Demo - The specification is a demo of MERT. For a full list of available versions, see the Directory of published versions

Scope

1. Overview

This section defines the functional and technical boundaries of the MERT specification.

MERT defines a FHIR R4–based approach for transferring complete patient charts between hosted EMR systems. The scope is intentionally focused on clinically relevant patient data required to support continuity of care when a patient changes providers or organizations.

MERT is strictly patient-level in scope. It does not support bulk organizational migration or non-patient-specific data exchange.

2. In-Scope Exchange Model

MERT supports:

Transfer of one or more selected patient charts.
Transaction-scoped, pull-based retrieval using FHIR RESTful endpoints.
Authorization-scoped data access based on the exporting user’s permissions.
Creation of a new chart or logically isolated record set in the receiving system.

MERT does not support:

Bulk practice-level export.
Full database migration.
Administrative system configuration transfer.
Snapshot-based archival exchange (in this release).

3. In-Scope FHIR Resources

The following FHIR R4 resources are in scope for MERT exchange:

Patient
Practitioner
Organization
Composition (Clinical Notes / Letters)
Observation (e.g., vitals, lab results, social history elements)
Condition
AllergyIntolerance
MedicationRequest
MedicationStatement
Immunization
Procedure
DocumentReference
Appointment
Task
ServiceRequest

These resources represent clinically relevant information that can be reliably exchanged between heterogeneous EMR systems.

Profiles and specific constraints for each resource are defined in the Profiles section.

4. Out-of-Scope FHIR Resources

The following resources and data domains are explicitly out of scope for this release:

Encounter
Many EMR systems do not consistently model structured Encounter resources. Where needed, downstream systems MAY reconstruct Encounter records using available appointment and clinical documentation data.
CarePlan
Due to modeling complexity and inconsistent implementation across EMRs.
Billing and Administrative Claims Data
Billing information is considered administrative and outside the clinical exchange focus of MERT.
Antenatal Record Structured Mapping
Jurisdictional variability makes standardized field-level mapping impractical in this release.
Unfiled Faxes and Unlinked Documents
Only documents already associated with a patient chart are in scope.
EMR Configuration Settings and Templates
System-specific configuration artifacts are excluded.

Additional resource types not explicitly listed as in-scope are considered out of scope unless defined in a future release.

5. Patient-Centric Boundaries

MERT is designed exclusively for patient chart portability.

Each TransactionID SHALL be associated with one or more specific Patient resources.

MERT does not define:

Practice-wide migration workflows.
Multi-tenant system exports.
Organizational master data synchronization.

All resources exchanged MUST be directly or indirectly associated with a Patient within the transaction scope.

6. Privacy and Authorization Boundaries

Data included in a MERT transfer is limited to:

The selected patient chart(s); and
The exporting user’s authorization scope at time of retrieval.

MERT does not define a separate privacy classification layer.

Privacy enforcement remains the responsibility of the source EMR system.

7. Deployment Scope

This release of MERT applies to hosted EMR systems only.

On-premise or self-hosted EMR deployments are outside the scope of this release.

8. Future Considerations

Future versions of MERT may consider:

Snapshot-based exchange models.
Additional FHIR resources (e.g., Encounters, CarePlan).
Enhanced bulk migration support.
Expanded privacy control semantics.

Such extensions are not part of the current specification.