millennium.  However for one patient, it is not returning any values., although I can see the lifetime primary care relationship in PowerChart.

Working example: ( X-Request-Id:  2af9a9dd-f411-4635-9f9e-99c77eac4dea+kTIn_4jyb)
(Returns relationship)

Non-working example (X-Request-Id: 0ca7869f-722b-48ab-8785-baf0a9e06bb0+xmgk_0dvU)

{"resourceType":"Bundle","id":"ab2b6e71-58f5-4bd9-888e-38c6b295b47c","type":"searchset","link":[{"relation":"self","url":"https://fhir-ehr.sandboxcerner.com/r4/2f8bb684-809c-47d9-8a7b-74e9f3a3da18/CareTeam?patient=1350150"}]}

What is the explanation for this, please?  Thank you.

Aaron McGinn (Oracle Cerner)

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Feb 10, 2023, 5:47:31 PM2/10/23
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It looks like there is a problem retrieving encounter-level CareTeam members for this particular patient—one of the encounters errored out. I'll have this investigated for further information.

-Aaron (Oracle Cerner)

Ralph Rostock

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Feb 17, 2023, 9:06:04 AM2/17/23
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Thanks Aaron.  Any update? Seems to be just this one patient, from my testing so far.

Sukesh Konjeti (Oracle Cerner)

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Mar 16, 2023, 8:18:59 AM3/16/23
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Hello Rostock,

Apologies for the late response. I'd recreated the issue in our internal domain and trying to get a solution for this.
can you make one more call for this patient 1350150 and provide the new X-Request-Id please.
The old X-request id seems to be expired or something, nothing is showing up in the logs.

Thank You,
Sukesh Konjeti (Oracle Cerner).

Ralph Rostock

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Mar 17, 2023, 4:34:09 PM3/17/23
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Hi Sukesh,
I ran it again, same response.   X-Request-Id: 0c4c643b-92b1-42da-b3d3-eaf3dc48e16e+G4h5_1a28

GET https://fhir-ehr.sandboxcerner.com/r4/2f8bb684-809c-47d9-8a7b-74e9f3a3da18/CareTeam?patient=1350150
Response Body
{"resourceType":"Bundle","id":"17081e8f-5bf4-4820-9351-3b3dd9527df9","type":"searchset","link":[{"relation":"self","url":"https://fhir-ehr.sandboxcerner.com/r4/2f8bb684-809c-47d9-8a7b-74e9f3a3da18/CareTeam?patient=1350150"}]}
Thanks

Sukesh Konjeti (Oracle Cerner)

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Mar 21, 2023, 2:44:20 AM3/21/23
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Hello Rostock,

Can you please update the Encounter Type for the patient 1350150.
It should be either InPatient/OutPatient. I have checked the database and encounter type is 0 for this encounter 9710699.
Since its 0 it will be considered as an invalid encounter by service team and returns 404 to us and we are returning empty response from FHIR.
So updating the encounter type will solve your issue. Please post here incase of any further queries or if this solution doesn't help.

Thank You,
Sukesh Konjeti(Oracle Cerner).

Ralph Rostock

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Mar 21, 2023, 10:17:00 AM3/21/23
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Hi Sukesh,
Thank you for the response.  I have a couple questions regarding this.  
First, I assume you mean the Encounter type class for the encounter 9710699.     The ENCNTR_TYPE_CD is already valued to   89357.00 (Employee Health).   The ENCNTR_TYPE_CLASS_CD is 0.0.
Secondly, I don't understand why this particular encounter having an encntr_type_class_cd = 0 is causing the lifetime relationship to be not returned.    Why this specific encounter?  Will this occur if any of the patients' encounters have this condition?
Thank you
Ralph Rostock

Sukesh Konjeti (Oracle Cerner)

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Mar 21, 2023, 11:09:02 PM3/21/23
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Hi Rostock,

1. If ENCNTR_TYPE_CLASS_CD is 0.0 then it will be considered as an invalid encounter by concept service team. And they also mentioned if we update the encounter in "add/modify encounter" section with proper encounter type(InPatient/OutPatient) then both ENCNTR_TYPE_CD,ENCNTR_TYPE_CLASS_CD will get updated to some appropriate values in the database and then we can expect 200 response from them.
2. For the concept service api request for any patient, fetches all the encounter(s) data (in a batch of 10 if no encounter count passed in request parameters). For ex say out of 10 if one encounter has missing encntr_type_class_cd it will skip such records, logs them as invalid encounter and continue to fetch others.After all valid encounters are retrieved, a validation check is performed on these encounters.Check if all encounters data are received (in our example it is 10 encounters data requested but received back data for only 9 encounters, as one was invalid).
If there's a mismatch on the requested encounters number vs the valid encounters number retrieved, they are throwing a HttpException 404.
There is an ongoing ticket logged for this issue, discussions are going on to remove this check and just send all the valid encounters related to that patient but they didn't come to any conclusion yet.

Thank You,
Sukesh Konjeti(Oracle Cerner) 

Sukesh Konjeti (Oracle Cerner)

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Mar 24, 2023, 1:37:01 AM3/24/23
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Hello Rostock,

Please post here incase of any further questions/clarifications.


Thank You,
Sukesh Konjeti(Oracle Cerner).

Ralph Rostock

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Mar 24, 2023, 9:45:01 AM3/24/23
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Thanks Sukesh.  We are looking at this from our side.  However, I would say that I don't think the service should fail completely for the patient if any of the encounters have no encounter_type_class_cd.  Hopefully that check that you mentioned does get removed.
Thank you
Ralph

Nimisha Nair (Oracle Cerner)

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Apr 12, 2023, 11:23:58 PM4/12/23
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Hello Ralph,
 Hope you are well. I just wanted to circle back and see if Sukesh's suggestion to update the encounter field has fixed the problem. Please let us know if the problem is still being seen.

Thank You,
Nimisha Nair (Oracle Cerner)

Ralph Rostock

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Apr 13, 2023, 11:19:37 AM4/13/23
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hi Nimisha, Yes, updating the encounter class code for that specific encounter resolved the issue for that patient.   Thank you.
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