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8.10.13.1 Operation $everything on EpisodeOfCare

Patient Administration Work Group

Maturity Level: 2

Trial Use

Compartments: N/A

This operation is used to return all the information related to an episodeofcare described in the resource on which this operation is invoked. The response is a bundle of type "searchset". At a minimum, the episodeofcare resource itself is returned, along with any other resources that the server has available for the given episodeofcare for the user. The server also returns whatever resources are needed to support the records - e.g. linked practitioners, locations, organizations etc. The principle intended use for this operation is to provide a patient with access to their record, or to allow a client to retrieve everything for an episodeofcare for efficient display).

The server SHOULD return all resources it has that:

• are included in the episodeofcare compartment for the identified episodeofcare (have a reference to the episodeofcare)
• are referenced by the standard extension for associating an episodeofcare (where no reference element exists) http://hl7.org/fhir/StructureDefinition/workflow-episodeOfCare
• the server believes are relevant to the context of the episodeofcare for any other reason (internally defined/decided)
• any resource referenced by the above, including binaries and attachments (to make a more complete package).

The canonical URL for this operation definition is

 http://hl7.org/fhir/OperationDefinition/EpisodeOfCare-everything

Formal Definition (as a OperationDefinition).

URL: [base]/EpisodeOfCare/[id]/$everything

This is an idempotent operation

The key differences between this operation and simply searching the episodeofcare 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 episodeofcare, or determine whether the context has the rights to the nominated episodeofcare, if there is one, or can determine an appropriate list of episodeofcares to provide data for from the context of the request. If there is no nominated episodeofcare (GET /[base]/EpisodeOfCare/$everything) and the context is not associated with a single episodeofcare record, the actual list of episodeofcares is all episodeofcares that the user associated with the request has access to. 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 episodeofcare records is outside the scope of this specification (though see The Smart App Launch Implementation Guide .

When this operation is used to access multiple episodeofcare records at once, the return bundle could be rather a lot of data; servers may choose to require that such requests are made asynchronously, and associated with bulk data formats. 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, using the _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. Servers should consider returning appropriate Provenance and AuditTrail on the returned resources, even though these are not directly part of the patient compartment.

The _since parameter is provided to support periodic queries to get additional information that has changed about the episodeofcare 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.

8.10.13.1.1 Examples

Request: Get all resources linked to a single patient

GET /open/EpisodeOfCare/example/$everything
[some headers]

Response: Everything linked to the nominated patient (in this case, built automatically by the publication tooling)

HTTP/1.1 200 OK
[other headers]

