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Ralph Parkison

Ralph Parkison

Haste Health maintainer

Healthcare engineer with over a decade of experience building clinical data platforms, interoperability tooling, and provider-facing workflows; Background includes working at Epic Systems and Commure and building FHIR tools with Augolit, Genfhi, and IGUHealth.

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May 2026 Feature Updates

· 6 min read
Ralph Parkison
Ralph Parkison
Haste Health maintainer

April 2026 Feature Updates

· 4 min read
Ralph Parkison
Ralph Parkison
Haste Health maintainer

March 2026 Feature Updates

· 3 min read
Ralph Parkison
Ralph Parkison
Haste Health maintainer

February 2026 Feature Updates

· 3 min read
Ralph Parkison
Ralph Parkison
Haste Health maintainer

January 2026 Feature Updates

· 3 min read
Ralph Parkison
Ralph Parkison
Haste Health maintainer

Writing a High-Performance Clinical Data Repository in Rust

· 16 min read
Ralph Parkison
Ralph Parkison
Haste Health maintainer

Background information​

Rust is a systems programming language focused on safety, speed, and concurrency. We use Rust as the primary language for our backend at Haste Health.

  • FHIR - Modern standard for storing/retrieving healthcare data.
  • Hl7V2 - Legacy healthcare standard for messaging healthcare data.

Why Rust​

Performance matters in healthcare​

Healthcare systems process massive amounts of data. Most healthcare systems broadcast their data and events using a legacy standard called Hl7V2. To have a real time clinical data repository a neccessary requirement is to be able to injest these Hl7V2 messages.

Hl7V2 messages can be published for a variety of events within a healthcare system including patient admission, patient discharge, medication orders as a few examples. For most large healthcare systems this ends up being millions of Hl7V2 messages being sent daily.

Compounding on top of this is that the translation from Hl7V2 to other standards often requires mutating or creating multiple resources. As an example an ADT (Admit, Discharge, Transfer) Hl7V2 Message can provide information for a Patient, details about their Hospital visit, observations and clinical information recorded during their visit. A single message may require your system to perform multiple operations at once see below for an example.

The following are a few real world examples:​

  • Healthcare System A

    • ~8 million HL7v2 messages a day
    • ~15 FHIR resources created per message for their implementation
    • ~1,500 FHIR resources/second being streamed out of their EHR.

  • Healthcare System B

    • ~15 million Hl7V2 message accross their organization
    • ~8,000 FHIR resources/second being streamed out of their EHR

Processing healthcare data can be compute intensive:​

For our CDR we natively store data as FHIR resources. This requires a significant amount of data processing in the application. For each Resource created we must index it according to SearchParameter resources. These are FHIR resources that define what parameters are available to search for a given resource. And how to index resources by extracting values from the resource using FHIRPath which is a query language similiar to JSONPath.

For example the Patient resource contains the following parameters (+ a few of our custom parameters for our system):

ParameterFHIRPath Expression
_haste-health-author (reference)Resource.meta.extension.where(url='https://haste.health/author').value
_type (token)$this.type().name
_id (token)Resource.id
_lastUpdated (date)Resource.meta.lastUpdated
_profile (uri)Resource.meta.profile
_security (token)Resource.meta.security
_source (uri)Resource.meta.source
_tag (token)Resource.meta.tag
active (token)Patient.active
address (string)Patient.address / Person.address / Practitioner.address / RelatedPerson.address
address-city (string)Patient.address.city / Person.address.city / Practitioner.address.city / RelatedPerson.address.city
address-country (string)Patient.address.country / Person.address.country / Practitioner.address.country / RelatedPerson.address.country
address-postalcode (string)Patient.address.postalCode / Person.address.postalCode / Practitioner.address.postalCode / RelatedPerson.address.postalCode
address-state (string)Patient.address.state / Person.address.state / Practitioner.address.state / RelatedPerson.address.state
address-use (token)Patient.address.use / Person.address.use / Practitioner.address.use / RelatedPerson.address.use
birthdate (date)Patient.birthDate / Person.birthDate / RelatedPerson.birthDate
death-date (date)(Patient.deceased.ofType(dateTime))
deceased (token)Patient.deceased.exists() and Patient.deceased != false
email (token)Patient.telecom.where(system='email') / Person.telecom.where(system='email') / Practitioner.telecom.where(system='email') / PractitionerRole.telecom.where(system='email') / RelatedPerson.telecom.where(system='email')
family (string)Patient.name.family / Practitioner.name.family
gender (token)Patient.gender / Person.gender / Practitioner.gender / RelatedPerson.gender
general-practitioner (reference)Patient.generalPractitioner
given (string)Patient.name.given / Practitioner.name.given
identifier (token)Patient.identifier
language (token)Patient.communication.language
link (reference)Patient.link.other
name (string)Patient.name
organization (reference)Patient.managingOrganization
phone (token)Patient.telecom.where(system='phone') / Person.telecom.where(system='phone') / Practitioner.telecom.where(system='phone') / PractitionerRole.telecom.where(system='phone') / RelatedPerson.telecom.where(system='phone')
phoneticPatient.name / Person.name / Practitioner.name / RelatedPerson.name
telecom (token)Patient.telecom / Person.telecom / Practitioner.telecom / PractitionerRole.telecom / RelatedPerson.telecom

