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Operation-patient-everything.xml

Patient Administration Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Patient, Practitioner, RelatedPerson

Raw XML (canonical form + also see XML Format Specification)

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Operation Definition

<?xml version="1.0" encoding="UTF-8"?>

<OperationDefinition xmlns="http://hl7.org/fhir">
  <id value="Patient-everything"/> 
  <text> 
    <status value="extensions"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <h2> everything</h2> 
      <p> OPERATION: everything</p> 
      <p> The official URL for this operation definition is: </p> 
      <pre> http://hl7.org/fhir/OperationDefinition/Patient-everything</pre> 
      <div> 
        <p> This operation is used to return all the information related to one or more patients described
           in the resource or context on which this operation is invoked. The response is a bundle
           of type &quot;searchset&quot;. At a minimum, the patient resource(s) itself is returned,
           along with any other resources that the server has that are related to the patient(s),
           and that are available for the given user. The server also returns whatever resources
           are needed to support the records - e.g. linked practitioners, medications, locations,
           organizations etc.</p> 

        <p> The intended use for this operation is to provide a patient with access to their entire
           record (e.g. &quot;Blue Button&quot;), or for provider or other user to perform a bulk
           data download.  The server SHOULD return at least all resources that it has that are in
           the patient compartment for the identified patient(s), and any resource referenced from
           those, including binaries and attachments. The server SHOULD resolve version-specific
           references by returning the explicitly named version. In the US Realm, at a minimum, the
           resources returned SHALL include all the data covered by the meaningful use common data
           elements as defined in the US Core Implementation Guide. Other applicable implementation
           guides may make additional rules about how much information that is returned.</p> 

      </div> 
      <p> URL: [base]/Patient/$everything</p> 
      <p> URL: [base]/Patient/[id]/$everything</p> 
      <p> Parameters</p> 
      <table class="grid">
        <tr> 
          <td> 
            <b> Use</b> 
          </td> 
          <td> 
            <b> Name</b> 
          </td> 
          <td> 
            <b> Cardinality</b> 
          </td> 
          <td> 
            <b> Type</b> 
          </td> 
          <td> 
            <b> Binding</b> 
          </td> 
          <td> 
            <b> Documentation</b> 
          </td> 
        </tr> 
        <tr> 
          <td> IN</td> 
          <td> start</td> 
          <td> 0..1</td> 
          <td> 
            <a href="datatypes.html#date">date</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> The date range relates to care dates, not record currency dates - e.g. all records relating
                 to care provided in a certain date range. If no start date is provided, all records prior
                 to the end date are in scope.</p> 

            </div> 
          </td> 
        </tr> 
        <tr> 
          <td> IN</td> 
          <td> end</td> 
          <td> 0..1</td> 
          <td> 
            <a href="datatypes.html#date">date</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> The date range relates to care dates, not record currency dates - e.g. all records relating
                 to care provided in a certain date range. If no end date is provided, all records subsequent
                 to the start date are in scope.</p> 

            </div> 
          </td> 
        </tr> 
        <tr> 
          <td> IN</td> 
          <td> _since</td> 
          <td> 0..1</td> 
          <td> 
            <a href="datatypes.html#instant">instant</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> Resources updated after this period will be included in the response. The intent of this
                 parameter is to allow a client to request only records that have changed since the last
                 request, based on either the return header time, or or (for asynchronous use), the transaction
                 time</p> 

            </div> 
          </td> 
        </tr> 
        <tr> 
          <td> IN</td> 
          <td> _type</td> 
          <td> 0..*</td> 
          <td> 
            <a href="datatypes.html#code">code</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> One or more parameters, each containing one or more comma-delimited FHIR resource types
                 to include in the return resources. In the absence of any specified types, the server
                 returns all resource types</p> 

            </div> 
          </td> 
        </tr> 
        <tr> 
          <td> IN</td> 
          <td> _count</td> 
          <td> 0..1</td> 
          <td> 
            <a href="datatypes.html#integer">integer</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> See discussion below on the utility of paging through the results of the $everything operation</p> 

            </div> 
          </td> 
        </tr> 
        <tr> 
          <td> OUT</td> 
          <td> return</td> 
          <td> 1..1</td> 
          <td> 
            <a href="bundle.html">Bundle</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> The bundle type is &quot;searchset&quot;</p> 

            </div> 
          </td> 
        </tr> 
      </table> 
      <div> 
        <p> The key differences between this operation and simply searching the patient compartment
           are:</p> 

