HL7.FHIR.US.DAVINCI-CDEX\Direct Query

This page is part of the Da Vinci Clinical Documentation Exchange (v1.0.0: STU1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Direct Query

Benefits
Sequence Diagram
Discovery of Patient FHIR IDs
Direct Query Transaction Scenarios
Provenance
Signatures

For Direct Query, the Payer directly queries the EHR for specific data using the standard FHIR RESTful search. This is the preferred option. Guidance for exchanging data with FHIR search is fully described in the base FHIR specification and the Da Vinci HRex Implementation Guide. Refer to the US Core Implementation guide for accessing the set of health data classes and data elements defined by the ONC United States Core Data for Interoperability (USCDI).

Benefits

“Out of the Box” FHIR transaction
Widely implemented
Simplest workflow
Authorization/Authentication protocols established
No human intervention needed

Sequence Diagram

The sequence diagram in Figure 5 below outlines a successful interaction between the Payer and EHR to query and retrieve the requested data using a direct query:

Figure 5

Discovery of Patient FHIR IDs

The patient’s FHIR id is a prerequisite to performing both a FHIR RESTful Direct Query and Task-based query. See this section for how to discover the patient’s FHIR id.

Direct Query Transaction Scenarios

The following example transactions show scenarios of using direct query to get clinical data from an EHR.

Scenario 1

Payer A Seeks Insured Person/Patient B’s Active Conditions from Provider C to support a claim submission.

Preconditions and Assumptions:

Payer A is authorized and has the appropriate scopes to access the health records of Patient B from Provider C using FHIR RESTful queries
Payer A knows the FHIR id of the Patient resource for Patient B
Payer A knows the appropriate codes for searching for active conditions

Following guidance in US Core, a search for all active conditions uses the combination of the patient and clinical-status search parameters:

GET [base]/Condition?patient=[FHIR id]&clinical-status=active,recurrance,remission

Request

GET [base]/Condition?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&clinical-status=active,recurrance,remission

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 04:54:56 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)

Response Body

{
  "resourceType": "Bundle",
  "id": "d88e2910-3c95-469d-b1f4-ab5553b471fb",
  "meta": {
    "lastUpdated": "2020-10-23T04:54:56.048+00:00"
  },
  "type": "searchset",
  "total": 1,
  "link": [ {
    "relation": "self",
    "url": "http://hapi.fhir.org/baseR4/Condition?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&clinical-status=active,recurrance,remission"
  } ],
  "entry": [ {
    "fullUrl": "http://hapi.fhir.org/baseR4/Condition/4ac41715-fcbd-421c-8796-9b2c9706dd3f",
    "resource": {
      "resourceType": "Condition",
      "id": "4ac41715-fcbd-421c-8796-9b2c9706dd3f",
      "meta": {
        "versionId": "10",
        "lastUpdated": "2020-04-28T20:28:00.008+00:00",
        "source": "#cabiJIK51sD2iz4N",
        "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition" ]
      },
      "clinicalStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
          "code": "active"
        } ]
      },
      "verificationStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
          "code": "confirmed"
        } ]
      },
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/condition-category",
          "code": "encounter-diagnosis",
          "display": "Encounter Diagnosis"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1234",
          "display": "Examplitis"
        } ],
        "text": "Examplitis"
      },
      "subject": {
        "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b"
      },
      "encounter": {
        "reference": "Encounter/5fe62cd5-bfcf-4d3b-a1e9-80d6f75d6f82"
      },
      "onsetDateTime": "2018-10-21T21:22:15-07:00",
      "recordedDate": "2018-10-21T21:22:15-07:00"
    },
    "search": {
      "mode": "match"
    }
  } ]
}

Scenario 2

Payer A Seeks Insured Person/Patient B’s glycated hemoglobin (HbA1c) test results after 2020-01-01 from Provider C for Quality reporting requirements and quality care scoring.

