R4 Overview

This topic describes the R4 (4.0.1) specification.

Schema

All API access is over HTTPS. See Service Root URL for more information on URL format. All data is sent and received as JSON.

$ curl -i -H "Accept: application/fhir+json" https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/metadata
HTTP/1.1 200 OK
Date: Tue, 26 Mar 2019 15:50:49 GMT
Cache-Control: no-cache
Vary: Origin
X-Request-Id: ecd13b72-4fde-11e9-8674-8b0a57a130fd
Content-Type: application/json+fhir

{
  "resourceType": "CapabilityStatement",
  "url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/metadata",
  "name": "CernerCapabilityStatement",
  "title": "Cerner Capability Statement",
  "status": "active",
  "publisher": "Cerner",
  "date": "2019-03-25",
  "description": "Cerner implementation of FHIR on top of Millennium",
  "kind": "instance",
  "implementation": {
    "description": "Cerner implementation of FHIR on top of Millennium",
    "url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d"
  },
  "fhirVersion": "4.0.1",
  "format": [
    "json"
  ],
  "patchFormat": [
    "application/json-patch+json"
  ],
  "rest": [
    {
      "mode": "server",
      "documentation": "Cerner implementation of FHIR on top of Millennium",
      "security": {
        "cors": true
      },
      "resource": [
        {
          "type": "CapabilityStatement",
          "interaction": [
            {
              "code": "read"
            }
          ]
        },
        {
          "type": "Condition",
          "interaction": [
            {
              "code": "read"
            },
            {
              "code": "search-type"
            }
          ],
          "searchParam": [
            {
              "name": "patient",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/clinical-patient",
              "type": "reference",
              "documentation": "Who has the condition. It is a required field if the subject field is not given."
            },
            {
              "name": "subject",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Condition-subject",
              "type": "reference",
              "documentation": "Who has the condition. It is a required field if the patient field is not given."
            },
            {
              "name": "clinical-status",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Condition-clinical-status",
              "type": "token",
              "documentation": "The clinical status of the condition."
            },
            {
              "name": "category",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Condition-category",
              "type": "token",
              "documentation": "The category of the condition. Categories problem-list-item and encounter-diagnosis are supported as of now."
            }
          ]
        },
        {
          "type": "Encounter",
          "interaction": [
            {
              "code": "read"
            },
            {
              "code": "search-type"
            }
          ],
          "searchParam": [
            {
              "name": "_id",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Resource-id",
              "type": "token",
              "documentation": "A single or comma separated list of Encounter ids. It is a required field if the patient or subject fields are not given."
            },
            {
              "name": "_count",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Resource-count",
              "type": "number",
              "documentation": "The maximum number of results to return. Not honored when '_id' is set."
            },
            {
              "name": "patient",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/clinical-patient",
              "type": "reference",
              "documentation": "The patient present at the encounter. It is a required field if the _id or subject fields are not given."
            },
            {
              "name": "subject",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Encounter-subject",
              "type": "reference",
              "documentation": "The patient present at the encounter. It is a required field if the _id or patient fields are not given."
            }
          ]
        },
        {
          "type": "OperationDefinition",
          "interaction": [
            {
              "code": "read"
            }
          ]
        },
        {
          "type": "Patient",
          "interaction": [
            {
              "code": "read"
            },
            {
              "code": "search-type"
            }
          ],
          "searchParam": [
            {
              "name": "_id",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Resource-id",
              "type": "token",
              "documentation": "A single or comma separated list of Patient ids. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "identifier",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Patient-identifier",
              "type": "token",
              "documentation": "A patient identifier. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "name",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Patient-name",
              "type": "string",
              "documentation": "The beginning of any name of the patient. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "given",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/individual-given",
              "type": "string",
              "documentation": "The beginning of the given name of the patient. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "family",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/individual-family",
              "type": "string",
              "documentation": "The beginning of the family name of the patient. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "address-postalcode",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/individual-address-postalcode",
              "type": "string",
              "documentation": "The postal code of the address of the patient. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "birthdate",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/individual-birthdate",
              "type": "date",
              "documentation": "The date of birth of the patient. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "phone",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/individual-phone",
              "type": "token",
              "documentation": "The value of the phone number of the patient. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "email",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/individual-email",
              "type": "token",
              "documentation": "The value of the email address of the patient. Either the '_id' parameter, or a combination of 'identifier', 'birthdate', 'name', 'given', 'family', 'address-postalcode', 'phone', or 'email' parameters must be provided."
            },
            {
              "name": "gender",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/individual-gender",
              "type": "token",
              "documentation": "The administrative gender of the patient. Gender may only be provided if another parameter other than '_id' is provided"
            },
            {
              "name": "_count",
              "definition": "http://hl7.org/fhir/R4/SearchParameter/Resource-count",
              "type": "number",
              "documentation": "The maximum number of results to return. Not honoured when '_id' or 'identifier' are set."
            }
          ]
        },
        {
          "type": "Procedure",
          "interaction": [
            {
              "code": "read"
            },
            {
              "code": "search-type"
            }
          ],
          "searchParam": [
            {
              name: '_id',
              definition: 'http://hl7.org/fhir/R4/SearchParameter/Resource-id',
              type: 'token',
              documentation: 'A single or comma separated list of Procedure ids. It is a required field if the patient or subject fields are not given'
            },
            {
              name: 'patient',
              definition: 'http://hl7.org/fhir/R4/SearchParameter/clinical-patient',
              type: 'reference',
              documentation: 'Search by subject - a patient. It is a required field if the _id or subject fields are not given'
            },
            {
              name: 'subject',
              definition: 'http://hl7.org/fhir/R4/SearchParameter/clinical-patient',
              type: 'reference',
              documentation: 'Search by subject. It is a required field if the _id or patient fields are not given'
            }
          ]
        },
        {
          "type": "StructureDefinition",
          "interaction": [
            {
              "code": "read"
            }
          ]
        }
      ]
    }
  ]
}