When a Patient resource is created we evaluate all of these parameters with fhirpath in the application and then index the extracted values to our search store.

Here is an example of indexing the name Parameter for a Patient resource:

Given the following Patient resource:

{
  "resourceType": "Patient",
  "id": "example",
  "name": [
    {
      "use": "official",
      "family": "Chalmers",
      "given": ["Peter", "James"]
    },
    {
      "use": "usual",
      "given": ["Jim"]
    }
  ]
}

The name parameter uses the FHIRPath expression Patient.name which extracts all name elements from the Patient resource. In this case

  • { "use": "official", "family": "Chalmers", "given": ["Peter", "James"] }
  • { "use": "usual", "given": ["Jim"] }.

We then run a conversion on these name elements to extract string tokens for indexing. From the first name element we extract the following tokens: Chalmers, Peter, James. From the second name element we extract the token: Jim.

For processing a single Patient resource you end up running ~25 FHIRPath expressions. Converting the results to indexable tokens and then writing those to your search index.

Compounding on top of this FHIR has a concept of transaction/batch processing where multiple resources can be created/updated/deleted in a single request.

Processing FHIR Transactions:​

In FHIR a transaction is a bundle of multiple operations that must be processed atomically. Each operation within the transaction may have inter-dependencies between operations within the transaction.

For example an operation may create a Patient resource and a subsequent operation within the same transaction may create an Observation resource that references the newly created Patient. The following bundle creates a Patient, Encounter and an Observation within a single transaction and links them together via references.

{
  "resourceType": "Bundle",
  "type": "transaction",
  "entry": [
    {
      "fullUrl": "observation",
      "resource": {
        "resourceType": "Observation",
        "identifier": [
          {
            "use": "official",
            "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
            "value": "6326"
          }
        ],
        "status": "final",
        "code": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "789-8",
              "display": "Erythrocytes [#/volume] in Blood by Automated count"
            }
          ]
        },
        "subject": {
          "reference": "patient"
        },
        "encounter": {
          "reference": "encounter"
        },
        "effectivePeriod": {
          "start": "2013-04-02T10:30:10+01:00",
          "end": "2013-04-05T10:30:10+01:00"
        },
        "issued": "2013-04-03T15:30:10+01:00",
        "performer": [
          {
            "reference": "Practitioner/f005",
            "display": "A. Langeveld"
          }
        ],
        "valueQuantity": {
          "value": 4.12,
          "unit": "10^12/L",
          "system": "http://unitsofmeasure.org",
          "code": "10*12/L"
        },
        "interpretation": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
                "code": "L",
                "display": "Low"
              }
            ]
          }
        ],
        "referenceRange": [
          {
            "text": " 12-14 y Male: 4.4 - 5.2  x  10^12/L ; 12-14 y Female: 4.2 - 4.8  x  10^12/L ; 15-17 y Male: 4.6 - 5.4  x  10^12/L ; 15-17 y Female: 4.2 - 4.8  x  10^12/L ; 18-64 y Male: 4.6 - 5.4  x  10^12/L ; 18-64 y Female: 4.0 - 4.8  x  10^12/L ; 65-74 y Male: 4.3 - 5.3  x  10^12/L ; 65-74 y Female: 4.1 - 4.9  x  10^12/L       "
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Observation"
      }
    },
    {
      "fullUrl": "patient",
      "resource": {
        "resourceType": "Patient",
        "name": [{ "given": ["Bob"], "family": "Peter" }]
      },
      "request": {
        "method": "POST",
        "url": "Patient"
      }
    },
    {
      "fullUrl": "encounter",
      "resource": {
        "resourceType": "Encounter",
        "id": "example",
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Encounter with patient @example</div>"
        },
        "status": "in-progress",
        "class": {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "IMP",
          "display": "inpatient encounter"
        },
        "subject": {
          "reference": "patient"
        }
      },

