Post Resource

A prior reading of how to use the SMART Client is required to understand this section.

Document Reference

Example: Post a DocumentReference to Epic

The following code snippet takes a Client object and uses it to post a DocumentReference note to Epic

Post new DocumentReference to Epic SMARTerFHIR client

const response = await client.create(myDocumentReference).catch((reason) => {
  throw new Error(`Failed to create resource because: ${reason}`);
});

console.log(response);

The following EMR FHIR scope is required to post this resource and must be included in the EMR Client App configuration:

DocumentReference.Create (Clinical Notes) (R4)

The corresponding myDocumentReference:

The original myDocumentreference object

import { DocumentReference } from "fhir/r4";

const noteText = "Some example Note text"
const myDocumentReference: DocumentReference = {
    "resourceType": "DocumentReference",
    "status": "current",
    "docStatus": "final",
    "type": {
        "coding": [
            {
                "system": "http://loinc.org",
                "code": "11488-4",
                "display": "Consultation Note"
            }
        ],
        "text": "Consultation Note"
    },
    "content": [
        {
            "attachment": {
                "contentType": "text/plain",
                "data": `${Buffer.from(noteText).toString('base64')}`
            }
        }
    ]
};

Note that we're posting the Document as an HL7 FHIR Resource defined using HL7's respective Typescript package

Additionally, our DocumentReference is missing Patient and Encounter information. That's because our create function for posting Resources automatically gets the Patient and Encounter context from our Client object and inserts it into myDocumentReference before posting it to the EMR. The respective response object shows us the Resource that was fully fleshed out and created as a result of calling the function:

DocumentReference as stored in the EMR

{
  "resourceType": "DocumentReference",
  "id": "eVehqmHLo5UycK879nxPi2g3",
  "identifier": [
    {
      "system": "urn:oid:1.2.840.114350.1.13.0.1.7.2.727879",
      "value": "196963"
    },
    {
      "system": "urn:oid:1.2.840.114350.1.72.3.15",
      "value": "1.2.840.114350.1.13.0.1.7.2.727879_196963"
    }
  ],
  "status": "current",
  "docStatus": "final",
  "type": {
    "coding": [
      {
        "system": "urn:oid:1.2.840.114350.1.13.0.1.7.4.737880.5010",
        "code": "2",
        "display": "Consults"
      },
      {
        "system": "urn:oid:1.2.840.114350.1.72.727879.69848980",
        "code": "2",
        "display": "Consults"
      },
      {
        "system": "http://loinc.org",
        "code": "11488-4",
        "display": "Consult note",
        "userSelected": true
      }
    ],
    "text": "Consults"
  },
  "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/eOPSKZbz6YIgoilQprzPy0Q3",
    "display": "Cadence, Anna"
  },
  "date": "2023-06-22T19:41:32Z",
  "author": [
    {
      "reference": "Practitioner/evNp-KhYwOOqAZn1pZ2enuA3",
      "type": "Practitioner",
      "display": "User Interconnect"
    }
  ],
  "authenticator": {
    "extension": [
      {
        "valueDateTime": "2023-06-22T19:41:32Z",
        "url": "http://open.epic.com/FHIR/StructureDefinition/extension/clinical-note-authentication-instant"
      }
    ],
    "reference": "Practitioner/evNp-KhYwOOqAZn1pZ2enuA3",
    "type": "Practitioner",
    "display": "User Interconnect"
  },
  "custodian": {
    "identifier": { "system": "urn:ietf:rfc:3986", "value": "urn:oid:fhir" },
    "display": "Epic USCDI on FHIR"
  },
  "securityLabel": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "NOPAT",
          "display": "no disclosure to patient, family or caregivers without attending provider's authorization"
        }
      ],
      "text": "no disclosure to patient, family or caregivers without attending provider's authorization"
    }
  ],
  "content": [
    {
      "attachment": {
        "contentType": "text/html",
        "url": "Binary/eKsW51SKNSHP1EO4P4wYFpA3"
      },
      "format": {
        "system": "http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem",
        "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
        "display": "mimeType Sufficient"
      }
    },
    {
      "attachment": {
        "contentType": "text/rtf",
        "url": "Binary/fXSaIwomPYHPUiA17s0dUWstMdTZcwU3xbmhNJrv7kck4"
      },
      "format": {
        "system": "http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem",
        "code": "urn:ihe:iti:xds:2017:mimeTypeSufficient",
        "display": "mimeType Sufficient"
      }
    }
  ],
  "context": {
    "extension": [
      {
        "valueCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:1.2.840.114350.1.13.0.1.7.4.836982.1040",
              "code": "3",
              "display": "Registered Nurse"
            }
          ],
          "text": "Registered Nurse"
        },
        "url": "http://open.epic.com/FHIR/StructureDefinition/extension/clinical-note-author-provider-type"
      }
    ],
    "encounter": [
      {
        "reference": "Encounter/eVffiE7SavpOc0PtATuBQWg3",
        "identifier": {
          "use": "usual",
          "system": "urn:oid:1.2.840.114350.1.13.0.1.7.3.698084.8",
          "value": "27485"
        },
        "display": "Office Visit"
      }
    ],
    "period": { "start": "2019-04-18T13:30:00Z" }
  }
}

Note that the content is stored in an attachment url.

The following is an example of how to read back the DocumentReference Binary content from the EMR to confirm that the POST was successful:

Retrieve Attachment Objects from Response

const docReferenceBinaryIds = response.content.map(item => item.attachment.url)
const attachments = docReferenceBinaryIds.filter((id): id is string => !!id).map(async id => {
    return await client.requestResource(id)
})
attachments.forEach(async attachment => console.log(await attachment))

The following EMR FHIR scopes are required to read these resources and must be included in the EMR Client App configuration:

DocumentReference.Read (Clinical Notes) (R4)
Binary.Read (Clinical Notes) (R4)

Patient

Example: Posting a Patient

The following code snippet takes a Client object and uses it to post a Patient resource to Epic:

Post new Patient to Epic SMARTerFHIR client

const response = await client.create(myPatient).catch((reason) => {
  throw new Error(`Failed to create resource because: ${reason}`);
});

console.log(response);

Unlike the DocumentReference example, we do not provide a patient or encounter ID to the create function

The following EMR FHIR scope is required to post this resource and must be included in the EMR Client App configuration:

Patient.Create (Clinical Notes) (R4)

The corresponding myPatient:

The original Patient object


const noteText = "Some example Note text"
const myPatient: Patient = {
    "resourceType": "Patient",
    "name": [
        {
            "use": "usual",
            "given": [
                "Demo"
            ],
            "family": "Patient",
            "prefix": [
                "Mr."
            ]
        }
    ],
    "gender": "male",
    "birthDate": "1990-01-01",
    "address": [
        {
            "use": "home",
            "type": "both",
            "line": [
                "123 Main St"
            ],
            "city": "Anytown",
            "state": "CA",
            "postalCode": "12345",
            "country": "US"
        }
    ]
};