One common operation performed with resources is to gather a collection of resources into a single instance
with containing context. In FHIR this is referred to as "bundling" the resources together. These resource bundles are useful for a variety of different reasons, including:
Returning a set of resources that meet some criteria as part of a server operation (see RESTful Search)
Returning a set of versions of resources as part of the history operation on a server (see History)
Sending a set of resources as part of a message exchange (see Messaging)
Grouping a self-contained set of resources to act as an exchangeable and persistable collection with clinical integrity - e.g. a clinical document (see Documents)
Creating/updating/deleting a set of resources on a server as a single operation (including doing so as a single atomic transaction) (see Transactions)
Sending an event notification related to an active Subscription (see Subscriptions)
Storing a collection of resources
2.4.2 Boundaries and Relationships
There are two ways to collect resources together for transport and persistence purposes - contained resources, and
bundles. There is an important difference between the two:
Contained resources are "in" the container resource - they can only ever be interpreted and/or changed in the context of the container
A bundle is a collection of resources that can have an independent existence - for example, they might also be accessed directly using the RESTful API
In addition to these two technical mechanisms, there are three administrative and infrastructure resources which also support grouping of content.
These resources do not contain resources directly, but instead use [Reference] to point to the grouped resources:
The List resource – Enumerates a flat collection of resources and provides features for managing the collection.
While a particular List instance may represent a "snapshot", from a business process perspective the notion of "List"
is dynamic – items are added and removed over time. The list resource references other resources. Lists may be
curated and have specific business meaning.
The Group resource – Defines a group of specific people, animals, devices, etc. by enumerating them,
or by describing qualities that group members have. The group resource refers to other resources, possibly implicitly.
Groups are intended to be acted upon or observed as a whole; e.g. performing therapy on a group, calculating risk for a group,
etc. This resource will commonly be used for public health (e.g. describing an at-risk population), clinical trials (e.g.
defining a test subject pool) and similar purposes.
The Composition resource – Defines a set of healthcare-related information that is assembled
together into a single logical document that provides a single coherent statement of meaning, establishes its own context and
that has clinical attestation with regard to who is making the statement. The composition resource provides the basic structure
of a FHIR document. The full content of the document is expressed using a Bundle. Compositions will
often reference Lists as the focus of particular sections.
These three resources represent meaningful groupings of the resources they refer to (e.g. a discharge medication List, a Group of
participants for a clinical trial, a set of resources that form a signed document), while a Bundle is merely is a container for
resources used for transfer and storage. This list is not exhaustive; other resources also provide grouping functionality.
Contains a collection of resources + Rule: total only when a search or history + Rule: entry.search only when a search + Rule: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles) + Rule: A document must have an identifier with a system and a value + Rule: A document must have a date + Rule: A document must have a Composition as the first resource + Rule: A message must have a MessageHeader as the first resource + Rule: A subscription-notification must have a SubscriptionStatus as the first resource + Rule: entry.request.method PATCH not allowed for history + Rule: Bundle resources where type is not transaction, transaction-response, batch, or batch-response or when the request is a POST SHALL have Bundle.entry.fullUrl populated + Rule: Issue.severity for all issues within the OperationOutcome must be either 'information' or 'warning'. + Rule: Use and meaning of issues for documents has not been validated because the content will not be rendered in the document. + Rule: Self link is required for searchsets. + Rule: For collections of type document, message, searchset or collection, all entries must contain resources, and not have request or response elements + Rule: For collections of type history, all entries must contain request or response elements, and resources if the method is POST, PUT or PATCH + Rule: For collections of type transaction or batch, all entries must contain request elements, and resources if the method is POST, PUT or PATCH + Rule: For collections of type transaction-response or batch-response, all entries must contain response elements
Entry in the bundle - will have a resource or information + Rule: must be a resource unless there's a request or response + Rule: fullUrl cannot be a version specific reference This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
@prefix fhir: <http://hl7.org/fhir/> .
