Cerner's SMART on FHIR support

[Josh Mouch]

There seems to be some inconsistencies when comparing the profiles defined by SMART on FHIR and when testing Cerner's FHIR sandbox.  Here are a few of them I've found so far.

1. Some conditions use ICD9 instead of SNOMED. (SMART requires SNOMED)
2. Smart defines a profile for MedicationOrder and MedicationDispense, but the Cerner FHIR documentation shows MedicationOrder and MedicationStatement.
3. Not all Medication contain a code. (SMART profile requires one)
4. Missing FamilyMemberHistory (defined as required by Smart profile)
   
5. Missing Procedures (defined as required by SMART profile)

[Kevin Shekleton]

Hi Josh!

As you've already noticed, we haven't implemented the SMART profiles. To my knowledge, the SMART profiles have not been implemented by any EHR vendor. In all of the conversations I'm in with those implementing SMART, the SMART profiles also have not come up. To be clear, FHIR profiles are essential to easy interoperability of SMART applications. However, the recent work in both Argonaut and DAF have shifted the profile work to those groups rather than SMART. From the SMART profile documentation:

"Our aim is to work with the broader community, including the Argonaut Project and the Data Access Framework to converge on a set of profiles that are specific and broadly applicable."

Once these groups (Cerner is a founding member of the Argonaut project) publish a converged set of profiles, Cerner will support this and I imagine SMART will likely reference those (at least for the US market).

The SMART profiles today are a great starting point but aren't completely fleshed out either. For instance, in the example you called out where Condition is defined as being from the SNOMED system but sometimes we're returning you a SNOMED from IC9, that is actually the correct behavior. If a Condition doesn't have a mapping in SNOMED (either because it wasn't mapped properly or there isn't an SNOMED code for this), it should still be returned with whatever code system it happens to have. This is to ensure that applications aren't missing any data.

Let me know if I can help fill in the details with anything else.

Best,

Kevin

[Josh Mouch]

Kevin,

Thanks for the detailed reply; it is very helpful.  There's information somewhere on their website hinting that their profiles are being used by the top 5 EHR vendors and that's obviously no longer correct. :)

So after browsing through the Argonaut profiles, I'm missing the following three sets of data that is not yet defined there (and is also, therefore, not in your Cerner FHIR API).  Are there plans to add these to the API in the near future?

Family History Conditions

Historical Procedures

Drinking status (Observation)

And as a long-shot: is the ProcedureRequest FHIR resource on the Cerner road map?

[Kevin Shekleton]

Josh,

Can you point me to the place on the SMART website where it hints at the top 5 EHR vendors using the SMART profiles? The developer documentation portion of the SMART website is open source so if you can point me to this mistake, I'll submit a pull request back to them. :-)

As for the three data elements you don't see in the Argonaut profile, I'd suggest you direct this question over to the Argonaut Project mailing list. As an aside, instead of drinking status, did you mean smoking status?

Regarding your question on ProcedureRequest, unfortunately we don't comment on any roadmap plans. Our roadmap is very fluid and is based upon a variety of factors and we don't want to set any incorrect expectations.

Best,

Kevin