      "request": {
        "method": "POST",
        "url": "Encounter"
      }
    }
  ]
}

This requires the application to process each operation in correct order. In our case we go through a resources fields and check for links between them. Afterwards we build a dependency graph of all operations within the transaction and perform a topological sort to determine the correct order to process each operation.

All of this processing requires significant CPU resources. Using Rust allows us to maximize performance in these hot paths of the application.

Here are a few benchmarks we have collected comparing our Rust implementation vs our Typescript implementation.

Benchmarking Rust vs Typescript implementations.​

FHIRPath Benchmarks:

RustTypescriptDescription
11.673 µs51.49 µsEvaluate all patient search parameters against a synthea generated patient

Transaction Processing Benchmarks:

RustTypescriptDescription
39ms110 msUsing a synthea transaction bundle with ~700 resources.

Challenges in Rust​

The following are a few challenges encountered when building a large-scale clinical data repository in Rust.

Rust does not have reflection built in​

Rust does not have a native reflection system like Java, We needed this for our FHIRPath engine to be able to evaluate FHIRPath expressions on arbitrary FHIR resources and for pieces down the road like FHIR Profiling.

We ended up building a simple custom derive macro that generates code to allow us to introspect FHIR resources at runtime.

Occasionally hitting a roadblock with the borrow checker​

Broadly speaking Rust's borrow checker errors were relatively straightforward to solve. However, we ran into a few specific scenarios that were tricky.

For example:

In our FP implementation we generally want to return references to data within the resource being queried. And these references need to have the same lifetime as the resource being queried. However, it is also possible to return owned data from FP expressions; for example, the following FHIRPath 'my-string' would create a new string. This made it tricky to define the correct lifetimes for our evaluation context and return types.

What ultimately worked for us was to use an internal data structure to allocate owned data into a vector and then return references to that vector. At the end of the evaluation we return a wrapped value with the data allocated in the vector and references to either the data owned in the vector or to the resource passed in.

** We weren't able to use Cow here because the returned value was a trait not compatible with Cow **

Custom Serialization/Deserialization​

FHIR is a very complex standard with many nuances. We had to implement custom serialization/deserialization for FHIR. The default serde_json implementation does not cover several edge cases within FHIR. Although not specific to Rust, this required building custom serialization/deserialization.

We ended up building a custom derive macro here. Here's a few examples of edge cases unique to FHIR Json serialization/deserialization.

  • Primitive types with extensions In FHIR primitive types can have extensions. These are represented in JSON by having a field with the same name as the primitive prefixed with an underscore. For example Patient.name.family is a FHIR string primitive. If it has extensions it would be represented in JSON as both Patient.name.family and for extension Patient.name._family.
  • Type choices In FHIR certain fields can be one of multiple types. These are represented in JSON by having the field name suffixed with the type name. For Example Patient.deceased can be a boolean or a dateTime. In JSON these would be represented as either deceasedBoolean or deceasedDateTime.

The following example shows "Patient.name.family" which is a FHIR string primitive with an extension, "Patient.name.given" primitve array with extensions. Finally "deceased" which is primitive with an extension and is a typechoice.