[ a fhir:Bundle;
fhir:nodeRole fhir:treeRoot; # if this is the parser root
# from Resource: .id, .meta, .implicitRules, and .language
fhir:identifier[ Identifier ] ; # 0..1 IPersistent identifier for the bundle
fhir:type[ code ] ; # 1..1 Idocument | message | transaction | transaction-response | batch | batch-response | history | searchset | collection | subscription-notification
fhir:timestamp[ instant ] ; # 0..1 IWhen the bundle was assembled
fhir:total[ unsignedInt ] ; # 0..1 ITotal matches across all pages
fhir:link( [ # 0..* ILinks related to this Bundle
fhir:relation[ code ] ; # 1..1 ISee http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1
fhir:url[ uri ] ; # 1..1 IReference details for the link
] ... ) ;
fhir:entry( [ # 0..* IEntry in the bundle - will have a resource or information
fhir:link ( [ See Bundle.link ] ... ) ; # 0..* Links related to this entry
fhir:fullUrl[ uri ] ; # 0..1 IURI for resource (e.g. the absolute URL server address, URI for UUID/OID, etc.)
fhir:resource[ Resource ] ; # 0..1 IA resource in the bundle
fhir:search[ # 0..1 ISearch related information
fhir:mode[ code ] ; # 0..1 match | include - why this is in the result set
fhir:score[ decimal ] ; # 0..1 Search ranking (between 0 and 1)
] ;
fhir:request[ # 0..1 IAdditional execution information (transaction/batch/history)
fhir:method[ code ] ; # 1..1 IGET | HEAD | POST | PUT | DELETE | PATCH
fhir:url[ uri ] ; # 1..1 URL for HTTP equivalent of this entry
fhir:ifNoneMatch[ string ] ; # 0..1 For managing cache validation
fhir:ifModifiedSince[ instant ] ; # 0..1 For managing cache currency
fhir:ifMatch[ string ] ; # 0..1 For managing update contention
fhir:ifNoneExist[ string ] ; # 0..1 For conditional creates
] ;
fhir:response[ # 0..1 IResults of execution (transaction/batch/history)
fhir:status[ string ] ; # 1..1 Status response code (text optional)
fhir:location[ uri ] ; # 0..1 The location (if the operation returns a location)
fhir:etag[ string ] ; # 0..1 The Etag for the resource (if relevant)
fhir:lastModified[ instant ] ; # 0..1 Server's date time modified
fhir:outcome[ Resource ] ; # 0..1 OperationOutcome with hints and warnings (for batch/transaction)
] ;
] ... ) ;
fhir:signature[ Signature ] ; # 0..1 Digital Signature
fhir:issues[ Resource ] ; # 0..1 IOperationOutcome with issues about the Bundle
]
Contains a collection of resources + Rule: total only when a search or history + Rule: entry.search only when a search + Rule: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles) + Rule: A document must have an identifier with a system and a value + Rule: A document must have a date + Rule: A document must have a Composition as the first resource + Rule: A message must have a MessageHeader as the first resource + Rule: A subscription-notification must have a SubscriptionStatus as the first resource + Rule: entry.request.method PATCH not allowed for history + Rule: Bundle resources where type is not transaction, transaction-response, batch, or batch-response or when the request is a POST SHALL have Bundle.entry.fullUrl populated + Rule: Issue.severity for all issues within the OperationOutcome must be either 'information' or 'warning'. + Rule: Use and meaning of issues for documents has not been validated because the content will not be rendered in the document. + Rule: Self link is required for searchsets. + Rule: For collections of type document, message, searchset or collection, all entries must contain resources, and not have request or response elements + Rule: For collections of type history, all entries must contain request or response elements, and resources if the method is POST, PUT or PATCH + Rule: For collections of type transaction or batch, all entries must contain request elements, and resources if the method is POST, PUT or PATCH + Rule: For collections of type transaction-response or batch-response, all entries must contain response elements
Entry in the bundle - will have a resource or information + Rule: must be a resource unless there's a request or response + Rule: fullUrl cannot be a version specific reference This repeating element order: For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
@prefix fhir: <http://hl7.org/fhir/> .
[ a fhir:Bundle;
fhir:nodeRole fhir:treeRoot; # if this is the parser root
# from Resource: .id, .meta, .implicitRules, and .language
fhir:identifier[ Identifier ] ; # 0..1 IPersistent identifier for the bundle
fhir:type[ code ] ; # 1..1 Idocument | message | transaction | transaction-response | batch | batch-response | history | searchset | collection | subscription-notification
fhir:timestamp[ instant ] ; # 0..1 IWhen the bundle was assembled
fhir:total[ unsignedInt ] ; # 0..1 ITotal matches across all pages
fhir:link( [ # 0..* ILinks related to this Bundle
fhir:relation[ code ] ; # 1..1 ISee http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1
fhir:url[ uri ] ; # 1..1 IReference details for the link
] ... ) ;
fhir:entry( [ # 0..* IEntry in the bundle - will have a resource or information
fhir:link ( [ See Bundle.link ] ... ) ; # 0..* Links related to this entry
fhir:fullUrl[ uri ] ; # 0..1 IURI for resource (e.g. the absolute URL server address, URI for UUID/OID, etc.)
