Patch patient with same identifier multiple times

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Assigned to mphil...@gmail.com by me

Rui Wang

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Mar 16, 2020, 4:10:02 PM3/16/20
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Hi Team,

It looks like I can call the R4 patch endpoint more than one time. For example, if I'd like to add an identifier, I can call the endpoint a few times with different values.
 However, when I do Patient Search call on the same patient, it will return all the identifier values I have added. 
Here is an example of the patient: X-Request-id is 09f50c48d1597483637612862b08beb6. The search result is showing multiple identifier with oid: urn:oid:1.1.1.1.1.1.

Is there a way to tell which one is the most recent value for this identifier from the search result?

Thanks,
Rui

Max Philips (Cerner)

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Mar 16, 2020, 4:19:56 PM3/16/20
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Hello Rui,

Cerner's Patient identifier patch operation is an add operation (not a replace): https://fhir.cerner.com/millennium/r4/individuals/patient/#patch-operations. This means that calling it multiple times results in adding multiple values. What you are describing is the expected behavior.

When you execute a patch operation for Patient identifier, you provide an operation value. In the operation value, you can set Identifier.period: http://hl7.org/fhir/R4/datatypes-definitions.html#Identifier.period. You should use the identifier period to determine which of the identifiers is the most recent.

Thanks,
Max (Cerner)

Rui Wang

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Mar 26, 2020, 1:33:05 PM3/26/20
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Hi Max,

I have one more question related to the patch endpoint so I'm reopening this thread.

We will need to send in an identifier from our system using the patch endpoint to Cerner patient so Cerner can store it for future uses.
The question is do you know what level will the identifier be stored in Cerner once it gets added?
Is it going to be Enterprise level, organization level or facility level?

Thanks,
Rui

Max Philips (Cerner)

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Mar 26, 2020, 1:43:13 PM3/26/20
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Hi Rui,

When you issue a Patient PATCH request to Cerner's FHIR server, the EHR source id in your request URL dictates the level the data is stored at.


The identifier PATCH operation included in that request adds an identifier to patient 5786010 in EHR source 0b8a0111-e8e6-4c26-a91c-5069cbc6b1ca (Cerner's sandbox environment). In a different EHR source, a patient with id 5786010 might exist, but that patient will not receive a new identifier.

EHR sources almost always align with client domains.

Thanks,
Max (Cerner)

Rui Wang

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Mar 26, 2020, 4:01:11 PM3/26/20
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Thanks Mark!
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