Blank fields are omitted.

All timestamps are returned in FHIR standard date/dateTime formats.

Media Types

Oracle Cerner supports the R4 FHIR standard defined media type for JSON content:

application/fhir+json

We encourage you to explicitly request this accept type via the Accept header.

Common Application Errors

Please visit our list of Common Issues under the FAQ topic to be aware of the common issues we've identified when validating apps to run on our platform.

Client Errors

There are seven possible types of client errors on API calls that receive request bodies:

  1. Failing to send a required query parameter will result in a 400 Bad Request response.

    HTTP/1.1 400 Bad Request
    
    no supported search parameters provided
  2. Requesting the secure endpoint (non-open) without valid credentials will result in a 401 Unauthorized response.

    HTTP/1.1 401 Unauthorized
  3. Requesting data from an unknown instance or an instance where the application is not authorized will result in a 403 Forbidden response.

    HTTP/1.1 403 Forbidden
    
    Tenant not valid or accessible
  4. Requesting a resource which does not exist will result in a 404 Not Found response.

    HTTP/1.1 404 Not Found
  5. Requesting a media type other than JSON will result in a 406 Not Acceptable response.

    HTTP/1.1 406 Not Acceptable
    
    Content-Length: 0
  6. Performing an update with an out-of-date version id will result in a 409 Conflict Error response.

    HTTP/1.1 409 Conflict Error
  7. Performing an add or update with syntactically correct JSON body which is invalid according to business rules will result in a 422 Unprocessable Entity response.

    HTTP/1.1 422 Unprocessable Entity

Operation Outcomes

An OperationOutcome may be returned to provide additional context to an error. The tables below describes common OperationOutcomes and their causes.

Retrieve/Search

HTTP Status Cause Severity Code

500

Response is missing a required field

fatal

required

Create/Update

HTTP Status Cause Severity Code

422

Body contained unsupported fields

error

business-rule

422

Body contained modifier extensions

error

extension

422

Body contained implicit rules

error

not-supported

Handling Required Fields

  1. Missing fields required by the HL7 FHIR specification or any missing status field will result in a 500 Internal Server Error and an OperationOutcome.

    {
       "resourceType": "OperationOutcome",
       "issue": [
         {
           "severity": "fatal",
           "code": "required",
           "location": [
             "/f:AllergyIntolerance/f:status"
           ]
         }
       ]
     }  
  2. Missing fields required by HL7 profiles such as Argonaut (DSTU 2) or US Core (STU 3) will result in a DataAbsentReason.

    {
       "coding": [
         {
           "extension": [
             {
               "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
               "valueCode": "unknown"
             }
           ]
         }
       ]
     }
  3. Patient consumers requesting a resource with a status of entered-in-error may result in a DataAbsentReason.

    {
       "coding": [
         {
           "extension": [
             {
               "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
               "valueCode": "masked"
             }
           ]
         }
       ]
     }
  4. Missing Coding or CodeableConcept fields with a required value set binding will result in a DataAbsentReason, though it may return a text component.

