Fetching FHIR R4 Resources for OpenMed

FHIR R4 is the modern EHR API: a RESTful, JSON-or-XML interface over resources like Patient, Encounter, Condition, Observation, DiagnosticReport, and DocumentReference. The unstructured clinical text you want for NLP lives in DocumentReference.content.attachment and DiagnosticReport.presentedForm — usually base64-encoded PDF, RTF, or plain text. This skill pulls those resources, pages through results, decodes the attachments, and hands the narrative to OpenMed.

When to use

• You have FHIR R4 access to an EHR (Epic, Oracle Health/Cerner, HAPI, Medplum, Azure/Google/AWS HealthLake) and want note text for de-id and NER.
• You need to page a large search result set safely (Bundle.link[next]).
• You want to pull a patient's documents/reports and rejoin NLP output by patient and encounter.

FHIR REST in one minute

Search is GET [base]/[Type]?param=value. Results come back as a searchset Bundle; the next page is the URL in Bundle.link where relation == "next". Use _count to size pages, _revinclude to pull related resources in one round trip, and _since/_lastUpdated for incremental sync.

GET /Patient?identifier=http://hospital.org/mrn|12345
GET /DocumentReference?patient=Patient/abc&category=clinical-note&_count=50
GET /DiagnosticReport?patient=Patient/abc&_revinclude=Observation:related

Quick start

Page a search, decode attachments, hand narrative to OpenMed:

import base64
import requests
import openmed

BASE = "https://fhir.example.org/r4"
HEADERS = {"Accept": "application/fhir+json", "Authorization": "Bearer <token>"}

def iter_bundle(url, params=None):
    """Yield resources across all pages following Bundle.link[next]."""
    while url:
        bundle = requests.get(url, params=params, headers=HEADERS, timeout=30).json()
        for entry in bundle.get("entry", []):
            yield entry.get("resource", {})
        params = None  # next links are fully-qualified
        url = next(
            (l["url"] for l in bundle.get("link", []) if l.get("relation") == "next"),
            None,
        )

def attachment_text(att):
    """Decode a FHIR Attachment to text (handles base64 and inline text/plain)."""
    if att.get("data"):
        raw = base64.b64decode(att["data"])
        if att.get("contentType", "").startswith("text/"):
            return raw.decode("utf-8", "replace")
        return ""  # PDF/RTF: route to OpenMed multimodal/OCR intake instead
    return ""

# Pull a patient's clinical notes and analyze each.
for doc in iter_bundle(f"{BASE}/DocumentReference",
                       {"patient": "Patient/abc",
                        "category": "clinical-note", "_count": 50}):
    for content in doc.get("content", []):
        text = attachment_text(content.get("attachment", {}))
        if not text.strip():
            continue
        deid = openmed.deidentify(text, method="replace", policy="hipaa_safe_harbor")
        result = openmed.analyze_text(deid.text, output_format="dict")
        patient_ref = doc.get("subject", {}).get("reference")  # rejoin key

Workflow

1. Authenticate. Most production FHIR endpoints use SMART-on-FHIR OAuth2 (client-credentials for backend services). Scope to the minimum (system/DocumentReference.read, system/DiagnosticReport.read).
2. Search narrowly. Filter by patient, category, type (LOINC), date, and _count. Prefer server-side filtering over client-side.
3. Page via Bundle.link[next] until exhausted. Never assume one page.
4. Extract narrative: DocumentReference.content.attachment and DiagnosticReport.presentedForm. Decode base64; for PDF/RTF/scanned content, route bytes to OpenMed's document intake (multimodal/ocr) rather than decoding as UTF-8.
5. De-identify → analyze each narrative with OpenMed.
6. Rejoin results to subject.reference (patient) and context.encounter so downstream consumers can group by patient/encounter — storing hashed, not raw, identifiers.

Hand-off to / from OpenMed

• To OpenMed (client-side): decoded narrative → openmed.deidentify → openmed.analyze_text. Carry subject.reference as the rejoin key.

• Server-side $de-identify: openmed.interop.fhir_operations implements the FHIR $de-identify operation logic over the OpenMed privacy pipeline:

  • de_identify_resource(resource, policy=..., method=...)
  • de_identify_bundle(bundle, policy=..., method=...)
  • de_identify(parameters) — accepts/returns a Parameters envelope and reports modified element paths as an OperationOutcome. It de-identifies free-text strings, identifier values, and text.div narrative while never altering codes, references, systems, or temporal values. Use this to de-identify a whole fetched Bundle before storage:

  from openmed.interop.fhir_operations import de_identify_bundle
  safe_bundle = de_identify_bundle(bundle, policy="hipaa_safe_harbor",
                                   method="replace")

• Onward: re-export structured findings with openmed.clinical.exporters.fhir (to_bundle, to_operation_outcome).

Edge cases & gotchas

• Attachments are often base64. attachment.data is base64; large files use attachment.url (a separate Binary fetch) instead. Handle both.
• Non-text content types. application/pdf, text/rtf, scanned TIFF — do not utf-8 decode these; send bytes to OpenMed multimodal/OCR intake.
• Pagination loops. Some servers emit cyclic or stale next links; cap page count and dedupe by resource id.
• _revinclude vs _include. _include pulls referenced resources; _revinclude pulls resources that reference yours. Mixing them changes Bundle entry search.mode (match vs include) — filter on it.
• Versioning & profiles. Confirm the server is R4 (/metadata CapabilityStatement) and US Core-conformant; field cardinality differs across FHIR versions.
• Throttling. Respect 429/Retry-After; batch with _count and back off.
• PHI everywhere. A FHIR resource is PHI by definition — never log raw resources; de-identify before persistence or analytics.

Standards & references

• FHIR R4 specification: https://hl7.org/fhir/R4/
• FHIR RESTful API & search: https://hl7.org/fhir/R4/http.html and https://hl7.org/fhir/R4/search.html
• US Core Implementation Guide: https://hl7.org/fhir/us/core/
• DocumentReference: https://hl7.org/fhir/R4/documentreference.html
• DiagnosticReport (presentedForm): https://hl7.org/fhir/R4/diagnosticreport.html
• SMART on FHIR (backend services auth): https://hl7.org/fhir/smart-app-launch/