{
  "resourceType": "Patient",
  "id": "pw7n1cwjla0vek6vg0u3bjm9r3",
  "meta": {
    "extension": [
      {
        "url": "https://haste.health/author",
        "valueReference": {
          "reference": "Membership/tfjpl0ob8rpvthppkk0uxks-gf"
        }
      }
    ],
    "versionId": "g43wfhebt6frvk1men5b6i0t42",
    "lastUpdated": "2026-01-24T03:19:46.542+00:00"
  },
  "name": [
    {
      "family": "example",
      "_family": {
        "extension": [
          {
            "url": "http://example.org/fhir/StructureDefinition/custom-extension",
            "valueString": "custom value"
          }
        ]
      },
      "_given": [
        {
          "extension": [
            {
              "url": "http://example.org/fhir/StructureDefinition/extension-1",
              "valueString": "value-1"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://example.org/fhir/StructureDefinition/extension-2",
              "valueString": "value-2"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://example.org/fhir/StructureDefinition/extension-3",
              "valueString": "value-3"
            }
          ]
        }
      ],
      "given": [
        "Bob",
        "Peter",
        "James"
      ]
    }
  ],
  "deceasedDateTime": "1974-12-25",
  "_deceasedDateTime": {
    "extension": [
      {
        "url": "http://hl7.org/fhir/StructureDefinition/birthdate-ext",
        "valueCode": "estimated"
      }
    ]
  }
}

This would deserialize into the following Rust structure:

Patient {
    id: Some(
        "pw7n1cwjla0vek6vg0u3bjm9r3",
    ),
    meta: Some(
        Meta {
            id: None,
            extension: Some(
                [
                    Extension {
                        id: None,
                        extension: None,
                        url: "https://haste.health/author",
                        value: Some(
                            Reference(
                                Reference {
                                    id: None,
                                    extension: None,
                                    reference: Some(
                                        FHIRString {
                                            id: None,
                                            extension: None,
                                            value: Some(
                                                "Membership/tfjpl0ob8rpvthppkk0uxks-gf",
                                            ),
                                        },
                                    ),
                                    type_: None,
                                    identifier_: None,
                                    display: None,
                                },
                            ),
                        ),
                    },
                ],
            ),
            versionId: Some(
                FHIRId {
                    id: None,
                    extension: None,
                    value: Some(
                        "bnim6uouyqzeajzp2gbxad4nla",
                    ),
                },
            ),
            lastUpdated: Some(
                FHIRInstant {
                    id: None,
                    extension: None,
                    value: Some(
                        Iso8601(
                            2026-01-24T03:24:17.805Z,
                        ),
                    ),
                },
            ),
            source: None,
            profile: None,
            security: None,
            tag: None,
        },
    ),
    implicitRules: None,
    language: None,
    text: None,
    contained: None,
    extension: None,
    modifierExtension: None,
    identifier_: None,
    active: None,
    name: Some(
        [
            HumanName {
                id: None,
                extension: None,
                use_: None,
                text: None,
                family: Some(
                    FHIRString {
                        id: None,
                        extension: Some(
                            [
                                Extension {
                                    id: None,
                                    extension: None,
                                    url: "http://example.org/fhir/StructureDefinition/custom-extension",
                                    value: Some(
                                        String(
                                            FHIRString {
                                                id: None,
                                                extension: None,
                                                value: Some(
                                                    "custom value",
                                                ),
                                            },
                                        ),
                                    ),
                                },
                            ],
                        ),
                        value: Some(
                            "example",
                        ),
                    },
                ),
                given: Some(
                    [
                        FHIRString {
                            id: None,
                            extension: Some(
                                [
                                    Extension {
                                        id: None,
                                        extension: None,
                                        url: "http://example.org/fhir/StructureDefinition/extension-1",
                                        value: Some(
                                            String(
                                                FHIRString {
                                                    id: None,
                                                    extension: None,
                                                    value: Some(
                                                        "value-1",
                                                    ),
                                                },
                                            ),
                                        ),
                                    },
                                ],
                            ),
                            value: Some(
                                "Bob",
                            ),
                        },
                        FHIRString {
                            id: None,
                            extension: Some(
                                [
                                    Extension {
                                        id: None,
                                        extension: None,
                                        url: "http://example.org/fhir/StructureDefinition/extension-2",
                                        value: Some(
                                            String(
                                                FHIRString {
                                                    id: None,
                                                    extension: None,
                                                    value: Some(
                                                        "value-2",
                                                    ),
                                                },
                                            ),
                                        ),
                                    },
                                ],
                            ),
                            value: Some(
                                "Peter",
                            ),
                        },
                        FHIRString {
                            id: None,
                            extension: Some(
                                [
                                    Extension {
                                        id: None,
                                        extension: None,
                                        url: "http://example.org/fhir/StructureDefinition/extension-3",
                                        value: Some(
                                            String(
                                                FHIRString {
                                                    id: None,
                                                    extension: None,
                                                    value: Some(
                                                        "value-3",
                                                    ),
                                                },
                                            ),
                                        ),
                                    },
                                ],
                            ),
                            value: Some(
                                "James",
                            ),
                        },
                    ],
                ),
                prefix: None,
                suffix: None,
                period: None,
            },
        ],
    ),
    telecom: None,
    gender: None,
    birthDate: None,
    deceased: Some(
        DateTime(
            FHIRDateTime {
                id: None,
                extension: Some(
                    [
                        Extension {
                            id: None,
                            extension: None,
                            url: "http://hl7.org/fhir/StructureDefinition/birthdate-ext",
                            value: Some(
                                Code(
                                    FHIRCode {
                                        id: None,
                                        extension: None,
                                        value: Some(
                                            "estimated",
                                        ),
                                    },
                                ),
                            ),
                        },
                    ],
                ),
                value: Some(
                    YearMonthDay(
                        1974,
                        12,
                        25,
                    ),
                ),
            },
        ),
    ),
    address: None,
    maritalStatus: None,
    multipleBirth: None,
    photo: None,
    contact: None,
    communication: None,
    generalPractitioner: None,
    managingOrganization: None,
    link: None,
}