    {
       "coding": [
         {
           "extension": [
             {
               "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
               "valueCode": "unknown"
             }
           ]
         }
       ],
       "text": "Auth (Verified)"
     }

Filtered Data for Patient or Proxy Access

When accessing data with a patient persona, some data may be filtered as compared to system or provider access. Resources with a status of "entered-in-error" will result in either some fields being filtered or returned with a data absent reason with a valueCode of masked. Fields that may contain sensitive information will be filtered such as non-instructional notes. For proxy users, regulatory laws or policies may restrict parental or guardian access to adolescent health records and these regulations vary from state to state.

General Security Filtering

Not all data can be accessed by all applications or users. Encounter or organization security, privileges, and preference may filter data based on the build in the domain.

HTTP Verbs

Where possible, the FHIR standard strives to use appropriate HTTP verbs for each action.

Verb Description

GET

Used for retrieving resources.

POST

Used for creating resources.

PUT

Used for updating resources.

HTTP Method Override

If there is no support for HTTP methods such as PUT or PATCH, the request can be made through POST using one of the following:

_method parameter

$ curl -i -X POST  "https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Encounter?_method=patch"

X-HTTP-Method-Override header

$ curl -i -X POST -H "X-HTTP-Method-Override: patch" "https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Encounter"

Note:

When making the override request, appropriate data and headers related to the method you are trying to switch to should be provided.

Authorization

We have an endpoint secured with OAuth 2.0 with support for SMART Applications. Refer to the extensions on the Conformance.rest.security element in our server metadata.

Scopes supported: launch, profile, fhirUser, openid, online_access, offline_access, patient/Account.read, patient/AllergyIntolerance.read, patient/AllergyIntolerance.write, patient/Appointment.read, patient/Appointment.write, patient/Basic.write, patient/Binary.read, patient/CarePlan.read, patient/CareTeam.read, patient/ChargeItem.read, patient/ChargeItem.write, patient/Communication.read, patient/Communication.write, patient/Condition.read, patient/Condition.write, patient/Consent.read, patient/Coverage.read, patient/Coverage.write, patient/Device.read, patient/DiagnosticReport.read, patient/DocumentReference.read, patient/DocumentReference.write, patient/Encounter.read, patient/Encounter.write, patient/FamilyMemberHistory.read, patient/FamilyMemberHistory.write, patient/Goal.read, patient/Immunization.read, patient/Immunization.write, patient/InsurancePlan.read, patient/MedicationAdministration.read, patient/MedicationRequest.read, patient/MedicationRequest.write, patient utritionOrder.read, patient/Observation.read, patient/Observation.write, patient/Patient.read, patient/Patient.write, patient/Person.read, patient/Procedure.read, patient/Procedure.write, patient/Provenance.read, patient/Provenance.write, patient/Questionnaire.read, patient/QuestionnaireResponse.read, patient/QuestionnaireResponse.write, patient/RelatedPerson.read, patient/RelatedPerson.write, patient/Schedule.read, patient/ServiceRequest.read, patient/Slot.read, patient/Slot.write, system/Account.read, system/AllergyIntolerance.read, system/AllergyIntolerance.write, system/Appointment.read, system/Appointment.write, system/Basic.write, system/Binary.read, system/CarePlan.read, system/CareTeam.read, system/ChargeItem.read, system/ChargeItem.write, system/Communication.read, system/Communication.write, system/Condition.read, system/Condition.write, system/Consent.read, system/Coverage.read, system/Coverage.write, system/Device.read, system/DiagnosticReport.read, system/DocumentReference.read, system/DocumentReference.write, system/Encounter.read, system/Encounter.write, system/FamilyMemberHistory.read, system/FamilyMemberHistory.write, system/FinancialTransaction.write, system/Goal.read, system/Immunization.read, system/Immunization.write, system/InsurancePlan.read, system/Location.read, system/MedicationAdministration.read, system/MedicationRequest.read, system/MedicationRequest.write, system utritionOrder.read, system/Observation.read, system/Observation.write, system/Organization.read, system/Organization.write, system/Patient.read, system/Patient.write, system/Person.read, system/Practitioner.read, system/Practitioner.write, system/Procedure.read, system/Procedure.write, system/Provenance.read, system/Provenance.write, system/Questionnaire.read, system/QuestionnaireResponse.read, system/QuestionnaireResponse.write, system/RelatedPerson.read, system/RelatedPerson.write, system/Schedule.read, system/ServiceRequest.read, system/Slot.read, system/Slot.write, user/Account.read, user/AllergyIntolerance.read, user/AllergyIntolerance.write, user/Appointment.read, user/Appointment.write, user/Basic.write, user/Binary.read, user/CarePlan.read, user/CareTeam.read, user/ChargeItem.read, user/ChargeItem.write, user/Communication.read, user/Communication.write, user/Condition.read, user/Condition.write, user/Consent.read, user/Coverage.read, user/Coverage.write, user/Device.read, user/DiagnosticReport.read, user/DocumentReference.read, user/DocumentReference.write, user/Encounter.read, user/Encounter.write, user/FamilyMemberHistory.read, user/FamilyMemberHistory.write, user/Goal.read, user/Immunization.read, user/Immunization.write, user/InsurancePlan.read, user/Location.read, user/MedicationAdministration.read, user/MedicationRequest.read, user/MedicationRequest.write, user utritionOrder.read, user/Observation.read, user/Observation.write, user/Organization.read, user/Organization.write, user/Patient.read, user/Patient.write, user/Person.read, user/Practitioner.read, user/Practitioner.write, user/Procedure.read, user/Procedure.write, user/Provenance.read, user/Provenance.write, user/Questionnaire.read, user/QuestionnaireResponse.read, user/QuestionnaireResponse.write, user/RelatedPerson.read, user/RelatedPerson.write, user/Schedule.read, user/ServiceRequest.read, user/Slot.read, user/Slot.write