Preconditions and Assumptions:

Payer A is authorized and has the appropriate scopes to access the health records of Patient B from Provider C using FHIR RESTful Queries
Payer A knows the FHIR id of the Patient resource for Patient B
Payer A knows the appropriate LOINC codes for searching for HbA1c test results (e.g.: 4548-5 Hemoglobin A1c/Hemoglobin.total in Blood)

Following guidance in US Core searches for all HbA1c test results by a date range using using the combination of the patient and code and date search parameters:

GET [base]/Observation?patient=[FHIR id]&code=[code]&date=gt[date]

Request

GET [base]/Observation?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&code=4548-4&date=gt2020-01-01

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 18:22:45 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)

Response Body

{
  "resourceType": "Bundle",
  "id": "3d4fdbbe-b73c-4c9f-89a0-4662506c4d25",
  "meta": {
    "lastUpdated": "2020-10-23T18:22:45.274+00:00"
  },
  "type": "searchset",
  "total": 4,
  "link": [ {
    "relation": "self",
    "url": "http://hapi.fhir.org/baseR4/Observation?code=4548-4&date=gt2020-01-01&patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b"
  } ],
  "entry": [ {
    "fullUrl": "http://hapi.fhir.org/baseR4/Observation/cdex-2020-01-23-hba1c-example",
    "resource": {
      "resourceType": "Observation",
      "id": "cdex-2020-01-23-hba1c-example",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-10-23T18:18:25.154+00:00",
        "source": "#ObC36PK40pQM6y5M",
        "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ]
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        }, {
          "system": "http://www.ama-assn.org/go/cpt",
          "code": "83036",
          "display": "Hemoglobin; glycosylated (A1c)"
        }, {
          "system": "http://example.org/lab-results",
          "code": "HBA1C",
          "display": "Hglycated hemoglobin (HbA1c)"
        } ],
        "text": "glycated hemoglobin (HbA1c)"
      },
      "subject": {
        "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
        "display": "Elden718 Halvorson124"
      },
      "effectiveDateTime": "2020-01-23T10:21:08-07:00",
      "valueQuantity": {
        "value": 6.0,
        "unit": "%",
        "system": "http://unitsofmeasure.org/",
        "code": "%"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "http://hapi.fhir.org/baseR4/Observation/cdex-2020-04-23-hba1c-example",
    "resource": {
      "resourceType": "Observation",
      "id": "cdex-2020-04-23-hba1c-example",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-10-23T18:17:49.885+00:00",
        "source": "#n7aoEe76sAQUBlns",
        "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ]
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        }, {
          "system": "http://www.ama-assn.org/go/cpt",
          "code": "83036",
          "display": "Hemoglobin; glycosylated (A1c)"
        }, {
          "system": "http://example.org/lab-results",
          "code": "HBA1C",
          "display": "Hglycated hemoglobin (HbA1c)"
        } ],
        "text": "glycated hemoglobin (HbA1c)"
      },
      "subject": {
        "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
        "display": "Elden718 Halvorson124"
      },
      "effectiveDateTime": "2020-04-23T10:21:08-07:00",
      "valueQuantity": {
        "value": 7.2,
        "unit": "%",
        "system": "http://unitsofmeasure.org/",
        "code": "%"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "http://hapi.fhir.org/baseR4/Observation/cdex-2020-10-23-hba1c-example",
    "resource": {
      "resourceType": "Observation",
      "id": "cdex-2020-10-23-hba1c-example",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-10-23T18:16:54.549+00:00",
        "source": "#fuIEQP7SJ9NfAlPN",
        "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ]
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        }, {
          "system": "http://www.ama-assn.org/go/cpt",
          "code": "83036",
          "display": "Hemoglobin; glycosylated (A1c)"
        }, {
          "system": "http://example.org/lab-results",
          "code": "HBA1C",
          "display": "Hglycated hemoglobin (HbA1c)"
        } ],
        "text": "glycated hemoglobin (HbA1c)"
      },
      "subject": {
        "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
        "display": "Elden718 Halvorson124"
      },
      "effectiveDateTime": "2020-10-23T10:21:08-07:00",
      "valueQuantity": {
        "value": 7.0,
        "unit": "%",
        "system": "http://unitsofmeasure.org/",
        "code": "%"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "http://hapi.fhir.org/baseR4/Observation/cdex-2020-07-23-hba1c-example",
    "resource": {
      "resourceType": "Observation",
      "id": "cdex-2020-07-23-hba1c-example",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-10-23T18:16:17.687+00:00",
        "source": "#X2hXINwPYymTmEJc",
        "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab" ]
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        }, {
          "system": "http://www.ama-assn.org/go/cpt",
          "code": "83036",
          "display": "Hemoglobin; glycosylated (A1c)"
        }, {
          "system": "http://example.org/lab-results",
          "code": "HBA1C",
          "display": "Hglycated hemoglobin (HbA1c)"
        } ],
        "text": "glycated hemoglobin (HbA1c)"
      },
      "subject": {
        "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
        "display": "Elden718 Halvorson124"
      },
      "effectiveDateTime": "2020-07-23T10:21:08-07:00",
      "valueQuantity": {
        "value": 7.0,
        "unit": "%",
        "system": "http://unitsofmeasure.org/",
        "code": "%"
      }
    },
    "search": {
      "mode": "match"
    }
  } ]
}

Scenario 3

Payer A Seeks Insured Person/Patient B’s latest history and physical exam notes from Provider C to support a claim submission.