Where Rust shines​

Data Modeling and validation​

The FHIR standard defines it's data model with a metadata resource called StructureDefinition. This resource behaves similiarly to a JSON Schema or Protobuf definition. It defines the fields, types and constraints for each FHIR resource. We use these StructureDefinitions to generate Rust types for each FHIR resource. A nice aspect of our generated rust types is how much we are able to represent as enums in rust. For example Patient.gender is a code [string value with a fixed set of allowed values]. What values are allowed are defined here.

We were able to represent these various terminologies in rust as follows::

#[derive(Debug, Clone, FHIRJSONSerialize, FHIRJSONDeserialize)]
#[fhir_serialize_type = "valueset"]
pub enum AdministrativeGender {
    #[doc = "Female"]
    #[code = "female"]
    Female(Option<Element>),
    #[doc = "Male"]
    #[code = "male"]
    Male(Option<Element>),
    #[doc = "Other"]
    #[code = "other"]
    Other(Option<Element>),
    #[doc = "Unknown"]
    #[code = "unknown"]
    Unknown(Option<Element>),
    #[doc = "If value is missing and just the element is present."]
    Null(Option<Element>),
}

Because rust enums support nesting structs we can also represent FHIR extensions on these code values. For example

{
  "resourceType": "Patient",
  "_gender": {
    "extension": [
      {
        "url": "https://haste.health/custom-extension",
        "valueCode": "my-value"
    }
    ]
  },
  "gender": "male"
}

gets deserialized into:

Patient {
    ...
    gender: Some(
        AdministrativeGender::Male (
            Some(
                Element {
                    ...,
                    extension: Some(
                        [
                            Extension {
                              ...
                                url: "https://haste.health/custom-extension",
                                value: Some(
                                    Code(
                                        FHIRCode {
                                            id: None,
                                            extension: None,
                                            value: Some(
                                                "my-value",
                                            ),
                                        },
                                    ),
                                ),
                            },
                        ],
                    ),
                },
            ),
        ),
    ),
    ...
}

Because validation of these code values is enforced at the type level we get a lot of safety when working with FHIR data. For example you cannot accidentally assign an invalid value to Patient.gender.

Also because we deserialize directly into types we get very fast validation of a significant subset of FHIR terminologies.

Ecosystem and Cargo​

Similiar to Clojure ecosystem the Rust libraries are generally very high quality and well maintained.
We ended up using axum for a backend and have found it to be flexible and easy to integrate with other libraries.

