Observation Write not allowed

[Sean C]

Hi,

I'm trying to create an Observation but I keep getting an error:

Http response 422   Body:{"resourceType":"OperationOutcome","issue":[{"severity":"error","code":"business-rule","details":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/operation-outcome","code":"MSG_OP_NOT_ALLOWED","display":"operation create not allowed for resource Observation (due to local configuration)"}],"text":"operation create for Observation is not allowed."},"diagnostics":"provider persona is not supported for a vital sign create"}]}

In my authorization, I've passed the required scope with "user/Observation.write" and I have the same setup under "User Scopes" for my app in Cerner Code.

Are there an issues with any of my settings? My x-request-id is:  f8d8d97c-be35-43a7-8644-c5ec48d8b01b

Thanks,

Sean

[Aaron McGinn (Cerner)]

As mentioned in the error message and in our documentation [1], the provider workflow currently only supports creating laboratory Observations.

[1] https://fhir.cerner.com/millennium/r4/diagnostic/observation/#create

-Aaron (Cerner)

[Sean C]

Thanks Aaron, I thought the error was telling me there was an issue in permission that prevents Observation creates. Do you know if there are plans to allow provider vital-sign writes in the future?

Sean

[Sean C]

HI Aaron,

What does it also mean with the error:

Http response 500   Body:{"resourceType":"OperationOutcome","issue":[{"severity":"fatal","code":"exception","details":{"text":"Internal service error from resource store"}}]}

x-request-id: 912204d1-6f3e-4374-94b7-c1d6b7da7ba9

Thank you,

Sean

[Brij Shah (Cerner)]

Hi Sean,

Can you provide us the request body you're sending in?

Thanks

[Sean C]

Hi Brij,

I've create another observation with the same error: This is the request body:

{"resourceType":"Observation","status":"final","category":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/observation-category","code":"laboratory"}]}],"code":{"coding":[{"system":"http://loinc.org","code":"39125-0"}]},"subject":{"reference":"Patient/12463979"},"encounter":{"reference":"Encounter/97703401"},"effectiveDateTime":"2021-01-27T10:58:23-05:00","performer":[{"reference":"Practitioner/607928"}],"valueQuantity":{"value":3.5,"unit":"cm","system":"http://unitsofmeasure.org","code":"cm"}}

This is the response:

Http response 500  Body: {"resourceType":"OperationOutcome","issue":[{"severity":"fatal","code":"exception","details":{"text":"Internal service error from resource store"}}]}

This is the x-request-id: acc53a74-dad7-461f-bf7c-dc6fbc28e6a1

Thanks,

Sean

[Brij Shah (Cerner)]

Hi Sean,

Thanks for that information.

It seems like we don't have that LOINC code (39125-0) in our system, I can get that added. 

Are there any other codes you're targeting?

Thanks,

Brij

[Sean C]

Thank you Brij,

That's good to know, could you add the following LOINC codes?

39127-6

89260-4

39126-8

39125-0

39132-6
39133-4
72300-7
94083-3

As well, do you have an estimated timeline for when the additions will be complete and usable?

Thanks,

Sean

[Brij Shah (Cerner)]

Hi Sean,

I've logged an internal request to get these codes added. At this point, I can not give any timeline on when this will be available to consume but I'll post back here when it is done.

Thanks,

Brij

[Sean C]

Thanks for your help Brij.

Sean

[Louis Leff]

Hi Brij,

As long as you are taking requests our EBMcalc FHIR App could use these LOINC's to write observations:

9264-3

9272-6

9273-4

9274-2

9271-8

9269-2

89547-4

89545-8

89693-6

90660-2

89548-2

90661-0

Best regards and stay safe!

Louis

[Aaron McGinn (Cerner)]

In general, to avoid adding a bunch of mappings that are only used once in the public sandbox, we typically only map a few of each "type" of mapping (i.e. wound on arm, COVID-19 result, blood pressure). If a use-case is encountered that can't be covered by existing mappings, we can help you find something similar to your exact needs.

Louis, as a code partner, I will reach out to your group to determine your needs.

-Aaron (Cerner)

[Louis Leff]

Thanks Aaron!

[Brij Shah (Cerner)]

This work is complete and can be tested now.

Thanks,

Brij

[Louis Leff]

Thanks Brij,

 

We just tried several, and get the 500 server error.

 

X-Request-Id

                9a030281-4c33-46b2-a028-417b80cdafed

For Apache II Score:

 

{"resourceType":"Observation","status":"final","category":[{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/observation-category","code":"laboratory","display":"Laboratory"}],"text":"Laboratory"}],"code":{"coding":[{"system":"http://loinc.org","code":"9264-3","display":"Apache II Score"}],"text":"Apache II Score"},"subject":{"reference":"Patient/12742400"},"effectiveDateTime":"2021-02-12T23:10:48.028Z","valueQuantity":{"value":12,"unit":"score","system":"http://unitsofmeasure.org","code":"score"}}

 

Insights welcome, and have a great, safe weekend!

