​
Overview

When using the Medical API, Metriport will send Webhook messages to your app as soon as data becomes available.

This is the usual flow to obtain Patient data:

  1. You trigger a document query to retrieve a Patient’s medical documents from HIEs;
    • XML C-CDA documents will be converted and stored on Metriport’s FHIR storage;
    • as documents get downloaded and converted, you should get patient document data webhook messages;
  2. Once document conversion is completed, you can query for patient consolidated data;
    • depending on the amount of data this can take some time to crunch together, so results are sent through a webhook message: patient consolidated data

You should expect to get more than one Webhook message per patient per request (document query and/or consolidated data).

To enable this integration approach with Metriport, and for some prerequesite reading to understand how the Webhook flow works, see our Webhooks guide.

When you receive a webhook message, you should respond with a 200 status code within 4 seconds. We recommend processing the webhook request asynchronously.

​
Types of Messages

  • medical.document-download: result of Document Query, containing the newly downloaded documents for the patient - see details below;
  • medical.document-conversion: result of converting the newly downloaded C-CDA documents into FHIR - see details below;
  • medical.document-bulk-download-urls: list of download urls for a patient’s documents, see details below;
  • medical.consolidated-data: result of a Consolidated Data Query, containing the patient’s data in FHIR format - see details below.
  • medical.bulk-patient-create: updates for a Bulk Patient Create

​
Workflow

​
Download URLs

Below is a flowchart of the process to download all the raw documents we’ve received from the networks for a patient:

​
Consolidated Data

Below is a flowchart of the process to get a patient’s consolidated FHIR data:

​
Passing Metadata

You can pass metadata to endpoints that support webhooks, and you will receive the meta.data field of the webhook request.

Metadata holds a record of up to 50 custom string key-value pairs. Key names can be up to 40 characters long and values up to 500 characters long. You may use this to attach whatever metadata is relevant for your use-case - for example, external IDs. Below is an example payload you could send in the request body of one of those endpoints and how you would use the sdk:

{
  "metadata": {
     "youCan": "putAny",
     "stringKeyValue": "pairsHere",
  }
}
Metriport SDK
import { MetriportMedicalApi } from "@metriport/api-sdk";

const metadata = {
    youCan: "putAny",
    stringKeyValue: "pairsHere",
};

const metriport = new MetriportMedicalApi(apiToken);

const consolidatedData = await metriport.startConsolidatedQuery(
  patientId,
  ["AllergyIntolerance", "Appointment"] as const,
  "2023-03-01",
  "2023-04-01",
  undefined,
  metadata
);

​
Patient Document Data

These are messages you can expect to receive in the following scenarios:

  1. When queried documents have completed downloading, the message type will be medical.document-download, and at this point you’ll be able to download the raw files;
  2. Then, if the downloaded documents contained C-CDA/XML files, when the conversion to FHIR has completed, the message type will be medical.document-conversion, and at this point you’ll be able to query for patient consolidated data in FHIR-compliant format.

Note that the webhooks will only contain updates for new data fetched in the current document query.

{
  "meta": {
    "messageId": "<message-id>",
    "when": "<date-time-in-utc>",
    "type": "medical.document-download"
    "data": {
        youCan: "putAny",
        stringKeyValue: "pairsHere",
    }
  },
  "patients": [
    {
      "patientId": "eddeefa1-b54a-41d6-854f-0e91b7871d6a",
      "externalId": "1234567890",
      "additionalIds": {
        "athenahealth": ["99992"]
      },
      "type": "document-download",
      "status": "completed",
      "documents": [
        {
          "id": "1.2.543.1.34.1.34.134",
          "fileName": "CCDA_Diag.xml",
          "description": "Patient Diagnoses",
          "status": "current",
          "indexed": "2019-09-07T15:50:00.000Z",
          "mimeType": "application/xml",
          "size": "17344007",
          "type": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "62479008",
                "display": "Diagnoses"
              }
            ],
            "text": "Diagnoses"
          }
        },
        {
          "id": "1.2.543.1.224.54.22.540",
          "fileName": "Progress_Notes.xml",
          "description": "Patient Encounter Progress Notes 2023-03-22",
          "status": "current",
          "indexed": "2023-03-22T08:34:00.000Z",
          "mimeType": "application/xml",
          "size": "8675545",
          "type": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "371532007",
                "display": "Progress Report"
              }
            ],
            "text": "Progress Notes"
          }
        }
      ]
    },
    {
      "patientId": "<patient-id-2>",
      "type": "document-download",
      "status": "completed",
      ...
    }
  ]
}

The format follows:

​
meta
required

Metadata about the message. The full format is described here.

​
patients
PatientDocQueryUpdate[]
required

Array of Document query status updates - where each item corresponds to a specific patient.

​
Patient Consolidated Data

A Patient’s consolidated data is the result of converting all C-CDA documents into deduplicated and standardized FHIR, as well as other FHIR data your application has inserted into Metriport’s FHIR repository.

This data can be retrieved in either FHIR JSON format, or a rendered PDF or HTML Medical Record Summary.

Patients can have a large amount of data, so in order to have access to a Patient’s data:

  1. Trigger a consolidated data query - one query per patient at any given time;
  2. Your app can check the status by calling get consolidated query status (optional);
  3. When the result is ready, we’ll send a webhook message with the results (below).

Note that inside the Bundle you’ll find a DocumentReference resource with the first item in the content array containing an attachment with a url which can be used to download the data.

If there was no data available for the Patient, the Bundle will be empty (the entry array will have no elements).