fhir:resource[ Resource ] ; # 0..1 IA resource in the bundle
fhir:search[ # 0..1 ISearch related information
fhir:mode[ code ] ; # 0..1 match | include - why this is in the result set
fhir:score[ decimal ] ; # 0..1 Search ranking (between 0 and 1)
] ;
fhir:request[ # 0..1 IAdditional execution information (transaction/batch/history)
fhir:method[ code ] ; # 1..1 IGET | HEAD | POST | PUT | DELETE | PATCH
fhir:url[ uri ] ; # 1..1 URL for HTTP equivalent of this entry
fhir:ifNoneMatch[ string ] ; # 0..1 For managing cache validation
fhir:ifModifiedSince[ instant ] ; # 0..1 For managing cache currency
fhir:ifMatch[ string ] ; # 0..1 For managing update contention
fhir:ifNoneExist[ string ] ; # 0..1 For conditional creates
] ;
fhir:response[ # 0..1 IResults of execution (transaction/batch/history)
fhir:status[ string ] ; # 1..1 Status response code (text optional)
fhir:location[ uri ] ; # 0..1 The location (if the operation returns a location)
fhir:etag[ string ] ; # 0..1 The Etag for the resource (if relevant)
fhir:lastModified[ instant ] ; # 0..1 Server's date time modified
fhir:outcome[ Resource ] ; # 0..1 OperationOutcome with hints and warnings (for batch/transaction)
] ;
] ... ) ;
fhir:signature[ Signature ] ; # 0..1 Digital Signature
fhir:issues[ Resource ] ; # 0..1 IOperationOutcome with issues about the Bundle
]
Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
Bundle resources where type is not transaction, transaction-response, batch, or batch-response or when the request is a POST SHALL have Bundle.entry.fullUrl populated
type='transaction' or type='transaction-response' or type='batch' or type='batch-response' or entry.all(fullUrl.exists() or request.method='POST')
For collections of type transaction-response or batch-response, all entries must contain response elements
type in ('transaction-response' | 'batch-response') implies entry.all(response.exists())
2.4.4.3 Notes about Bundle
Conceptually, a bundle is a list of resources with some context (named links, and status on the entries)
Since a Bundle is itself a Resource it has the same common metadata as all resources, including profile assertions, tags, and security labels. Note that the values in Bundle.meta.security will generally be influenced by the meta.security values of the entries within the Bundle; see http://hl7.org/fhir/security.html
Although there are no extensions on the Bundle itself, link, entry, and search/request/response can all have extensions. See Patient and Location for examples on search
Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. HATEOAS ).
Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was read directly.
This specification defines some specific uses of Bundle.link for searching and paging, but no specific uses for Bundle.entry.link, and no defined function in a transaction - meaning is implementation specific
Bundles have both .id and .identifier - see Resource Identities for further information
2.4.4.4 Using additional resources in Bundles
Bundle entries contain resources which may be either be one of the 160 resources
defined in this specification, or an additional resource.
The content and rules for using a Bundle depend on the type of the bundle.
Note that all bundle types use resource identity resolution as described below.
2.4.4.5.1 Document
A document Bundle (type = "document") consists of a series of
entries, the first of which is a Composition.
Each entry element contains a resource. See Documents for further information.
A message Bundle (type = "message") consists of a series of
entries, the first of which is a MessageHeader.
Each entry element contains a resource. See Messaging for further information.
A set of search results (type = "searchset") consists of a series of 0 or more entries. Each entry element contains a resource. See Search for further information.
In addition, Bundle.total may be
used to return the total number of resources that match the search, and that may be
returned by following the "next" link.
This total MAY be an estimate. Full iteration of the search set or using
_total=accurate are the only mechanisms to reliably determine an exact count against
an arbitrary system.
