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Primary care EMR locations

What is a "location"

In this context (primary care EMR data), in simple terms, a "location" is one of several real world locations that leverage a primary care EMR.

FHIR says: "A Location includes both incidental locations (a place which is used for healthcare without prior designation or authorization) and dedicated, formally appointed locations. Locations may be private, public, mobile or fixed and scale from small freezers to full hospital buildings or parking garages." Also" The Location is intended to describe the more physical structures managed/operated by an organization, whereas the Organization is intended to represent the more conceptual hierarchies, such as a ward. Location may also be used to represent virtual locations, for example for telehealth visits. As noted in the Event pattern, a Location represents where a service is performed. An Organization can represent who performed the service." This is all relevant here.

Things worth knowing about legacy EMR locations (the source data)

  • different primary care EMRs have radically different models of locations. Some EMRs have two or more mechanisms to set them up.
  • THe ability for one location to see the data from another location varies widely.
  • The ability to assign patients, providers, and other clinical data varies widely.
  • EMR provincial conformance programs have made this slightly better, but not much.

Nexus EMR Location Requirements

Mandatory Location Creation

Every EMR instance MUST create at least one Location resource, even if the EMR doesn't explicitly use a location/site concept internally. This requirement exists for two critical reasons:

  1. Downstream Consumer Simplification: Having a guaranteed Location resource makes it significantly easier for downstream consumers to process FHIR data. They can always assume at least one Location exists, simplifying their logic and reducing edge cases.

  2. Appointment Requirement: The NexusEmrCoreAppointment profile requires a Location as a mandatory participant. Without this guarantee, appointments from single-site clinics would fail validation.

Implementation Guidelines

For Multi-Site EMRs

EMRs that already have a location/site concept should map each location to a corresponding NexusEmrCoreLocation resource.

For Single-Site EMRs

EMRs that don't use locations internally should create a single "default" Location resource that represents the main clinical site. This Location should:

  • Have a meaningful name (e.g., the clinic name)
  • Include the physical address if available
  • Be referenced by all appointments and other resources that require location context

Location as Participant in Appointments

The NexusEmrCoreAppointment profile enforces that every appointment MUST have exactly one Location participant. This ensures:

  • Clear identification of where the appointment takes/took place
  • Consistency across all EMR implementations
  • Support for location-based reporting and analytics

The participant slicing in appointments is configured as:

  • Location: 1..1 (exactly one required)
  • Patient: 0..* (zero or more)
  • PractitionerRole: 0..* (zero or more)

This design ensures that regardless of the EMR's internal model, every appointment in the Nexus EMR ecosystem has a clear location context.