Example payload:

{
  "meta": {
    "messageId": "1e82424a-1220-473d-a0d1-6e5fde15159e",
    "when": "2023-08-23T22:09:11.373Z",
    "type": "medical.consolidated-data"
  },
  "patients": [
    {
      "patientId": "eddeefa1-b54a-41d6-854f-0e91b7871d6a",
      "externalId": "1234567890",
      "additionalIds": {
        "athenahealth": ["99992"]
      },
      "status": "completed",
      "filters": {
        "resources": "Encounter,Observation"
      },
      "bundle": {
        "resourceType": "Bundle",
        "total": 1,
        "type": "collection",
        "entry": [
          {
            "resource": {
              "resourceType": "DocumentReference",
              "subject": {
                "reference": "Patient/eddeefa1-b54a-41d6-854f-0e91b7871d6a"
              },
              "content": [
                {
                  "attachment": {
                    "contentType": "application/json",
                    "url": "https://documents.s3.amazonaws.com/abc123-Amz-SignedHeaders=host"
                  }
                }
              ]
            }
          }
        ]
      }
    }
  ]
}

The format follows:

​
meta
required

Metadata about the message. The full format is described here.

​
patients
PatientConsolidatedData[]
required

Array of consolidated data query results - where each item corresponds to a specific patient.

​
Bulk Patient Create

During the processing of a Bulk Patient Create, the Metriport API sends Webhook messages of type medical.bulk-patient-create to indicate the status update and provide relevant information.

You can expect to get two messages of this type for each Bulk Patient Create, with the status being the main difference between each:

  • First message:
    • processing: the CSV file has been uploaded and is being processed;
  • Second message - one of:
    • completed: the bulk create is completed - includes the result CSV file;
    • failed: the bulk create failed (likely due to the uploaded file being invalid).

The URL will only be valid for 180 seconds (3 minutes).

Example payload:

{
  "meta": {
    "messageId": "00000000-00000000-00000000-00000000",
    "when": "2024-12-30T05:05:12.215Z",
    "type": "medical.bulk-patient-create"
  },
  "bulkPatientCreate": {
    "requestId": "00000000-00000000-00000000-00000000",
    "status": "completed",
    "result": "<presigned-download-url>"
  }
}

The format follows:

​
meta
required

Metadata about the message. The full format is described here.

​
bulkPatientCreate
BulkPatientCreate
required

The information about the Bulk Patient Create request.

​
Result CSV File

The message medical.bulk-patient-create with status completed includes a URL in the result field, which you can use to download the result of the Bulk Patient Create.

The URL will only be valid for 180 seconds (3 minutes).

The file is based on the same format as the input CSV, with the following additional columns:

​
metriportId
string

The ID of the Patient on Metriport - only provided if the Patient was created successfully.

​
status
string
required

Whether the respective demographics was accepted and used to create a Patient. Can be one of succeeded or failed.

​
reason
string

If the patient failed to be created, this indictes the reason for failure. Only included if the patient fails to be created.

An example of a result file can be accessed here.

​
Bulk Document Download URLs

If you want to download all of a patient’s documents, especially when they have a large volume of documents, you can start a Bulk Get Document URL query. We’ll send a webhook message with all the downloadable URLs for all the patient’s documents. You can use the value of the url property in the returned documents objects to download the files.

The URLs will only be valid for 600 seconds (10 minutes).

Here is an example payload:

{
"meta": {
    "messageId": "bd4184dd-3b35-4c60-8130-447d1d528fea",
    "when": "2023-11-30T05:05:12.215Z",
    "type": "medical.document-bulk-download-urls"
  },
  "patients": [
    {
      "status": "completed",
      "patientId": "eddeefa1-b54a-41d6-854f-0e91b7871d6a",
      "externalId": "1234567890",
      "additionalIds": {
        "athenahealth": ["99992"]
      },
      "documents": [
        {
          "id": "018c1b94-57dc-7950-b564-f74ab9b56cc4",
          "size": 40670,
          "fileName": "81f2ec4e-c71c-4090-bf1c-9d8529f25b5a/018c1b94-2ed9-70f2-8b0f-ad4f8e8c7a16/81f2ec4e-c71c-4090-bf1c-9d8529f65b5a_018c1b94-2ed9-70f2-8b0f-ad4f8e8c7a16_018c1b94-57dc-7950-b564-f74ab9b56cc4.xml",
          "description": "Patient Diagnoses",
          "status": "current",
          "indexed": "2019-09-07T15:50:00.000Z",
          "mimeType": "application/xml",
          "size": 40670,
          "type": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "62479008",
                "display": "Diagnoses"
              }
            ],
            "text": "Diagnoses"
          }
          "url": "<a-document-url>"
        },
        {
          "id": "018c1b94-57dc-7950-b564-f749bcf9be3e",
          "fileName": "81f2ec4e-c71c-4090-bf1c-9d8529f25b5a/018c1b94-2ed9-70f2-8b0f-ad4f8e8c7a16/81f2ec4e-c71c-4090-bf1c-9d8529f65b5a_018c1b94-2ed9-70f2-8b0f-ad4f8e8c7a16_018c1b94-57dc-7950-b564-f749bcf9be3e.pdf",
          "description": "Patient Diagnoses",
          "status": "current",
          "indexed": "2019-09-07T15:50:00.000Z",
          "mimeType": "application/pdf",
          "size": 77093,
          "type": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "62479008",
                "display": "Diagnoses"
              }
            ],
            "text": "Diagnoses"
          }
          "url": "<another-document-url>"
        }
      ],
    }
  ]
}

The format is as follows:

​
meta
required

Metadata about the message. The full format is described here.

​
patients
DocumentBulkDownloadUrls[]
required

An array of Document bulk download URLs, where each item corresponds to the queried patient.