Cargo the Rust package manager is also fantastic. We setup our repository as a monorepo which cargo supports natively via workspaces.

Conclusion​

Using Rust for processing FHIR resources in our clinical data repository has provided significant performance improvements in critical areas such as FHIRPath evaluation, search parameter indexing, and FHIR transaction processing.

Coming from a background in higher-level languages like TypeScript and Clojure, Rust was easy to build performant and reliable systems for handling complex healthcare data.

Hl7V2 Example​

Using FHIR-Converter for an ADT A01 hl7v2 message we get corresponding FHIR transaction bundle. Each entry within the FHIR Bundle corresponds to an individual operation (PUT Patient, Put Practitioner etc...). When the system receives this bundle it processes all of these operations at once.

ADT A01 Raw Message

MSH|^~\\&|SIMHOSP|SFAC|RAPP|RFAC|20200508131015||ADT^A01|517|T|2.3|||AL||44|ASCII\nEVN|A01|20200508131015|||C005^Whittingham^Sylvia^^^Dr^^^DRNBR^PRSNL^^^ORGDR|\nPID|1|3735064194^^^SIMULATOR MRN^MRN|3735064194^^^SIMULATOR MRN^MRN~2021051528^^^NHSNBR^NHSNMBR||

Converts to the following:

FHIR Bundle

{
    "resourceType": "Bundle",
    "type": "transaction",
    "timestamp": "2020-05-08T13:10:15Z",
    "identifier": {
      "value": "517"
    },
    "id": "7dcb7d92-7a75-3d65-42f9-0f790afac4db",
    "entry": [
      {
        "fullUrl": "urn:uuid:aa521dd9-b613-0210-a661-82ce17e38fb3",
        "resource": {
          "resourceType": "MessageHeader",
          "id": "aa521dd9-b613-0210-a661-82ce17e38fb3",
          "source": {
            "name": "SIMHOSP",
            "_endpoint": {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
                  "valueCode": "unknown"
                }
              ]
            }
          },
          "destination": [
            {
              "name": "RAPP",
              "_endpoint": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
                    "valueCode": "unknown"
                  }
                ]
              },
              "receiver": {
                "reference": "Organization/ab0676d9-fa24-ffd3-327d-f5b4c26ae628"
              }
            }
          ],
          "meta": {
            "tag": [
              {
                "code": "T",
                "system": "http://terminology.hl7.org/CodeSystem/v2-0103"
              }
            ]
          },
          "eventCoding": {
            "code": "A01",
            "system": "http://terminology.hl7.org/CodeSystem/v2-0003",
            "display": "ADT^A01"
          },
          "sender": {
            "reference": "Organization/33e23f3e-47b2-9c1b-c1f0-f964c2d28946"
          }
        },
        "request": {
          "method": "PUT",
          "url": "MessageHeader/aa521dd9-b613-0210-a661-82ce17e38fb3"
        }
      },
      {
        "fullUrl": "urn:uuid:428efe87-9b32-2610-d2d2-0edfdc356ebe",
        "resource": {
          "resourceType": "Provenance",
          "id": "428efe87-9b32-2610-d2d2-0edfdc356ebe",
          "occurredDateTime": "2020-05-08T13:10:15Z",
          "recorded": "2020-05-08T13:10:15Z",
          "agent": [
            {
              "type": {
                "coding": [
                  {
                    "code": "author",
                    "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type"
                  }
                ]
              },
              "who": {
                "reference": "Organization/33e23f3e-47b2-9c1b-c1f0-f964c2d28946"
              }
            }
          ],
          "activity": {
            "coding": [
              {
                "display": "ADT^A01^"
              }
            ]
          },
          "target": [
            {
              "reference": "Bundle/7dcb7d92-7a75-3d65-42f9-0f790afac4db"
            }
          ]
        },
        "request": {
          "method": "PUT",
          "url": "Provenance/428efe87-9b32-2610-d2d2-0edfdc356ebe"
        }
      },
      {
        "fullUrl": "urn:uuid:33e23f3e-47b2-9c1b-c1f0-f964c2d28946",
        "resource": {
          "resourceType": "Organization",
          "id": "33e23f3e-47b2-9c1b-c1f0-f964c2d28946",
          "identifier": [