Preconditions and Assumptions:

Payer A is authorized and has the appropriate scopes to access the health records of Patient B from Provider C using FHIR RESTful Queries
Payer A knows the FHIR id of the Patient resource for Patient B
Payer A knows the appropriate LOINC codes for searching for History and Physical CCDA documents (34117-2 History & Physical Note)
Provider C supports the standard FHIR search parameters, _search and _count (if this is not the case, then the Payer can search using the date parameter and select the most recent history and physical exam notes for the query results.)

Getting the latest History and Physical is typically a two step process:

Query DocumentReference which references the actual notes file
Fetch the notes file

Following the US Core Clinical Notes Guidance section, Payer searches for History and Physical CCDA document using the combination of the patient and type search parameters. In addition, the combination of _sort and _count is used to return only the latest resource that meets a particular criteria. With _sort=-period (sort by the date parameter in descending order) and _count=1 the last matching resource will be returned.

GET [base]/DocumentReference?patient=[FHIR id]&type=[type-code]&_sort=-period&_count=1

The actual CCDA document is referenced in DocumentReference.content.attachment.url and can be fetched using a RESTful GET.

GET [base]/[url]

Step 1 - Search for DocumentReference

Request

GET [base]/DocumentReference?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&type=34117-2&_sort=-period&_count=1`

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 18:22:45 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)

Response Body

{
  "resourceType": "Bundle",
  "id": "041a1b5c-87b7-482c-8c80-637965d2d4bb",
  "meta": {
    "lastUpdated": "2020-10-23T20:29:25.663+00:00"
  },
  "type": "searchset",
  "total": 1,
  "link": [ {
    "relation": "self",
    "url": "http://hapi.fhir.org/baseR4/DocumentReference?_count=1&_sort=-period&patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&type=34117-2"
  } ],
  "entry": [ {
    "fullUrl": "http://hapi.fhir.org/baseR4/DocumentReference/cdex-HP-example1",
    "resource": {
      "resourceType": "DocumentReference",
      "id": "cdex-HP-example1",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-10-23T20:27:18.976+00:00",
        "source": "#XOrE2IwfLwl5C1RV",
        "profile": [ "http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference" ]
      },
      "identifier": [ {
        "system": "urn:ietf:rfc:3986",
        "value": "urn:oid:2.16.840.1.113883.19.5.99999.2"
      } ],
      "status": "current",
      "type": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "34117-2",
          "display": "History & Physical Note"
        } ],
        "text": "History & Physical Note"
      },
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category",
          "code": "clinical-note",
          "display": "Clinical Note"
        } ],
        "text": "Clinical Note"
      } ],
      "subject": {
        "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b",
        "display": "Elden718 Halvorson124"
      },
      "date": "2020-10-23T10:21:08-07:00",
      "author": [ {
        "reference": "Practitioner/0000016f-57cb-cdac-0000-00000000014a",
        "display": "Janeth814 Jakubowski832, MD"
      } ],
      "description": "Pulmonology clinic acute visit",
      "content": [ {
        "attachment": {
          "contentType": "text/plain",
          "url": "/Binary/cdex-example-hpnote",
          "title": "Uri where the data can be found: [base]/Binary/1-note"
        },
        "format": {
          "system": "urn:oid:1.3.6.1.4.1.19376.1.2.3",
          "code": "urn:hl7-org:sdwg:ccda-structuredBody:2.1",
          "display": "Documents following C-CDA constraints using a structured body"
        }
      } ],
      "context": {
        "period": {
          "start": "2020-10-23T10:21:06-07:00",
          "end": "2020-10-23T10:21:08-07:00"
        }
      }
    },
    "search": {
      "mode": "match"
    }
  } ]
}

Step 2 - Fetch Document

Request

GET [base]/Binary/cdex-example-hpnote`

Request Headers

...(other headers)

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 22:02:15 GMT
Content-Type: application/pdf
...(other headers)

Response Body = PDF

Provenance

To the extent that the Provider keeps a record of the provenance for the source of the data, the FHIR Provenance Resource can be requested as documented in US Core’s Basic Provenance page. When returning provenance the HRex Provenance Profile should be used. An example illustrating this transaction is shown below.

