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Supported FHIR Interactions and Operations

When using the Resource Repository storage strategy provided with the FHIR server, the server supports the following interactions and operations. If your custom FHIR server extends the Resource Repository, it also supports these interactions and operations by default.


HL7® FHIR® interactionsOpens in a new tab are the set of actions that a FHIR client can take on resources. These interactions can be grouped according to whether they act upon an instance, a type, or the whole system. An instance is a specific instance of a resource, for example, Patient/1 refers to an instance of a Patient resource with an id of 1. A type refers to a particular FHIR resource, for example, a Patient or Observation.

The following table summarizes the support for FHIR interactions in the Resource Repository, or a custom FHIR server that has extended the Resource Repository. Click on an interaction to see how it is defined in the HL7 REST API and how to use it.

Interaction Level of Support
createOpens in a new tab Fully supported, including conditional create.
readOpens in a new tab

Conditional read is not supported.

vreadOpens in a new tab

Conditional read is not supported.

updateOpens in a new tab Fully supported, including conditional update.
patchOpens in a new tab Only JSON Patch documents are supported.
deleteOpens in a new tab Fully supported, including conditional delete.
historyOpens in a new tab

Supported for instance interactions only, not type or system. For example, GET [baseURL]/Patient/1/_history is supported, but not GET [baseURL]/Patient/_history or GET [baseURL]/_history.

The _count and _at parameters are not supported.

Paging is not supported.

batchOpens in a new tab Fully supported
transactionOpens in a new tab Circular references within the bundle are not supported.
search Supported with some limitations. For details, see Search Interaction.


For FHIR servers using or extending the default Resource Repository, the following operations are supported:

Operation Level of Support

Fully supported for Patient and Encounter.

Not supported for Group and MedicinalProduct.


The validation modes (create, update, delete) are supported.

Validation by profile is not supported.

When a FHIR $validate request includes a resource payload, the resource may be enclosed in a Parameters resource.

$lastn Fully supported

Operation Query Parameters

For specific operations, certain operation query parameters are supported:

Operation Query Parameter
$lastn max is supported.

Recursive Behavior of the _type Operation Query Parameter for $everything

When a list of resource types is provided in the _type query parameter for the $everything operation, the compartment search will return only resources of the type listed. Recursive resource reference retrieval in the compartment will skip over references to resource types that are not specified in the _types parameter. Some examples illustrate how the _type query parameter for $everything operates on the PatientOpens in a new tab compartment:

  1. /Patient/123/$everything?_type=DiagnosticReport,Observation — returns DiagnosticReport and Observation resources but not the Patient resource.

  2. /Patient/123/$everything?_type=Observation — returns the patient's Observation resources, even though the referring DiagnosticReport resources are not included, because Observation is also in the Patient compartment.

  3. /Patient/123/$everything?_type=Practitioner — returns nothing. Practitioner is not in the Patient compartment, and no other resource type that could refer to Practitioner was specified.

  4. /Patient/123/$everything?_type=Patient,DiagnosticReport,Practitioner — returns the Patient resource, all of the DiagnosticReport resources, and only the Practitioner resources directly referred to by the returned DiagnosticReport resources.

Migrating from Legacy Resource Repository

For FHIR servers developed using InterSystems IRIS for Health 2019.4 or earlier, the data in the legacy Resource Repository must be migrated before using the new FHIR server architecture. To migrate your FHIR data:

  1. In the Management Portal, switch to the namespace of your legacy FHIR server, and then create a STU3 endpoint.

  2. Open the InterSystems Terminal and navigate to the namespace of your legacy FHIR server.

  3. Run:

     do ##class(HS.FHIRServer.ConsoleSetup).Migrate()
  4. Select the STU3 endpoint and confirm the migration.

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