Each resource interaction documents the type of authentication acceptable (patient, provider, and/or system).

Please reference the Authorize topics for details on how to authorize with our server.

Pagination

The pagination links are included in the Bundle when a resource returns more items than the Bundle page size. It is important to follow these Link header values instead of constructing your own URLs.

{
  "resourceType": "Bundle",
  "id": "f22ca456-19a7-45ce-8586-0079495783ef",
  "type": "searchset",
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Observation?subject%3APatient=12742400&_count=50"
    },
    {
      "relation": "next",
      "url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Observation?subject%3APatient=12742400&pageContext=35d95fe0-03bf-426c-bc35-2533f7fde4eb&direction=NEXT"
    }
  ],
  ...
}

The possible relation values are:

Name Description

self

Shows the URL of the current page of results.

next

Shows the URL of the immediate next page of results.

previous

If paging, shows the URL of the previous page of results.

Concurrency

Developers need to account for data concurrency within the response. The FHIR specification states:

The results of a search operation are only guaranteed to be current at the moment the operation is executed. After the operation is executed, ongoing actions performed on the resources against which the search was executed will render the results increasingly stale. The significance of this depends on the nature of the search, and the kind of use that is being made of the results.

This is particularly relevant when the server is returning the results in a series of pages. It is at the discretion of the search engine of how to handle ongoing updates to the resources while the search is proceeding.

When results are returned in a series of pages, you may see the same resource id on subsequent pages. Developers need to take this situation into account by filtering by resource id and only return the latest version of that resource id. Displaying duplicate resource ids or any other manipulation may misrepresent the data thus impacting clinical decision support and patient safety.

Cross Origin Resource Sharing

The API supports Cross Origin Resource Sharing (CORS) for AJAX requests from any origin. You can read the CORS W3C Recommendation, or this intro from the HTML 5 Security Guide.

Here's a sample GET request sent from the Origin http://example.com:

$ curl -X GET -i -H "Origin: http://example.com" https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/metadata
HTTP/1.1 200 OK
Access-Control-Allow-Methods: DELETE, GET, POST, PUT, PATCH, OPTIONS, HEAD
Access-Control-Allow-Origin: *
Access-Control-Expose-Headers: ETag, Content-Location, Location, X-Request-Id, WWW-Authenticate, Date
Access-Control-Max-Age: 0

This is what a CORS preflight request looks like:

$ curl -X OPTIONS -i -H "Origin: http://example.com" -H "Access-Control-Request-Headers: authorization,content-type" -H "Access-Control-Request-Method: GET" https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/metadata
HTTP/1.1 200 OK
Access-Control-Allow-Methods: DELETE, GET, POST, PUT, PATCH, OPTIONS, HEAD
Access-Control-Allow-Origin: *
Access-Control-Expose-Headers: ETag, Content-Location, Location, X-Request-Id, WWW-Authenticate, Date
Access-Control-Max-Age: 0
Access-Control-Allow-Headers: authorization, content-type