Example of Direct Query Response Including Provenance

This example is the same as Scenario 1 above except that it also includes the corresponding Provenance records.

GET [base]/Condition?patient=[FHIR id]&clinical-status=active,recurrance,remission&_revinclude=Provenance:target

Request

GET [base]/Condition?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&clinical-status=active,recurrance,remission&_revinclude=Provenance:target

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 04:54:56 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)

Response Body

{
  "resourceType": "Bundle",
  "id": "d88e2910-3c95-469d-b1f4-ab5553b471fb",
  "meta": {
    "lastUpdated": "2020-10-23T04:54:56.048+00:00"
  },
  "type": "searchset",
  "total": 1,
  "link": [
    {
      "relation": "self",
      "url": "http://hapi.fhir.org/baseR4/Condition?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&clinical-status=active,recurrance,remission&_revinclude=Provenance:target"
    }
  ],
  "entry": [
    {
      "fullUrl": "http://hapi.fhir.org/baseR4/Condition/4ac41715-fcbd-421c-8796-9b2c9706dd3f",
      "resource": {
        "resourceType": "Condition",
        "id": "4ac41715-fcbd-421c-8796-9b2c9706dd3f",
        "meta": {
          "versionId": "10",
          "lastUpdated": "2020-04-28T20:28:00.008+00:00",
          "source": "#cabiJIK51sD2iz4N",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition"
          ]
        },
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
              "code": "active"
            }
          ]
        },
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
              "code": "confirmed"
            }
          ]
        },
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/condition-category",
                "code": "encounter-diagnosis",
                "display": "Encounter Diagnosis"
              }
            ]
          }
        ],
        "code": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "1234",
              "display": "Examplitis"
            }
          ],
          "text": "Examplitis"
        },
        "subject": {
          "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b"
        },
        "encounter": {
          "reference": "Encounter/5fe62cd5-bfcf-4d3b-a1e9-80d6f75d6f82"
        },
        "onsetDateTime": "2018-10-21T21:22:15-07:00",
        "recordedDate": "2018-10-21T21:22:15-07:00"
      },
      "search": {
        "mode": "match"
      }
    },
    {
      "fullUrl": "http://hapi.fhir.org/baseR4/Provenance/b2ce4584-b213-411b-bdc9-d515dc92eadf",
      "resource": {
        "resourceType": "Provenance",
        "id": "b2ce4584-b213-411b-bdc9-d515dc92eadf",
        "target": [
          {
            "reference": "Condition/4ac41715-fcbd-421c-8796-9b2c9706dd3f"
          }
        ],
        "recorded": "2018-10-21T21:22:15-07:00",
        "agent": [
          {
            "type": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
                    "code": "author",
                    "display": "Author"
                  }
                ]
              }
            ],
            "who": {
              "reference": "Practitioner/Dr-Jones-12345"
            },
            "onBehalfOf": {
              "reference": "Organization/good-health-54321"
            }
          }
        ]
      },
      "search": {
        "mode": "include"
      }
    }
  ]
}

Signatures

The following section content is DRAFT. It it has not yet undergone HL7 balloting.

Some data consumers may require that the data they receive are signed. When performing direct queries when signatures are required on the returned results, the following general rules apply:

The signature SHALL represent a system-level attestation by the sending organization that they are the source of the information.
The Bundle.signature element on the FHIR searchset Bundle SHALL be used to exchange the signature.

The Data Consumer/Requester Requirements

When a electronic or digital signature is required for a FHIR RESTful Queries, the Data Consumer/Requester SHALL:

Pre-negotiate the signature requirement with the organization representing the Data Source/Responder.
- If the signature requirement is pre-negotiated, it SHALL be assumed that all search query response will be signed.
- Conversely, it SHOULD NOT be assumed that a query response will be signed unless there exists a pre-negotiated agreement
- Unlike Task based queries, the actual FHIR queries won’t indicate that a signature is required.
- Based on the agreement, Electronic or digital signatures MAY be used
Follow the documentation in the Signatures page for validating signatures.

