International Patient Access
1.0.0 - STU1 International flag

This page is part of the International Patient Access (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Finding and Retrieving Patient Information

Once an application has obtained access to the patient record with a SMART on FHIR access token, it can find and retrieve information about the patient.

Initial Patient Identity Check

The first thing the application should do is retrieve the patient record it has obtained access to and confirm that it is about the right patient.

GET [url]/Patient/[id]

This read returns a single FHIR Patient resource. The details in the patient record should match what the user of the application is expecting. The application chooses how to check this, though some jurisdictions may make additional rules about how it is done. If the app suspects it has been incorrectly granted access, consider: informing the resource server owner, aborting the workflow without showing data to the current user, and looking to local jurisdictional policies for guidance.

Notes:

  • A user may grant access to their or another patient’s record (e.g., a family member or other patient for whom the user is an authorized representative).
  • Identifying the patient is a significant challenge - and safety issue, and the application should never take a correct match for granted. This step is an essential check if the client application is synchronizing its own copy of the patient record.
  • Jurisdictions may have applicable laws or regulations about displaying/checking this information in the application.

Fetching Patient Records

Once the patient’s identity is confirmed, the application can access the patient record by searching on a set of different resources, using this pattern:

GET [url]/Condition?[params]

or more generally,

GET [url]/[Resource]?[params]

Where “[Resource]” is the name of a resource taken from the table below, and the list of parameters includes the patient identifier. (See FHIR’s RESTful API for the details). Some of the lists returned from these calls will be relatively short, but some may be very long - potentially many thousands of resources for Observation and DocumentReference, for example.

Servers will generally use paging to manage requests for long lists of resources.

Servers SHALL support the required search parameters and SHOULD support the recommended search parameters documented; therefore, clients may use these required search parameters to narrow the search scope and reduce the number of resources returned. However, except for these required search parameters, servers are not obligated to support other search parameters. For this reason, clients should always check the self link in the returned result of the search to see what parameters were processed (or consult the server’s CapabilityStatement in advance to know which parameters are supported).

The application can also use the $docref operation to obtain a document, or a set of documents, related to the patient. This operation is particularly useful for implementations not based on FHIR and that do not expose data as FHIR resources. It allows them to share their information with patient-facing applications.

Supported Searches by Resource

As defined in the IPA Server Capability Statement and IPA Client Capability Statement, the following resources can be searched to access patient information. Required or recommended combinations of search parameters are separated by a plus sign. IPA Clients are expected to support the required search parameters for each IPA resource type they support.

For example, an IPA-compliant server returns all lab results for a single patient with: Observation?patient=123&category=laboratory but may not support returning all labs, vital signs, social history, surveys, exams, activities, etc, with: Observation?patient=123.

Resource Required search params Recommended search params
AllergyIntolerance patient patient+clinical-status
Condition patient patient+category, patient+clinical-status, patient+verification-status, patient+code, patient+onset-date, patient+category+clinical-status
DocumentReference _id, patient, patient+category, patient+type patient+category+date, patient+status, patient+type+period
Immunization patient patient+date, patient+status
MedicationRequest patient patient+intent, patient+intent+authoredon, patient+intent+status
MedicationStatement patient patient+status
Observation patient+category, patient+code, patient+category+date patient+category+status, patient+code+date
Patient _id, identifier birthdate, family, gender, given, name, family+gender, birthdate+family, birthdate+name, gender+name

Supporting Resources

The API also provides access to the following resources, which are referred to from the resources above and may be read directly. Servers are not required to support search functionality on Practitioner or PractitionerRole. However, if they do, they may choose to communicate only relevant information related to the patient (for example, only the practitioner’s name).

  • Medication
  • Practitioner
  • PractitionerRole

All these resources are accessed by

GET [url]/[type]/[id]

[type] is from the list above, and “[id]” is the FHIR ID obtained from clinical resources that refer directly to them. E.g.

"author": {
  "reference": "Practitioner/23"
}

Note that the API does not specify search parameters for these resources; applications only need to access them in support of existing records that refer directly to them.

Client applications may ask for these resources to be included in the search response, but servers are not required to do this, so clients should be prepared to fetch these directly and cache them locally.

Generating Patient Documents

A patient’s record may contain any number and type of documents, from interoperable C-CDA documents to binary PDFs. The $docref operation returns DocumentReference resources describing these existing documents, but can also cause a document to be newly generated and returned.

If a server conforms to this specification and also to IPS, this API can be used to generate IPS documents, using the $docref operation with a specific code as defined in the IPS implementation guide.

See the $docref operation definition for the details.