        <ul> 

          <li> unless the client requests otherwise, the server returns the entire result set in a single
             bundle (rather than using paging)</li> 

          <li> the server is responsible for determining what resources to return as included resources
             (rather than the client specifying which ones).</li> 

        </ul> 

        <p> This frees the client from needing to determine what it could or should ask for, particularly
           with regard to included resources. Servers should consider returning appropriate Provenance
           and AuditTrail on the returned resources, even though these are not directly part of the
           patient compartment.</p> 

        <p> It is assumed that the server has identified and secured the context appropriately, and
           can either associate the authorization context with a single patient, or determine whether
           the context has the rights to the nominated patient, if there is one, or can determine
           an appropriate list of patients to provide data for from the context of the request. 
            If there is no nominated patient (GET /Patient/$everything) and the context is not associated
           with a single patient record, the actual list of patients is all patients that the user
           associated with the request has access to. This may be all patients in the family that
           the patient has access to, or it may be all patients that a care provider has access to,
           or all patients on the entire record system. In such cases, the server may choose to return
           an error rather than all the records.  Specifying the relationship between the context,
           a user and patient records is outside the scope of this specification (though see 
          <a href="http://hl7.org/fhir/smart-app-launch">The Smart App Launch Implementation Guide</a> .
        </p> 

        <p> When this operation is used to access multiple patient records at once, the return bundle
           could be rather a lot of data; servers may choose to require that such requests are made
           
          <a href="async.html">asynchronously</a> , and associated with 
          <a href="formats.html#bulk">bulk data formats</a> . Alternatively, clients may choose to page through the result set (or servers may require
           this). Paging through the results is done the same as for 
          <a href="http.html#paging">Searching</a> , using the 
          <a href="search.html#count">_count</a>  parameter, and Bundle links. Implementers should note that paging will be slower than
           simply returning all the results at once (more network traffic, multiple latency delays)
           but may be required in order not to exhaust available memory reading or writing the whole
           response in a single package. Unlike searching, there is no inherent user-display order
           for the $everything operation. Servers might consider sorting the returned resources in
           descending order of last record update, but are not required to do so.
        </p> 

        <p> The _since parameter is provided to support periodic queries to get additional information
           that has changed about the patient since the last query. This means that the _since parameter
           is based on record time. The value of the _since parameter should be set to the time from
           the server. If using direct response, this is the timestamp in the response header. If
           using the async interface, this is the transaction timestamp in the json response. Servers
           should ensure that the timestamps a managed such that the client does not miss any changes.
           Clients should be able to handle getting the same response more than once in the case
           that the transaction falls on a time boundary. Clients should ensure that the other query
           parameters are constant to ensure a coherent set of records when doing periodic queries.</p> 

      </div> 
    </div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="5"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/> 
  </extension> 
  <url value="http://hl7.org/fhir/OperationDefinition/Patient-everything"/> 
  <version value="4.6.0"/> 
  <name value="everything"/> 
  <title value="Fetch Patient Record"/> 
  <status value="draft"/> 
  <kind value="operation"/> 
  <date value="2021-12-03T19:35:47+00:00"/> 
  <publisher value="HL7 (FHIR Project)"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
    <telecom> 
      <system value="email"/> 
      <value value="fhir@lists.hl7.org"/> 
    </telecom> 
  </contact> 
  <description value="This operation is used to return all the information related to one or more patients described
   in the resource or context on which this operation is invoked. The response is a bundle
   of type &quot;searchset&quot;. At a minimum, the patient resource(s) itself is returned,
   along with any other resources that the server has that are related to the patient(s),
   and that are available for the given user. The server also returns whatever resources
   are needed to support the records - e.g. linked practitioners, medications, locations,
   organizations etc.   

The intended use for this operation is to provide a patient with access to their entire
   record (e.g. &quot;Blue Button&quot;), or for provider or other user to perform a bulk
   data download.  The server SHOULD return at least all resources that it has that are in
   the patient compartment for the identified patient(s), and any resource referenced from
   those, including binaries and attachments. The server SHOULD resolve version-specific
   references by returning the explicitly named version. In the US Realm, at a minimum, the
   resources returned SHALL include all the data covered by the meaningful use common data
   elements as defined in the US Core Implementation Guide. Other applicable implementation
   guides may make additional rules about how much information that is returned."/> 
  <affectsState value="false"/> 
  <code value="everything"/> 
  <comment value="The key differences between this operation and simply searching the patient compartment
   are:    

* unless the client requests otherwise, the server returns the entire result set in a
   single bundle (rather than using paging)  
* the server is responsible for determining what resources to return as included resources
   (rather than the client specifying which ones). 