Data Source/Responder

When a electronic or digital signature is required for a FHIR RESTful Queries, the Data Source/Responder SHALL:

Return a signed FHIR searchset Bundle using the Bundle.signature element for the signature.
Be signed by the organization that is responding the query.
Follow the documentation in the Signatures page for producing signatures.
As discussed in the What is Signed section, a signed search bundle could have a entries within it that are individually signed as well. If the Consumer/Requester assumed there would be a signature (wet, electronic, or digital) on an individual returned object within the searchset Bundle (e.g CCDA, PDF, Image, CDA on FHIR ) and it is not present. They MAY re-request the signed object using Task based request (see Signatures for Task Based Requests).

Because the signature is represented by Bundle.signature, this precludes using FHIR RESTful read transactions which returns a single instances of a resource. Therefore, the following rules apply for read transactions:

If signatures are required, the Consumer/Requester SHALL NOT use read transaction to fetch data.

If signatures are required the Data Source/Responder SHALL return a http 400 Bad Request and an OperationOutcome describing the business rule error for any read transactions as shown in the following example:

HTTP/1.1 400 Not Found
[other headers]
{
  "resourceType": "OperationOutcome",
  "id": "cdex-signed-read-response",
  "issue": [
{
  "severity": "error",
  "code": "business-rule",
  "details": {
    "text": "signed FHIR RESTful read response is not supported."
  },
  "diagnostics": "Resubmit the request as a FHIR RESTful search'"
}
  ]
}

Example of Signed Direct Query Response

This example is the same as Scenario 1 above except that it also includes a digital signature. See the Signatures page for a complete worked example on how the signature was created and verified.

Preconditions and Assumptions:

In addition to the Scenario 1 assumptions above, Payer A pre-negotiated with Provider B that digital signatures are required for direct query responses.

GET [base]/Condition?patient=[FHIR id]&clinical-status=active,recurrance,remission

Request

GET [base]/Condition?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b&clinical-status=active,recurrance,remission

Request Headers

Accept: application/fhir+json
Content-Type: application/fhir+json
...(other headers)

Response Headers

HTTP/1.1 200 OK
Server: nginx/1.14.0 (Ubuntu)
Date: Fri, 23 Oct 2020 04:54:56 GMT
Content-Type: application/fhir+json;charset=utf-8
...(other headers)

Response Body

{
    "resourceType": "Bundle",
    "id": "d88e2910-3c95-469d-b1f4-ab5553b471fb",
    "meta": {
        "lastUpdated": "2020-10-23T04:54:56.048+00:00"
    },
    "type": "searchset",
    "total": 1,
    "link": [
        {
            "relation": "self",
            "url": "http://hapi.fhir.org/baseR4/Condition?patient=06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b"
        }
    ],
    "entry": [
        {
            "fullUrl": "http://hapi.fhir.org/baseR4/Condition/4ac41715-fcbd-421c-8796-9b2c9706dd3f",
            "resource": {
                "resourceType": "Condition",
                "id": "4ac41715-fcbd-421c-8796-9b2c9706dd3f",
                "meta": {
                    "versionId": "10",
                    "lastUpdated": "2020-04-28T20:28:00.008+00:00",
                    "source": "#cabiJIK51sD2iz4N",
                    "profile": [
                        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition"
                    ]
                },
                "clinicalStatus": {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                            "code": "active"
                        }
                    ]
                },
                "verificationStatus": {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                            "code": "confirmed"
                        }
                    ]
                },
                "category": [
                    {
                        "coding": [
                            {
                                "system": "http://terminology.hl7.org/CodeSystem/condition-category",
                                "code": "encounter-diagnosis",
                                "display": "Encounter Diagnosis"
                            }
                        ]
                    }
                ],
                "code": {
                    "coding": [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "1234",
                            "display": "Examplitis"
                        }
                    ],
                    "text": "Examplitis"
                },
                "subject": {
                    "reference": "Patient/06e1f0dd-5fbe-4480-9bb4-6b54ec02d31b"
                },
                "encounter": {
                    "reference": "Encounter/5fe62cd5-bfcf-4d3b-a1e9-80d6f75d6f82"
                },
                "onsetDateTime": "2018-10-21T21:22:15-07:00",
                "recordedDate": "2018-10-21T21:22:15-07:00"
            },
            "search": {
                "mode": "match"
            }
        }
    ],
    "signature": {
        "type": [
            {
                "system": "urn:iso-astm:E1762-95:2013",
                "code": "1.2.840.10065.1.12.1.5",
                "display": "Verification Signature"
            }
        ],
        "when": "2020-10-23T04:54:56.048+00:00",
        "who": {
            "reference": "Organization/123"
        },
        "data": "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"
    }
}