Querying by MRN (identifier) when system: isn't there? Is that possible? (DSTU2 Sandbox)

[Manabu Tokunaga]

This is the famous SMART^JEREMY^CERNER patient in the sandbox. 

I do see that I can query for this person by Identifier where the system: attribute is available for example,

{{baseUrl}}/Patient?identifier=urn:oid:2.16.840.1.113883.3.13.6|URN:CERNER:IDENTITY-FEDERATION:REALM:2E882EFF-FA72-4882-ADC8-A685F7D2BFA6:PRINCIPAL:XY1234

But the very first entry does not have the system: so there is no real way to query for this patient's MRN by the MRN code of 230 or 00000230.

A few questions about this;

1. Why this specific one is this way? Is this more of an error? Is this specific to this dataset?
2. Will I encounter this on a live Cerner Millennium instance? What I am most afraid of is that when we go live the MRN they use most commonly is the one without system:. Right now, I cannot locate this patient by 00000230 or 230.
3. Will there be another way to query for this if the clinical user only knows this patient by 00000230?

Thank you in advance.   Manabu Tokunaga

    "entry": [

        {

            "fullUrl": "https://fhir-open.sandboxcerner.com/dstu2/0b8a0111-e8e6-4c26-a91c-5069cbc6b1ca/Patient/687923",

            "resource": {

                "resourceType": "Patient",

                "id": "687923",

                "meta": {

                    "versionId": "8",

                    "lastUpdated": "2018-10-17T15:05:08.000Z"

                },

                "text": {

                    "status": "generated",

                    "div": "<div><p><b>Patient</b></p><p><b>Name</b>: SMART, JEREMY CERNER</p><p><b>DOB</b>: Sep  9, 1975</p><p><b>Administrative Gender</b>: Male</p><p><b>Marital Status</b>: Single</p><p><b>Status</b>: Active</p></div>"

                },

                "identifier": [

                    {

                        "use": "usual",

                        "type": {

                            "coding": [

                                {

                                    "system": "http://hl7.org/fhir/v2/0203",

                                    "code": "MR",

                                    "display": "Medical record number",

                                    "userSelected": false

                                }

                            ],

                            "text": "MRN"

                        },

                        "value": "230",

                        "_value": {

                            "extension": [

                                {

                                    "url": "http://hl7.org/fhir/StructureDefinition/rendered-value",

                                    "valueString": "00000230"

                                }

                            ]

                        },

                        "period": {

                            "start": "2004-09-08T19:32:31.000Z"

                        }

                    },

                    {

                        "use": "usual",

                        "type": {

                            "coding": [

                                {

                                    "system": "http://hl7.org/fhir/v2/0203",

                                    "code": "AN",

                                    "display": "Account number",

                                    "userSelected": false

                                }

                            ],

                            "text": "Federated Person Principal"

                        },

                        "system": "urn:oid:2.16.840.1.113883.3.13.6",

                        "value": "URN:CERNER:IDENTITY-FEDERATION:REALM:2E882EFF-FA72-4882-ADC8-A685F7D2BFA6:PRINCIPAL:XY1234",

                        "_value": {

                            "extension": [

                                {

                                    "url": "http://hl7.org/fhir/StructureDefinition/rendered-value",

                                    "valueString": "URN:CERNER:IDENTITY-FEDERATION:REALM:2E882EFF-FA72-4882-ADC8-A685F7D2BFA6:PRINCIPAL:XY1234"

                                }

                            ]

                        }

                    }

                ],

[Benjamin Eichhorn (Cerner)]

Hi,

The reason that the mentioned MRN number does not contain a system is because, in Millennium, this specific MRN hasn't been mapped or associated. Specifically in regards to the system not getting returned, for an identifier, these are client defined. You may encounter this in a client domain since this is client defined. However, based upon my experience, it is easy to fix and clients will generally map it accordingly. No, the system must be given to search by an identifier. From a general perspective when an application has specific requirements (such as needing to search by MRN) upon on-boarding that app into a clients domain, we do ensure that these specific requirements have been met and we gather these requirements beforehand. 

Thanks,

Ben (Cerner)

[Manabu Tokunaga]

Hello Ben,

Thank for all these clarifications. For the time and probably for a long time, our requirement is to find the MRN that was registered at the hospital on Millenium, so I presume there will be "system:" for all of  their MRN.

A few other search modes I will likely need.

* By FIN

* By Imaging Order Accession Number

So I might have a few questions when I get there (not yet).

Thanks again (I will be at the FHIR training next week).

Manabu Tokunaga (ZenSnapMD/WinguMD)

[Jenni Syed (Cerner)]

Hi Manabu,

Just for clarity: FIN is an Encounter.identifier. We don't currently expose this as a search parameter on Encounter. The Accession Number would be an ProcedureRequest.identifier (we don't expose this right now).

Regards,

Jenni

[Manabu Tokunaga]

Hi Jenni,

Thank you for the clarification. Just for sharing (not a request)... I have long been on radiology PACS side and as you know I have been immersed in "What the MRN" and "What's the Accession" world. Now I am crossing the bridge as we are doing some Encounger Based Mobile Imaging Workflow, and our customer (Cerner site, of course) seems to be more interested in FIN. And this appears to be also true for another Cerner site. I think FIN based search will probably become important as more Point of Care data acquisition starting to gain momentum. 

In the interim the FHIR records will have what I need in the Encouners and Orders so I think I will have to catch those in a document DB on our side (likely Mongo) and do the search internally. 

There are so many good tools out there now that I have been having some smooth sail to get to where I need. Thanks to the sandbox. I am using it a lot!