            {
              "value": "SFAC",
              "system": "http://example.com/v2-to-fhir-converter/Identifier/SFAC"
            }
          ],
          "address": [
            {
              "country": "44"
            }
          ]
        },
        "request": {
          "method": "PUT",
          "url": "Organization/33e23f3e-47b2-9c1b-c1f0-f964c2d28946"
        }
      },
      {
        "fullUrl": "urn:uuid:ab0676d9-fa24-ffd3-327d-f5b4c26ae628",
        "resource": {
          "resourceType": "Organization",
          "id": "ab0676d9-fa24-ffd3-327d-f5b4c26ae628",
          "identifier": [
            {
              "value": "RFAC",
              "system": "http://example.com/v2-to-fhir-converter/Identifier/RFAC"
            }
          ],
          "address": [
            {
              "country": "44"
            }
          ]
        },
        "request": {
          "method": "PUT",
          "url": "Organization/ab0676d9-fa24-ffd3-327d-f5b4c26ae628"
        }
      },
      {
        "fullUrl": "urn:uuid:9d697ec3-48c3-3e17-db6a-29a1765e22c6",
        "resource": {
          "resourceType": "Patient",
          "id": "9d697ec3-48c3-3e17-db6a-29a1765e22c6",
          "identifier": [
            {
              "value": "3735064194",
              "type": {
                "coding": [
                  {
                    "code": "MRN",
                    "display": "MRN"
                  }
                ]
              },
              "system": "http://example.com/v2-to-fhir-converter/Identifier/SIMULATOR-MRN"
            },
            {
              "value": "3735064194",
              "type": {
                "coding": [
                  {
                    "code": "MRN",
                    "display": "MRN"
                  }
                ]
              },
              "system": "http://example.com/v2-to-fhir-converter/Identifier/SIMULATOR-MRN"
            },
            {
              "value": "2021051528",
              "type": {
                "coding": [
                  {
                    "code": "NHSNMBR",
                    "display": "NHSNMBR"
                  }
                ]
              },
              "system": "http://example.com/v2-to-fhir-converter/Identifier/NHSNBR"
            }
          ]
        },
        "request": {
          "method": "PUT",
          "url": "Patient/9d697ec3-48c3-3e17-db6a-29a1765e22c6"
        }
      },
      {
        "fullUrl": "urn:uuid:4f1394cd-4fdc-2671-f985-0ef923c48c5c",
        "resource": {
          "resourceType": "Provenance",
          "id": "4f1394cd-4fdc-2671-f985-0ef923c48c5c",
          "recorded": "2020-05-08T13:10:15Z",
          "agent": [
            {
              "who": {
                "reference": "Practitioner/07cb183d-bae8-cbc9-56cc-764ecfa02850"
              }
            }
          ],
          "activity": {
            "text": "ADT^A01"
          },
          "target": [
            {
              "reference": "Bundle/7dcb7d92-7a75-3d65-42f9-0f790afac4db"
            }
          ]
        },
        "request": {
          "method": "PUT",
          "url": "Provenance/4f1394cd-4fdc-2671-f985-0ef923c48c5c"
        }
      },
      {
        "fullUrl": "urn:uuid:07cb183d-bae8-cbc9-56cc-764ecfa02850",
        "resource": {
          "resourceType": "Practitioner",
          "id": "07cb183d-bae8-cbc9-56cc-764ecfa02850",
          "identifier": [
            {
              "value": "C005",
              "system": "http://example.com/v2-to-fhir-converter/Identifier/DRNBR",
              "type": {
                "coding": [
                  {
                    "code": "ORGDR",
                    "display": "ORGDR"
                  }
                ]
              }
            }
          ],
          "name": [
            {
              "family": "Whittingham",
              "given": [
                "Sylvia"
              ],
              "prefix": [
                "Dr"
              ],
              "use": "PRSNL"
            }
          ]
        },
        "request": {
          "method": "PUT",
          "url": "Practitioner/07cb183d-bae8-cbc9-56cc-764ecfa02850"
        }
      }
    ]
  }