FHIR resource references

This page explains how the Cloud Healthcare API supports FHIR resource references.


FHIR resource references are directional links from a source resource to a target resource. FHIR resource references can be used to connect resources. For example, the FHIR resource type Observation has a subject field of Reference type, which can be used to link to a Patient resource as the subject of the observation.

FHIR resource references can also be circular. For example, the FHIR resource type CarePlan has a replaces field that can point to another CarePlan.

The most important element in the FHIR reference structure is reference. The other elements, such as display and identifier are persisted as they are in the Cloud Healthcare API.

The supported formats of Reference.reference in the Cloud Healthcare API include:

Local resource reference

Resource references are defined as RESOURCE_TYPE/RESOURCE_ID. The Cloud Healthcare API also supports prepending the full FHIR store name in front of RESOURCE_TYPE/RESOURCE_ID. For example, FHIR_STORE_NAME/RESOURCE_TYPE/RESOURCE_ID. If you use this format, the store name must match the FHIR store of the request. Otherwise, the request is rejected due to non-local references.

The store configuration option FhirStore.disableReferentialIntegrity controls the referential integrity check for local reference validation, which is enabled by default. For more information on the referential integrity check, see FHIR referential integrity.

Versioned references

Cloud Healthcare API supports references to a specific version of the target resource. To link to a specific version of the target resource, use the format after the RESOURCE_ID/_history/VERSION_ID] in the local reference.

When the referential integrity check is enabled, the server verifies that the historical version exists in the FHIR store. The Resource-purge method removes historical versions regardless of whether they are referenced.

Conditional references

As an alternative to explicitly specifying the target resource ID, executeBundle accepts a conditional reference search query for the target resource that resolves to the target resource ID at request time. For example, Patient?identifier=abc.

If the search query does not resolve to a target resource or resolves to more than one target resource, the server rejects the request regardless of whether referential integrity checking is enabled.

URI beginning with urn:uuid or urn:oid

When using the executeBundle method with a transaction bundle, universally unique identifier (UUID) or object identifier(OID) references can be used to resolve references to other resources being created or updated in the same bundle. For more information, see the Managing FHIR bundles guide.

Full external URL

Full external URLs such as http://www.example.com/abc are stored unmodified in the reference field. The Cloud Healthcare API does not resolve the URL or try to verify its validity.

When the full external URL matches the full URL of the FHIR store of the request, the reference is treated as a local resource reference.

Fragment reference

A fragment reference points to a contained resource inlined in a resource. For example, if an Observation record mentions a general practitioner but there is no controlled practitioner directory, a full Practitioner resource can't be created. The general practitioner is a contained resource in the Observation record. The Reference fields on a resource can point to the inlined resources using the form of #[INLINE_RESOURCE_ID].

In the following FHIR R4 sample, p1 and p2 are inline resource IDs that are referenced as #p1 and #p2:

  "resourceType": "Observation",
  "contained": [
      "id": "p1",
      "generalPractitioner": {"reference": "#p2"}
      "id": "p2"
  "status": "final",
  "subject": {"reference": "#p1"},
  "performer": [{"reference": "#p2"}]

The [INLINE_RESOURCE_ID] must exist as a contained resource inside the resource, otherwise the server rejects the request. The contained resource can only be referenced by its container or other contained resources inside the same container.