<Bundle xml="http://hl7.org/fhir">
  <id value="21c7aeb5-840c-4923-ba22-18cb79e2e678"/>
  <type value="searchset"/>
  <entry>
    <fullUrl value="http://hl7.org/fhir/EpisodeOfCare/example"/>
    <resource>
     <EpisodeOfCare xmlns="http://hl7.org/fhir">
       <id value="example"/>
       <text>
         <status value="generated"/>
         <div xmlns="http://www.w3.org/1999/xhtml">
           HACC Program for Peter James Chalmers at HL7 Healthcare 15 Sept 2014 - current<br/>
     			was on leave from 22 Sept - 24 Sept while in respite care
         </div>
       </text>
       <identifier>
         <system value="http://example.org/sampleepisodeofcare-identifier"/>
         <value value="123"/>
       </identifier>
       <status value="active"/>
       <statusHistory>
         <status value="planned"/>
         <period>
           <start value="2014-09-01"/>
           <end value="2014-09-14"/>
         </period>
       </statusHistory>
       <statusHistory>
         <status value="active"/>
         <period>
           <start value="2014-09-15"/>
           <end value="2014-09-21"/>
         </period>
       </statusHistory>
       <statusHistory>
         <status value="onhold"/>
         <period>
           <start value="2014-09-22"/>
           <end value="2014-09-24"/>
         </period>
       </statusHistory>
       <statusHistory>
         <status value="active"/>
         <period>
           <start value="2014-09-25"/>
         </period>
       </statusHistory>
       <type>
         <coding>
             <system value="http://terminology.hl7.org/CodeSystem/episodeofcare-type"/>
             <code value="hacc"/>
             <display value="Home and Community Care"/>
         </coding>
       </type>
       <diagnosis>
         <condition>
           <reference>
             <reference value="Condition/stroke"/>
           </reference>
         </condition>
         <use>
           <coding>
             <system value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
             <code value="CC"/>
             <display value="Chief complaint"/>
           </coding>
         </use>
       </diagnosis>
       <patient>
         <reference value="Patient/example"/>
       </patient>
       <managingOrganization>
         <reference value="Organization/hl7"/>
       </managingOrganization>
       <period>
         <start value="2014-09-01"/>
       </period>
       <referralRequest>
         <display value="Referral from Example Aged Care Services"/>
       </referralRequest>
       <careManager>
         <reference value="Practitioner/14"/>
         <display value="Amanda Assigned"/>
       </careManager>
       <careTeam>
         <reference value="CareTeam/example"/>
         <display value="example care team"/>
       </careTeam>
       <account>
         <reference value="Account/example"/>
         <display value="example account"/>
       </account>
     </EpisodeOfCare>
    </resource>
  </entry>
  <entry>
    <fullUrl value="http://hl7.org/fhir/Encounter/f203"/>
    <resource>
     <?xml-model href="../../publish/encounter.sch" type="application/xml" schematypens="http://purl.oclc.org/dsdl/schematron"?><Encounter xmlns="http://hl7.org/fhir">
         <id value="f203"/>
         <identifier>
             <use value="temp"/>
             <value value="Encounter_Roel_20130311"/>
         </identifier>
         <status value="completed"/>
         <!--Encounter has been completed-->
         <class>
     		<coding>
     			<!--Inpatient encounter for straphylococcus infection-->
     			<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
     			<code value="IMP"/>
     			<display value="inpatient encounter"/>
     		</coding>
         </class>
         <priority>
             <!--High priority-->
             <coding>
                 <system value="http://snomed.info/sct"/>
                 <code value="394849002"/>
                 <display value="High priority"/>
             </coding>
         </priority>
         <type>
             <coding>
                 <system value="http://snomed.info/sct"/>
                 <code value="183807002"/>
                 <display value="Inpatient stay for nine days"/>
             </coding>
         </type>
         <subject>
             <reference value="Patient/f201"/>
             <display value="Roel"/>
         </subject>
         <episodeOfCare>
             <reference value="EpisodeOfCare/example"/>
         </episodeOfCare>
         <basedOn>
             <reference value="ServiceRequest/myringotomy"/>
         </basedOn>
         <partOf>
             <reference value="Encounter/f203"/>
         </partOf>
         <serviceProvider>
             <reference value="Organization/2"/>
         </serviceProvider>
         <participant>
             <type>
                 <coding>
                     <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/>
                     <code value="PART"/>
                 </coding>
             </type>
             <actor>
                 <reference value="Practitioner/f201"/>
             </actor>
         </participant>
         <appointment>
             <reference value="Appointment/example"/>
         </appointment>
         <actualPeriod>
             <start value="2013-03-11"/>
             <end value="2013-03-20"/>
         </actualPeriod>
         <reason>
             <value>
                 <concept>
                     <text value="The patient seems to suffer from bilateral pneumonia and renal insufficiency, most likely due to chemotherapy."/>
                 </concept>
             </value>
         </reason>
         <diagnosis>
           <condition>
             <reference>
                 <reference value="Condition/stroke"/>
             </reference>
           </condition>
           <use>
             <coding>
               <system value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
               <code value="AD"/>
               <display value="Admission diagnosis"/>
             </coding>
           </use>
         </diagnosis>
         <diagnosis>
           <condition>
             <reference>
                 <reference value="Condition/f201"/>
             </reference>
           </condition>
           <use>
             <coding>
               <system value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
               <code value="DD"/>
               <display value="Discharge diagnosis"/>
             </coding>
           </use>
         </diagnosis>
         <account>
             <reference value="Account/example"/>
         </account>
         <!--No indication, because no referral took place-->
         <dietPreference>
             <coding>
                 <system value="http://snomed.info/sct"/>
                 <code value="276026009"/>
                 <display value="Fluid balance regulation"/>
             </coding>
         </dietPreference>
         <specialArrangement>
             <coding>
                 <system value="http://terminology.hl7.org/CodeSystem/encounter-special-arrangements"/>
                 <code value="wheel"/>
                 <display value="Wheelchair"/>
             </coding>
         </specialArrangement>
         <specialCourtesy>
             <coding>
                 <system value="http://terminology.hl7.org/CodeSystem/v3-EncounterSpecialCourtesy"/>
                 <code value="NRM"/>
                 <display value="normal courtesy"/>
             </coding>
         </specialCourtesy>
         <admission>
             <origin>
                 <reference value="Location/2"/>
             </origin>
             <admitSource>
                 <coding>
                     <system value="http://snomed.info/sct"/>
                     <code value="309902002"/>
                     <display value="Clinical Oncology Department"/>
                 </coding>
             </admitSource>
             <reAdmission>
                 <coding>
                     <display value="readmitted"/>
                 </coding>
             </reAdmission>
             <!--accomodation details are not available-->
             <destination>
                 <!--Fictive-->
                 <reference value="Location/2"/>
             </destination>
         </admission>
     </Encounter>
    </resource>
  </entry>
</Bundle>

For more information about operations, including how they are invoked, see Operations.