Getting resources (conditions, medication orders, observations) for multiple patients

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ericjust...@gmail.com

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Apr 9, 2019, 12:38:58 PM4/9/19
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Hello,

I'm building out a feature for our app that allows practitioners to search across a group of patients by a condition, medication, or observation code (i.e. SNOMED, RxNorm, LOINC, etc).

As far as I can tell, there wouldn't be a way to do this with a single FHIR request.  A Patient or Subject reference is always required for these resources which codes are attached to (https://fhir.cerner.com/millennium/dstu2/diagnostic/observation/).  Ideally we would like the following type of query to be available that just specifies the code but doesn't specify the patient:

GET /Observation?code=http://loinc.org|3094-0,http://loinc.org|3139-3

Understandably, this might produce a large number of results, but I know Cerner can provide paginated results which we would be happy with.  We could also limit the results to a certain date range.

The alternative solution we're considering is to get and insert each patient/code combination into our own tablespace and to make searches against that.  We've experimented with bulk importing all observation/med/condition codes for a group of patients and found that these resources only support querying for one patient at a time.  I just want to confirm that Cerner does not support getting these resources across multiple patients, such as the following:

GET /Observation?patient=1316024,823429,3425673

Does Cerner have any plans to support either of these types of searches (either unspecified patient w/ codes or multi-patient search)?  If not, would Cerner suggest investigating another form of importing bulk patient data (i.e. exported CCDAs) instead of planning to make a large number of requests for FHIR resources to get each patient's data individually?  If we schedule a large import of data for many patients, I'm afraid that the 1000's of requests to a FHIR endpoint may get us rate throttled.

Thanks!
-Eric

Benjamin Eichhorn (Cerner)

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Apr 9, 2019, 4:20:40 PM4/9/19
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Hi Eric,

We do not currently support querying for resources using multiple Patients for any resources (excluding the Patient resource) at this time. Unfortunately, we do not comment on public timelines or our development roadmap within this group either.

Thanks,
Ben (Cerner)

ericjust...@gmail.com

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Apr 9, 2019, 5:03:59 PM4/9/19
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Hi Ben,

Can you speak at all on rate limiting of requests?

Is there a max number of requests you accept from an IP per minute on a FHIR endpoint?

Max Philips (Cerner)

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Apr 9, 2019, 5:44:03 PM4/9/19
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Hi Eric,

We do monitor traffic coming into the server and various criteria may influence the current rate limit for a particular client. Unfortunately I don't have many specific details to share beyond that.

If you are interested in bulk data, you may want to take a look at the Bulk Data FHIR Connectathon track which Cerner has participated in. Functionality that we have worked on for the Bulk Data use case is not currently available in our public sandbox as we are still testing it out via the FHIR Connectathons. Here's a link to the track summary from Connectathon 20: http://wiki.hl7.org/index.php?title=201901_Bulk_Data

Your concerns are well-founded by my judgment - loading all Observations for thousands of Patients is quite a large chunk of data.

Thanks,
Max (Cerner)

Thomas Kuklenski

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May 23, 2019, 11:29:09 AM5/23/19
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Hi Max,

Is there any idea about a timeline for Bulk FHIR integration into the Cerner Ignite API and connectivity into Millennium?

thanks
thomas

Max Philips (Cerner)

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May 23, 2019, 11:46:36 AM5/23/19
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Hi Thomas,

Per group guidelines, we will not comment on any future timelines.

Thanks,
Max (Cerner)
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