This frees the client from needing to determine what it could or should ask for, particularly
   with regard to included resources. Servers should consider returning appropriate Provenance
   and AuditTrail on the returned resources, even though these are not directly part of the
   patient compartment. 

It is assumed that the server has identified and secured the context appropriately, and
   can either associate the authorization context with a single patient, or determine whether
   the context has the rights to the nominated patient, if there is one, or can determine
   an appropriate list of patients to provide data for from the context of the request. 
    If there is no nominated patient (GET /Patient/$everything) and the context is not associated
   with a single patient record, the actual list of patients is all patients that the user
   associated with the request has access to. This may be all patients in the family that
   the patient has access to, or it may be all patients that a care provider has access to,
   or all patients on the entire record system. In such cases, the server may choose to return
   an error rather than all the records.  Specifying the relationship between the context,
   a user and patient records is outside the scope of this specification (though see [The
   Smart App Launch Implementation Guide](http://hl7.org/fhir/smart-app-launch). 

When this operation is used to access multiple patient records at once, the return bundle
   could be rather a lot of data; servers may choose to require that such requests are made
   [asynchronously](async.html), and associated with [bulk data formats](formats.html#bulk).
   Alternatively, clients may choose to page through the result set (or servers may require
   this). Paging through the results is done the same as for [Searching](http.html#paging),
   using the [_count](search.html#count) parameter, and Bundle links. Implementers should
   note that paging will be slower than simply returning all the results at once (more network
   traffic, multiple latency delays) but may be required in order not to exhaust available
   memory reading or writing the whole response in a single package. Unlike searching, there
   is no inherent user-display order for the $everything operation. Servers might consider
   sorting the returned resources in descending order of last record update, but are not
   required to do so.

The _since parameter is provided to support periodic queries to get additional information
   that has changed about the patient since the last query. This means that the _since parameter
   is based on record time. The value of the _since parameter should be set to the time from
   the server. If using direct response, this is the timestamp in the response header. If
   using the async interface, this is the transaction timestamp in the json response. Servers
   should ensure that the timestamps a managed such that the client does not miss any changes.
   Clients should be able to handle getting the same response more than once in the case
   that the transaction falls on a time boundary. Clients should ensure that the other query
   parameters are constant to ensure a coherent set of records when doing periodic queries."/> 
  <resource value="Patient"/> 
  <system value="false"/> 
  <type value="true"/> 
  <instance value="true"/> 
  <parameter> 
    <name value="start"/> 
    <use value="in"/> 
    <min value="0"/> 
    <max value="1"/> 
    <documentation value="The date range relates to care dates, not record currency dates - e.g. all records relating
     to care provided in a certain date range. If no start date is provided, all records prior
     to the end date are in scope."/> 
    <type value="date"/> 
  </parameter> 
  <parameter> 
    <name value="end"/> 
    <use value="in"/> 
    <min value="0"/> 
    <max value="1"/> 
    <documentation value="The date range relates to care dates, not record currency dates - e.g. all records relating
     to care provided in a certain date range. If no end date is provided, all records subsequent
     to the start date are in scope."/> 
    <type value="date"/> 
  </parameter> 
  <parameter> 
    <name value="_since"/> 
    <use value="in"/> 
    <min value="0"/> 
    <max value="1"/> 
    <documentation value="Resources updated after this period will be included in the response. The intent of this
     parameter is to allow a client to request only records that have changed since the last
     request, based on either the return header time, or or (for asynchronous use), the transaction
     time"/> 
    <type value="instant"/> 
  </parameter> 
  <parameter> 
    <name value="_type"/> 
    <use value="in"/> 
    <min value="0"/> 
    <max value="*"/> 
    <documentation value="One or more parameters, each containing one or more comma-delimited FHIR resource types
     to include in the return resources. In the absence of any specified types, the server
     returns all resource types"/> 
    <type value="code"/> 
  </parameter> 
  <parameter> 
    <name value="_count"/> 
    <use value="in"/> 
    <min value="0"/> 
    <max value="1"/> 
    <documentation value="See discussion below on the utility of paging through the results of the $everything operation"/> 
    <type value="integer"/> 
  </parameter> 
  <parameter> 
    <name value="return"/> 
    <use value="out"/> 
    <min value="1"/> 
    <max value="1"/> 
    <documentation value="The bundle type is &quot;searchset&quot;"/> 
    <type value="Bundle"/> 
  </parameter> 
</OperationDefinition> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.