Custom FHIR Operations

Custom FHIR Operations is a powerful feature that allows you to extend the Medplum FHIR server with your own custom operations using the Medplum Bots framework. This feature enables you to create sophisticated business logic that integrates seamlessly with the FHIR API while leveraging the full power of JavaScript execution.

warning

Medplum Custom FHIR Operations are in beta. As this is a beta feature, please note:

• APIs may change based on feedback
• Performance characteristics are still being optimized
• Some edge cases may not be fully handled
• Documentation and tooling are evolving

What are Custom FHIR Operations?

Custom FHIR Operations combine two key Medplum features:

1. FHIR Operations - Standard FHIR operations (like $validate, $expand, etc.) that can be invoked via HTTP requests
2. Medplum Bots - JavaScript functions that can be executed server-side with access to the Medplum SDK

This integration allows you to:

• Define custom business logic using JavaScript
• Expose that logic as standard FHIR operations
• Maintain full FHIR compliance while extending functionality
• Process and transform FHIR resources programmatically
• Integrate with external systems and APIs

How It Works

Custom operations are implemented through three main components:

1. Bot - Contains the JavaScript code that implements your custom logic
2. OperationDefinition - Defines the operation interface and links to your Bot
3. Extension - Links the OperationDefinition to the Bot implementation

When a client calls your custom operation (e.g., POST /fhir/R4/Patient/$my-custom-operation), Medplum:

1. Looks up the corresponding OperationDefinition
2. Finds the linked Bot via the extension
3. Executes the Bot with the operation input
4. Returns the Bot's output as the operation result

How to Use Custom FHIR Operations

Step 1: Create a Bot

First, create a Bot that contains your custom logic:

exports.handler = async function (medplum, event) {
  const patient = event.input;

  // Your custom logic here
  patient.identifier = patient.identifier || [];
  patient.identifier.push({
    system: 'https://example.com/patient-id',
    value: '12345',
  });

  return patient;
};

See Bot Basics for more details on creating Bots.

Important Requirements:

• Your Medplum project must have the bots feature enabled
• The handler function receives medplum (SDK instance) and event (operation context)
• event.input contains the operation input (request body for POST, query params for GET)
• Return value becomes the operation output

Step 2: Deploy the Bot

Deploy your Bot code using the $deploy operation:

curl -X POST "https://api.medplum.com/fhir/R4/Bot/{bot-id}/\$deploy" \
  -H "Content-Type: application/fhir+json" \
  -H "Authorization: Bearer {access-token}" \
  -d '{
    "code": "exports.handler = async function (medplum, event) { ... }"
  }'

Step 3: Create an OperationDefinition

Create an OperationDefinition that describes your operation and links to your Bot:

{
  "resourceType": "OperationDefinition",
  "extension": [
    {
      "url": "https://medplum.com/fhir/StructureDefinition/operationDefinition-implementation",
      "valueReference": {
        "reference": "Bot/{bot-id}"
      }
    }
  ],
  "name": "my-custom-operation",
  "status": "active",
  "kind": "operation",
  "code": "my-custom-operation",
  "system": true,
  "type": false,
  "instance": false,
  "parameter": [
    {
      "use": "in",
      "name": "input",
      "type": "Patient",
      "min": 1,
      "max": "1"
    },
    {
      "use": "out",
      "name": "return",
      "type": "Patient",
      "min": 1,
      "max": "1"
    }
  ]
}

Key Requirements:

• Must include the operationDefinition-implementation extension
• Extension must reference a Bot resource
• Define appropriate input/output parameters

Step 4: Invoke Your Custom Operation

Once deployed, you can invoke your custom operation like any standard FHIR operation:

curl -X POST "https://api.medplum.com/fhir/R4/Patient/\$my-custom-operation" \
  -H "Content-Type: application/fhir+json" \
  -H "Authorization: Bearer {access-token}" \
  -d '{
    "resourceType": "Patient",
    "name": [
      {
        "family": "Smith",
        "given": ["John"]
      }
    ]
  }'

Operation Types

Custom operations support all standard FHIR operation types:

• System-level operations: /fhir/R4/$my-operation
• Type-level operations: /fhir/R4/Patient/$my-operation
• Instance-level operations: /fhir/R4/Patient/123/$my-operation

Configure the operation type using the system, type, and instance properties in your OperationDefinition.

Input and Output Handling

Input Processing

• POST requests: Request body is passed as event.input
• GET requests: Query parameters are passed as event.input
• Access to full request context via event.headers, etc.

Output Processing

The Bot's return value is automatically formatted according to the OperationDefinition's output parameters. You can return:

• FHIR resources directly
• Primitive values (strings, numbers, booleans)
• Complex objects that match the defined output structure

Security and Permissions

Custom operations inherit the security model of both Bots and FHIR operations:

• Users must have permission to read the Bot resource
• Bot execution follows the Bot's runAsUser configuration
• Standard FHIR access controls apply to the operation endpoint
• Operations can be system-level, type-level, or instance-level with appropriate permissions

Error Handling

If your Bot encounters an error:

• Return an OperationOutcome resource for controlled error responses
• Thrown exceptions will be caught and converted to appropriate HTTP error responses
• Use standard FHIR error patterns for consistent client handling

Example Use Cases

• Data validation: Custom validation rules beyond standard FHIR constraints
• Data transformation: Convert between different FHIR profiles or external formats
• Integration: Connect to external systems, APIs, or databases
• Workflow automation: Implement complex business processes
• Reporting: Generate custom reports or analytics
• Decision support: Implement clinical decision support algorithms

Feedback and Support

We'd love your feedback on this beta feature! Please share:

• Use cases you're implementing
• Issues or limitations you encounter
• Suggestions for improvements
• Performance observations