Sandbox Patients Family History

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Nick Stocchero

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Jul 22, 2018, 5:53:08 PM7/22/18
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Hello

There is a list of patients inside the sandbox provided here

Let's investigate SMART Nancy as an example. The document says her father Steve had a heart attack at 78, and had high blood pressure. I am looking to consume that information through FHIR. 

I've searched her patient through RelatedPerson, but it only shows her husband. I know that FamilyMemberHistory is disabled (per previous discussions). I also tried looking at Observation and DocumentReference, and I cannot find anything that has reference to Steve, Blood Pressure, or a Heart Attack.

My question is....where is the appropriate place to consume that information through FHIR?

Thanks!


Nick Stocchero

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Jul 24, 2018, 12:17:51 PM7/24/18
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Hi there - Would anyone from Cerner be able to weigh in here?

Max Philips (Cerner)

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Jul 24, 2018, 1:08:59 PM7/24/18
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Hi,

The information noted in the document about Steve, his heart attack, and his high blood pressure would all fall under FamilyMemberHistory. This information will not return on any search driving off Nancy's id currently.

To find this information you would need to search using Steve's id - you could find his id by performing a Patient search by name.

I just double checked what data Steve has staged and it looks like he is not built out, so unfortunately you will not be able to view his specific heart attack or high BP as noted in the patient guide, but this is the general process you'd have to follow to track stuff like this down.

Please let me know if this addresses your question.

Thanks,
Max (Cerner)

Nick Stocchero

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Jul 24, 2018, 1:24:08 PM7/24/18
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OK - that makes sense in the sandbox, but doesn't seem like a viable option for an actual application. But, I guess that's what we have to work with.

Nick

Max Philips (Cerner)

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Jul 24, 2018, 1:30:43 PM7/24/18
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In a production environment it is also likely that there would be more RelatedPerson entries as a simpler way to grab the patient id of a father.

If you wanted to consume a FHIR response by first looking for a RelatedPerson, then falling back to a Patient search by name, that might allow you to test against multiple FHIR implementations.

Thanks,
Max (Cerner)

Jenni Syed (Cerner)

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Jul 24, 2018, 1:39:06 PM7/24/18
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Hi Nick,

In the absence of FamilyMemberHistory, there's not a great way to do this for a production use case. It's not guaranteed in a production environment that the RelatedPerson will link to the actual patient record (it links to a Person record, not Patient). Similarly, the patient search isn't an EMPI search - and the related person's record may not even be present in this system (parents and children don't often go to the same doctor, and may not go to doctors in the same system).

You also start treading into the murky waters of both trying to be very "smart" about healthcare and where the privacy line is drawn - it's possible a child isn't aware of (nor has access to) the records of their parent. Their doctor may also not have access to this data.

Regards,
~ Jenni


Nick Stocchero

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Jul 24, 2018, 2:34:53 PM7/24/18
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Understood - I know you can't comment on roadmap, but my suggestion would be to consider supporting the FamilyMemberHistory resource in the future (elementary patient-reported family member history). I'm positive it's collected in Cerner, and it's supported by the Epic FHIR endpoints. It would make a pretty big difference in any FHIR applications performing clinical decision support.

Anyways, thank you for your responses and assistance - you've all been very helpful!

Nick

Rob Rucker

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Mar 24, 2020, 1:51:15 PM3/24/20
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Hi group! Would it be possible to get the patient's family history through the CCD returned by the DocumentReference resource? Does Cerner support that section in its CCDs?

-Rob Rucker
Moxe Health

Kathy Pickering (Cerner)

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Mar 24, 2020, 5:58:40 PM3/24/20
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Rob - We do not currently support returning Family History in the CCD.

-  Kathy
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