FHIR Patient.Create, Patient.Search API questions

[Rui Wang]

Hi,

I have a few questions regarding the FHIR API for patient create and search. The API I'm referring to are http://fhir.cerner.com/millennium/dstu2/individuals/patient/#.

1. During my testing with the search patient API, I found that the identifier array could return more than one MRNs. Can you confirm if the system OID field (urn:oid:1.1.1.1.1.1) is the value we should be using to identify MRN for the sandbox environment? Will the oid value change per customer? (See attached for an example I saw in the sandbox where urn:oid:1.1.1.1.1.1 and urn:oid:2.2.2.2.2.2 are present and their type are both MRN )

2. Is it guaranteed that after I call the create patient API, the MRN will always be created so I will be able to retrieve it in a following read patient call?
3. The create Patient API requires reference id in the identifier field.  Is Organization/619848 what we can use for the sandbox but when it comes to actual site, they will have to provide their organization ids?  

"identifier": [

    {
      "assigner": {
        "reference": "Organization/619848"
      }
 
Thanks in advance! 
Rui

[Benjamin Eichhorn (Cerner)]

Hi Rui,

The OID value in our sandbox is an example. OIDs are going to be unique per client site, and you will need to account for that. An MRN is not guaranteed to be created when the patient is created. You can use that Organization ID for our sandbox environment, but that ID is unique only within our sandbox environment. Those IDs will change as you go to separate client domains so you will need to get the appropriate org IDs from the client.

Thanks,

Ben (Cerner)

[Rui Wang]

Hi Ben,

Thanks for the information.
Just to confirm, should I use urn:oid:1.1.1.1.1.1 to match on MRN for sandbox environment? 
Also, if it's not guaranteed that the MRN will be created when patient is created, will it be created most of the time? Or is there another call I can perform to get the newly created patient MRN? 

Thanks.

Rui

[Benjamin Eichhorn (Cerner)]

Hi Rui,

Yes, you can use that OID for our sandbox environment. Most of the time MRNs will be created, but there are cases where they are not. This is a client configuration so if a client for whatever reason doesn't want MRNs to be created, they won't be. The Patient resource is the only resource at this time that returns MRNs.

Thanks,

Ben (Cerner)

[Rui Wang]

Thanks for the confirmation!

On Monday, November 11, 2019 at 5:10:09 PM UTC-5, Benjamin Eichhorn (Cerner) wrote:

Hi Rui,

Yes, you can use that OID for our sandbox environment. Most of the time MRNs will be created, but there are cases where they are not. This is a client configuration so if a client for whatever reason doesn't want MRNs to be created, they won't be. The Patient resource is the only resource at this time that returns MRN numbers.

Thanks,

Ben (Cerner)

[Rui Wang]

Hi Ben,

I think this might be a question that should go to this topic:

Once we created a patient via patient create endpoint, do you know if the generated MRN for that patient is organization level or facility level? 

Thanks,

Rui

[Benjamin Eichhorn (Cerner)]

Hi Rui,

The MRN number generated will vary in terms of if it is at the organization or facility level depending upon client configuration.

Thanks,

Ben (Cerner)

[Rui Wang]

Hi Ben,

I have a follow up question on the MRN numbers.
The searching results returned Patient Search endpoint,  is it possible that multiple MRNs will be returned?
For example, a patient could have a MRN number assigned by location A, and may have another MRN number assigned by location B, Will they both be returned and each of them has a unique system oid value ?

Thanks,
Rui

[Benjamin Eichhorn (Cerner)]

Apologies for the delayed response.

It is possible multiple MRN numbers are returned, again, this will depend upon how the client has built out their configuration. If a domain has been configured to do so, they can generate multiple MRNs for a patient for each location or hospital they visit. If a client has configured this, then the OIDs should be different.

Thanks,

Ben (Cerner)

[Rui Wang]

Ben,

You also mentioned whether MRN is organization level or facility level is also depending on client configuration earlier.
Can I assume if a client has configured MRN to be organization level, then there will be only one MRN in the searching result. 
If client has configured MRN to be facility level, then there will be multiple MRN present for each facility. 
And the Org id in the create patient request is always supposed to be an organization level value.

Are these assumptions correct?
Thanks,

Rui

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[Benjamin Eichhorn (Cerner)]

Hi Rui,

If you're working with a specific client, you can work with them to try and determine their configuration to make assumptions. But MRNs in general, are incredibly configurable by clients and you unfortunately can't make assumptions such as that. The FHIR spec, and our implementation of it, allows multiple MRNs to be returned, and they could be from within the current hospital system, but they could also be from an entirely different system. You unfortunately can't assume that only one MRN is returned or that multiple MRNs are return given specific configurations.

Thanks,

Ben (Cerner)

[Rui Wang]

Hi Ben,

Thanks for the explanation. That's really helpful. 

Rui