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">
      <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> Scope</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/>  
          <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/>  
          <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/>  
          <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/>  
          <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/>  
          <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/>  
          <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 /[base]/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="resource-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="5.0.0"/> 
  <name value="Everything"/> 
  <title value="Fetch Patient Record"/> 
  <status value="draft"/> 
  <kind value="operation"/> 
  <experimental value="false"/> 
  <date value="2023-03-26T15:21:02+11:00"/> 
  <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."/> 
  <jurisdiction> 
    <coding> 
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/> 
      <code value="001"/> 
      <display value="World"/> 
    </coding> 
  </jurisdiction> 
  <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 /[base]/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](resource-forma
  ts.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>