 

Louis

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[Louis Leff]

Hi Brij,

 

Any follow up on this write issue?

 

Louis

[Aaron McGinn (Cerner)]

Hey Louis, I reached out to you via uCern for your requests.

-Aaron (Cerner)

[Sean C]

Hi Brij,

I sent a Observation create with x-request-id: 35f6a21b-2050-41bb-b73b-9cbb11aedbda

The Observation was written and responded with success, however I see this key-value in the returned Observation json and I'm don't know how to interpret it:

 "category":[

      {

         "extension":[

            {

               "valueCode":"unknown",

               "url":"http://hl7.org/fhir/StructureDefinition/data-absent-reason"

            }

         ]

      }

   ]

Note that I included a "valueQuantity"  in json sent to create the Observation, but I'm not sure what "data-absent-reason" means.

As well, I also see a repeat of the LOINC system and code (39126-8) in the code.coding object:

   "code":{

      "coding":[

         {

            "system":"https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/72",

            "code":"704005",

            "display":"Incision/Wound Length",

            "userSelected":true

         },

         {

            "system":"http://loinc.org",

            "code":"39126-8"

         },

         {

            "system":"http://loinc.org",

            "code":"39126-8"

         }

      ],

      "text":"Incision/Wound Length"

   },

Is this expected?

Thanks,

Sean

[Brij Shah (Cerner)]

Hi Sean,

It is possible that the code you're sending in doesn't have a category mapped in our system. Please refer to our documentation for data absent reason.

[1] https://fhir.cerner.com/millennium/r4/diagnostic/observation/#overview

[Sean C]

Hi Brij,

The Observation I sent to be created does not have any Observation.category.extension value set. In the documentation, there is only info for Observation.dataAbsentReason and Observation.component.dataAbsentReason, and the value that I sent with unit "cm" came back without any errors.

Do you have any other information on this? Can this be ignored?

Thanks,

Sean

[Sean C]

Hi,

I'm testing the LOINC codes, but when I send an Observation with code 89260-4,  I am still getting the following response:

Http response 500   Body:{"resourceType":"OperationOutcome","issue":[{"severity":"fatal","code":"exception","details":{"text":"Internal service error from resource store"}}]}

Are all the LOINC code above now supported, or will there only be subset available?

x-request-id: 22b047c1-9a46-4c45-a812-a1af7de94fb7

Thanks,

Sean

[Brij Shah (Cerner)]

Hi Sean,

Apologies for the delay to respond.

The data absent reason response you're seeing it seems to be for "category" field. I believe you should still be able to see "valueQuantity" on the response you provided on POST request.

The duplicate loincs on response is currently a known issue on our server. However, we currently do not have any timeline for when it would be fixed.

The loincs which we currently can not support on our public domains are 89260-4, 39133-4, and 94083-3. The rest of the loincs you provided should work now.

Thanks,

Brij

[Sean C]

Hi Brij,

Yes the valueQuantity is there and the all the information is as expected, however still I can't see what is the issue with the Observation.category sent, which is :

   "category":[

      {

         "coding":[

            {

               "system":"http://terminology.hl7.org/CodeSystem/observation-category",

               "code":"laboratory"

            }

         ]

      }

   ],

I believe this is the only valid system and code for provider apps and thus I'm not sure why there is a data-absent-reason. Is there a reason why this would not work?

Thanks,

Sean

[Brij Shah (Cerner)]

The category is mapped against the loinc code you're providing while creating data. It is possible that the public domain does not have those codes mapped. 

You might want to add logic on your end to handle data absent reason for the category as it is possible that you come across this scenario again.

Thanks,

Brij

[Sean C]

Just want to be sure I understand the situation. The LOINC codes that I provided are now supported in the public sandbox after your team entered them into the system, however them have not been mapped to the category and that I have to be aware that this may occur in the future.

Is this right?

Thanks,

Sean

[Brij Shah (Cerner)]

That is correct.

[Sean C]

Hi Brij,

I've tried creating Observations with codes "39126-8", "39125-0", "39127-6", "72300-7" and I am again receiving this error:

Http response 500   Body:{"resourceType":"OperationOutcome","issue":[{"severity":"fatal","code":"exception","details":{"text":"Internal service error from resource store"}}]}

Have these codes been removed again?

Thank you,

Sean

[Brij Shah (Cerner)]

Hi Sean,

I see that those codes are still in our system. 

Can you share x-request-id you get back on the response header for this failure? Also, if it is possible can you also share the request body JSON you're sending in?

Thanks,

Brij

[Sean C]

Hi Brij,

It's really strange, since everything is working again today. Did something get reset in the sandbox yesterday afternoon?

I no longer have x-request-ids for those errors, but I will record them if it happens again.

Sean

[Brij Shah (Cerner)]

Thanks for the feedback.

It could be an intermittent issue if you face failures again do let us know.

Thanks,

Brij