For each entry, a search set can also contain two specific pieces of search related
information:
search.mode: An indication of whether the resource is in the search set because it matched the search criteria or whether it is included because another resource refers to it (e.g. by the _include parameter)
search.score: The server's search ranking score for the entry. Servers are not required to return a ranking score, but if they do, 1 is most relevant, and 0 is least relevant. Note: often, search results are sorted by score, but the client may specify a different sort order (see Search Relevance)
A change history (type = "history") consists of a series of
0 or more entries. Each entry element SHALL contain a request element that describes the change
that was made and, if the method is a POST, PATCH, or PUT, a resource that represents the state of the
resource at the conclusion of the operation. A response element SHALL also be present so that consumers
can access the location header. See History for further information.
In addition, Bundle.total may be
used to return the total number of resources that are included in the change history,
including those that may be returned by following the "next" link.
2.4.4.5.5 Transaction / Batch
A transaction (type = "transaction") or batch (type = "batch") consists of a series of 0 or more entries.
Each entry element contains a request element has the details of an HTTP operation that informs the system
processing the transaction what to do with the entry. If the entry method is a 'PUT', 'PATCH' or
'POST', then the entry contains a resource that becomes the body of the HTTP operation.
See Transactions for further information.
A transaction response (type = "transaction-response") or batch response (type="batch-response")
consists of a series of 0 or more entries: 1 for each entry in the transaction or batch it is in response to.
Each entry element contains a response element which indicates
the outcome of the HTTP operation that the server performed for the entry.
A collection (type = "collection") consists of a series of
0 or more entries. No particular use with respect to the FHIR specification is associated with this Bundle.
Each entry element contains a resource.
Normative Candidate Note: This BundleType is not normative - it is still undergoing Trial Use while more experience is gathered.
A subscription notification (type = "subscription-notification") consists of a series of
1 or more entries, the first of which is a SubscriptionStatus. There
may be additional contents, as specified by the subscription responsible for generating the notification. See
Subscription for further information.
Except for transactions and batches, each entry in a Bundle SHALL have a fullUrl
which is the identity of the resource in the entry. Note that this is not a versioned reference to the resource, but its
identity. Where a resource is not assigned a persistent identity that can be used
in the Bundle, a UUID SHALL be used in fullUrl (urn:uuid:...).
For transactions and batches, entries MAY omit fullURLs when the entry.request.method = POST,
and the resource has no identity. Note that even in this case, there may still be a fullURL in a
transaction when entry.request.method = POST so that relationships between resources can be represented (see Transactions).
A given version of a resource SHALL only appear once in each Bundle. There MAY, however,
be multiple versions of a single resource present in a single bundle. This would be expected
in Bundles of type history, and also might be necessitated by closely tracking
Provenance.
Note that the meaning of an unversioned reference to a resource that appears multiple times
is potentially ambiguous, though processors may have additional information to help resolve
this (e.g. change order in a history bundle).
When processing batches and transactions, it is at server discretion how to behave if multiple
versions of a single resource are present.
2.4.5.1 Resolving references in Bundles
The Bundle resource is a packaging construct that has one of more entries that
are other kinds of resources. Those resources themselves have references to other resources - e.g.
an Observation that refers to a Patient. The referenced resources may also be found
in the Bundle. For example, the system that constructed the Bundle may have included both
the Observation and the Patient. The content of the references between resources doesn't
change because of the bundle.
This section documents a method that resolves references correctly within a bundle. Note
that this method does not define any new semantics; resolution is based on the way
resource identity and resource references work.
Applications reading a Bundle should always look for a resource
by its identity in the bundle first before trying to access it by its URL externally.
Note that reference.value in entry resources can use any URI scheme (in addition to using
relative values like "Patient/123").
How to resolve a reference in a Bundle:
Resolving urns. If the reference.value is a URN (always absolute) (e.g.
"urn:uuid:9d1714da-b7e6-455b-bfd2-69ce0ff5fb12")
Look for an entry with a fullUrl that matches the reference.value
If one is found, the resolution succeeds (and ends) here
Otherwise, the resolution fails (and ends) here. The reference has no defined meaning within
this specification.
Resolving absolute references. If the reference.value is an absolute URL (e.g.,
"https://fhir.example.org/base/Patient/123",
"https://fhir.example.org/base/Patient/123/_history/a"):
If the reference.value is versionless (i.e. it has no "/_history/" path segment - e.g.
"https://fhir.example.org/base/Patient/123"):
Look for an entry with a fullUrl that matches the reference.value
If one is found, the resolution succeeds (and ends) here
If more than one is found, the server MAY look for the most recent version (based on
meta.lastUpdated). If it is able to find exactly one most recent this way, the resolution
succeeds (and ends) here
If the reference.value includes a "_history" path segment (e.g.
