Error in FHIR Patient resource?

Andries_Hamster · September 22, 2023, 7:36pm

Situation
Using the FHIR API to retrieve patient records. When inspecting the response the patient.identifier array seems off.

“identifier”: [
{
“use”: “official”,
“type”: {
“coding”: [
{
“system”: “http://terminology.hl7.org/CodeSystem/v2-0203”,
“code”: “PT”
}
]
},
“system”: “http://terminology.hl7.org/CodeSystem/v2-0203”,
“value”: “1”
}
],

I believe that “system”: “http://terminology.hl7.org/CodeSystem/v2-0203” should reference the “assigning authority” (or patient identifier domain) that issues this patient identifier. Since it is coded as “PT” (external patient identifier) it should state systems such as as the “S.S.” identifier (which has system = http://hl7.org/fhir/sid/us-ssn)

Possible solution would be to use the OID linked to the facility that created this patient record.

OpenEMR Version
7.0.1-dev

Browser:
I’m using: none (using Postman)

Operating System
I’m using: Mac Os Ventura

Search
Yes

Logs
No

adunsulag · September 22, 2023, 8:06pm

If there is a SSN populated it shows up in the response. @see here:

github.com

openemr/openemr/blob/2415f81f85a95c6697e24d37929b87935448e526/src/Services/FHIR/FhirPatientService.php#L415

      
        
            private function parseOpenEMRSocialSecurityRecord(FHIRPatient $patientResource, $ssn)
            {
                // Not sure what to do here but this is on the 2021 HL7 US Core page about SSN
                // * The Patient’s Social Security Numbers SHOULD NOT be used as a patient identifier in Patient.identifier.value.
                // There is increasing concern over the use of Social Security Numbers in healthcare due to the risk of identity
                // theft and related issues. Many payers and providers have actively purged them from their systems and
                // filter them out of incoming data.
                // @see http://hl7.org/fhir/us/core/2021Jan/StructureDefinition-us-core-patient.html#FHIR-27731
                if (!empty($ssn)) {
                    $patientResource->addIdentifier(
                        $this->createIdentifier(
                            'official',
                            'http://terminology.hl7.org/CodeSystem/v2-0203',
                            'SS',
                            'http://hl7.org/fhir/sid/us-ssn',
                            $ssn
                        )
                    );
                }
            }

The response you are seeing is where someone specifies a value for the pubpid which people usually use as the MRN of the local practice.

Andries_Hamster · September 22, 2023, 8:21pm

The latter is what I thought as well. So if the pubpid = the local MRN I would expect the FHIR response to be something like:

“identifier”: [
{
“use”: “official”,
“type”: {
“coding”: [
{
“system”: “http://terminology.hl7.org/CodeSystem/v2-0203”,
“code”: “SS”
}
]
},
“system”: “http://hl7.org/fhir/sid/us-ssn”,
“value”: “12345”
},
{
“use”: “official”,
“type”: {
“coding”: [
{
“system”: “http://terminology.hl7.org/CodeSystem/v2-0203”,
“code”: “PT”
}
]
},
“system”: “urn:oid:1.20.300.4000.500.60.7”,
“value”: “192”
}
],

In the above snippet the ssn|12345 is the identifier I entered in the S.S. field in the patient demographics window. 192 is the number I entered for External ID. The urn:oid value I entered in the configuration under Admin | Clinic |Facilities | → OID field.

I furthermore would expect that the patient’s License/ID number is also added to the patient.identifier array (if know). I assume this is the patient’s driver license id. As the issue state doesn’t seem to be captured the following identifier seem reasonable.

{
“use”: “official”,
“type”: {
“coding”: [
{
“system”: “http://terminology.hl7.org/CodeSystem/v2-0203”,
“code”: “DL”
}
]
},
“system”: “urn:oid:2.16.840.1.113883.4.3”,
“value”: “123456789”
}

Obviously when SSN and Driver License are not filled in they are not included in the identifier array.

adunsulag · September 22, 2023, 8:45pm

Since patients can attend multiple facilities in the same EMR installation, I’m guessing you’d want to use the primary business facility’s oid. As I mentioned in another post, feel free to open a feature request issue to request this change in the FHIR api.