Storing Clinical Notes (DocumentReference Resource) from a third-party app

[Pangratios Cosma]

Hello,

We have a web application that we want to integrate with Cerner code.

Our users (registered nurses) call patients and provide care services through telephone.

They document their calls in our system (by completing a form). We call these "notes".

Our goal is to have these notes saved into Cerner EHR without our users having to access Cerner EHR.

In order to do that, we would need to:

• Create/Register a Smart on FHIR app on Cerner. I assume that it would be a System app.
• Use FHIR Api to create a DocumentReference resource:
  
  • The author field is optional for System app type. Does this mean that we can skip the field entirely, or pass a default value (i.e. null)?
  • The context.encounter field appears to be optional. What are the implications of having an encounter reference set versus not having one?
• If we decide that we want to set an encounter reference, then we'd have to issue a FHIR Api call to create an encounter and then use that encounter to create a DocumentReference. The following questions relate to the creation of an Encounter resource:
  
  • status and class fields: What status codes are acceptable?
  • Is there a field we could set that would specify that this was a telephone encounter?
• In the FAQ page, it says that it takes 10-14 weeks for the review process before an app is listed on the App Gallery. Is it really that long? Is there any way we can speed up this process for an app such as the above?
• After the app is listed on the App Gallery, what is the process of getting an app installed to a Cerner client? Are there instructions outlined somewhere that we can take a look at?

Thanks!

[Fenil Desani (Cerner)]

Hello,

• Create/Register a Smart on FHIR app on Cerner. I assume that it would be a System app.

• Use FHIR Api to create a DocumentReference resource:
  

• • The author field is optional for System app type. Does this mean that we can skip the field entirely, or pass a default value (i.e. null)? - Optional fields can be left out from the POST body. Or you can work with the Health System to create an user on your behalf and that user can be used.
  • The context.encounter field appears to be optional. What are the implications of having an encounter reference set versus not having one? - If the document is posted without Encounter it would be stored as a patient level document.

• If we decide that we want to set an encounter reference, then we'd have to issue a FHIR Api call to create an encounter and then use that encounter to create a DocumentReference. The following questions relate to the creation of an Encounter resource:
  

• • status and class fields: What status codes are acceptable? Status can be ''in-progress', 'finished', 'arrived'., etc.  The type of Encounter can be in-patient, outpatient,  Recurring, etc. The values may differ for each Health Systems based on their build.
  • Is there a field we could set that would specify that this was a telephone encounter? - Maybe possible if Health System has/builds such a type of Encounter.
• In the FAQ page, it says that it takes 10-14 weeks for the review process before an app is listed on the App Gallery. Is it really that long? Is there any way we can speed up this process for an app such as the above? - That is correct. 10-14 weeks is only approximation and includes various stages of Applications Validation and Implementation. This may decrease or increase based on various factors.
• After the app is listed on the App Gallery, what is the process of getting an app installed to a Cerner client? Are there instructions outlined somewhere that we can take a look at? - Those instructions will be provided at the end of your Validation.

[Pangratios Cosma]

Hi,

Thanks for the prompt reply.

That was really helpful!

Best,

Pangratios