"https://fhir.example.org/base/Patient/123/_history/a"), split the value into two parts: a
versionless reference (e.g. "https://fhir.example.org/base/Patient/123" and a version id (e.g.
"a")
Look for an entry with a fullUrl that matches the versionless reference and a
resource.meta.versionId that matches the reference's version id.
If a single record is found, the resolution succeeds (and ends) here.
If multiple records are found, it is an error.
Optionally, attempt to resolve the URI if possible (e.g. by issuing a FHIR [read] on an
https URL if not version-specific or a [vread] it the URL is version-specific).
If found, the resolution succeeds (and ends) here.
Otherwise, the resolution fails (and ends) here. The reference has no defined meaning
within this specification.
Resolving relative references against a RESTful base. If the reference.value is of the
form "[type]/[id]" (e.g., "Patient/123"):
If the Bundle entry containing the reference has a fullUrl matching the RESTful URL regex
(e.g., "https://fhir.example.org/Observation/456"):
Extract the [root] from the Bundle entry's fullUrl and append the relative reference to
it (e.g., "https://fhir.example.org/" + "Patient/123" -->
"https://fhir.example.org/Patient/123")
Follow the steps for Resolving absolute references above
If the Bundle entry containing the reference does not have a fullUrl that matches the
[RESTful URL regex] and the Bundle is a batch or transaction and the entry.request.method is
POST, PUT or PATCH
take the base URL of the server that is the target of the batch/transaction and append
the relative reference to it (e.g., transaction is being posted to
"https://fhir.somewhere.org", then the expanded reference would be
"https://fhir.somewhere.org/Patient/123"
Follow the steps for Resolving absolute references above
Resolving conditional references. If the reference occurs in a transaction Bundle and the
reference.value is a conditional reference (e.g.
"http://example.org/base/Patient?identifier=1234"):
Perform the [search] specified in the conditional reference on the server.
If the search succeeds with a single resource, the resolution succeeds (and ends)
here.
If the search succeeds with multiple matching resources, resolution fails (and ends)
here. An error SHOULD be raised.
Otherwise the resolution fails (and ends) here.
Resolving other references. If the rules above do not apply, the resolution fails (and
ends) here. The reference has no defined meaning within this specification.
Note that the rules for resolving references in contained resources are the same as those for
resolving references in the resource that contains the contained resource. I.e. the fullUrl of
the containing resource is used when determining the base for relative references, etc.
Several portions of this algorithm are dependent on on the presence of Bundle.entry.fullUrl. In
instances where references might be resolved within a Bundle but entries do not have fullURLs,
resolution expectations are undefined. For this reason, Bundles where cross-Bundle references
are present SHOULD always populate Bundle.entry.fullUrl.
If multiple matches are found (except where explicitly handled in the above algorithm), it is
ambiguous which is correct. Applications MAY return an error or take some other action as they
deem appropriate
The Bundle resource type has an end-point like all most other resources. This
end-point serves the usual interactions.
Bundles are treated as static resources on the /Bundle end-point (i.e. when a
batch, transaction, or message is POSTed to /Bundle, it is stored as is, and
the content is not processed as batch, transaction, or message - instead, they
are processed like normal resource, with indexing / auditing etc. Performing a
GET /[base]/Bundle/[location] will return the same resource.
The Bundle end point does have two special search parameters - composition and message,
which allow for chained search into the first (special) entries in document and message resources.
All elements in Bundle are marked as summary because Bundle resources need to be
fully populated when doing a search, and most use cases for retrieving summaries
of documents or other types of bundles are not well suited by the standard isSummary
mechanism and are better handles by operations or other mechanisms.
Note to Implementers:
If an element marked as 'summary' is itself a nested resource (i.e. type is Resource),
then the expectation is that the conveyed resource will also be expressed in its summary form.
The typical place this applies is Bundle.entry.resource. This statement is left as STU because
there is not yet significant implementer experience on its ramifications.
2.4.5.3 Signatures
The Bundle resource includes a signature element (digital signature) which can be used for
standards based integrity verification and non-repudiation purposes. The Signature datatype
provides details on use of the signature element. The Signature.type coded value of "Source" should be used
when the signature is for simply proving that the resource content is the same as it was when the resource
was updated or created.
The first resource in the bundle, if the bundle type is "message" - this is a message header, and this parameter provides access to search its contents