fhir-loco

A FHIR® RESTful API server: Rust, Loco, Axum, Tokio and Hyper.

The HTTP half of this repository's FHIR persistence. The engine-agnostic storage half is fhir-store; the SQL engines are the six fhir-<engine> ports.

This project is the HTTP surface for the FHIR database libraries in the same monorepo — not sibling repositories, which is what this line said until 2026-08-03; all four families live in fhir-rust/fhir-rust (F-11). Those libraries — fhir-sqlite, fhir-mysql, fhir-mariadb, fhir-postgresql, fhir-mssql, and fhir-oracle (all six at Store level or above since F-65/F-68; an earlier revision called the last two "the two scaffolds") — are deliberately embeddable and carry no server of their own (C0.17, C0.18), so that a program wanting FHIR storage does not also acquire a web framework. The split is the point: storage guarantees live in the library, HTTP lives here.

Specification: spec/index.md, ids SV1.x–SV4.x, added 2026-08-03. Every externally visible promise below is a numbered requirement there — 410 versus 404 is SV2.4, If-Match is SV2.5, the CapabilityStatement is SV2.8–SV2.11, PASETO is SV3.2–SV3.6.

What this crate does not do is recorded at its own id rather than in a list that drifts: no concurrency limit (SV4.2, a Loco 1.0.1 framework limit), and within $export no _since and no compartment exports — the served slice's edges are stated in SV2.15 itself. The listener speaks plain HTTP behind a TLS-terminating proxy, and SV3.11 enforces that posture: a non-loopback bind refuses to boot unless FHIR_LOCO_TLS_TERMINATED_UPSTREAM=true acknowledges the proxy. (Conditional create, the admin plane, and system-level async Bulk Data $export — all formerly on this list — are served: SV2.14 and SV4.3 since 2026-08-07, SV2.15 since 2026-08-09. Set FHIR_LOCO_ADMIN_BIND for /health, /ready, and /metrics on their own listener; FHIR_LOCO_EXPORT_DIR/FHIR_LOCO_EXPORT_TTL_SECS govern where export files live and how long.)

What belongs where#

Everything this service claims — versioned history, the tamper-evident audit chain, search semantics, GDPR erasure, decimal fidelity — is the storage crate's work. This layer translates HTTP to store calls and back, and its own job is narrow: get the status codes right.

Where the store draws a distinction, the HTTP layer has to preserve it. A resource that was deleted answers 410 Gone; one that never existed answers 404 Not Found. Collapsing those would tell a caller that a record it once held never was.

Running it#

The library owns schema installation, so a database is prepared with the storage crate and served from here:

export FHIR_LOCO_DB=/path/to/fhir.sqlite
export FHIR_LOCO_ASSETS=../fhir-sqlite/crates/fhir-sqlite-map/assets
cargo run --bin fhir_loco-cli -- start

Both variables have defaults (fhir.sqlite and assets). A FHIR version is mounted only if its schema is actually installed — an empty database would otherwise advertise a CapabilityStatement for resources that cannot be read, and a server lying about what it can do is worse than one admitting it serves nothing.

Backends are selected by configuration rather than by Cargo feature, so a deployment can change engine without a rebuild.

Authentication#

PASETO v4.public, required. There is no unauthenticated mode.

# 32-byte Ed25519 public key, hex. The issuer signs; this service only verifies.
export FHIR_LOCO_PASETO_PUBLIC_KEY=<64 hex chars>

The process refuses to boot without it — absent, empty, non-hex, or the wrong length all stop startup. Every request must carry Authorization: Bearer v4.public.…; missing, malformed, tampered or expired is 401 before any handler runs. The sub claim becomes the audit actor, recorded as paseto:v4.public (PR12.9).

There is no header fallback#

An earlier revision accepted x-fhir-loco-principal when no key was configured. It is gone, for two reasons.

Two modes meant the unsafe one was the default: a deployment that forgot the variable ran unauthenticated while looking configured, and the only signal was a log line at boot.

And it never satisfied PR12.2, which says a principal header is trusted only when the request arrives from a configured trusted proxy. This service had no proxy allowlist — it could not tell a perimeter-set header from a client-set one, so under PR12.2 the header should have been ignored rather than honoured. A signature it can verify itself is a property of the request rather than an assumption about the network.

There is likewise no mode that checks a token when present and shrugs when absent: that accepts an unauthenticated request whenever the caller omits the header, which is the same as not checking.

Why PASETO rather than JWT#

A JWT names its own algorithm in a field the attacker also controls, which is the root of the alg: none and RS256→HS256 confusion families. PASETO fixes the algorithm per version: a v4.public token is Ed25519 and cannot claim to be anything else.

Why v4.public rather than v4.local#

v4.local is symmetric — verifying and minting use the same key, so every instance that checks credentials could also issue them, and one read of the configuration would be enough to impersonate any principal. v4.public is asymmetric: this service holds only the public half and cannot mint a token at all.

What this does not change#

Authorization — scopes, compartments, consent — is still your deployment's. This establishes who, not what they may do. The storage crates still do not authenticate; that boundary is unmoved, and this is the layer §12 always expected to hold it.

Endpoints#

Search accepts _count, _offset, and _total; everything else is treated as a search parameter. If-Match takes a weak ETag (W/"3"); a header that is present but unparseable is an error rather than being ignored, because a client asking for optimistic concurrency and not getting it is worse than one told no.

Reads are recorded in the store's disclosure log — "who looked at this patient" is usually the first question an audit asks, and reads are where it is easiest to forget. A logging failure is reported but does not fail the request.

{version} is r3, r4, or r5. Responses are application/fhir+json — plain application/json is wrong enough that conformance tooling rejects it — and carry a weak ETag, weak because two representations of one version may differ in whitespace.

Errors are OperationOutcome. Their text describes the request, never storage, so it can be returned verbatim without leaking schema names or stored values; anything else is logged and answered with a generic 500.

Status#

SQLite by default; PostgreSQL by configuration (SV1.10). Read, vread, create, update, delete, search (including _include/_revinclude, SV2.16), history at instance, type and system level (SV2.17), conditional create (SV2.14), and system-level $export (SV2.15) work and have been exercised end to end against a real database. (Until 2026-08-10 this paragraph still listed conditional create as unimplemented — stale since 2026-08-07.) Not implemented: conditional delete over HTTP, and transaction Bundles — the store refuses those explicitly rather than pretending.

FHIR_LOCO_BACKEND=postgresql (with FHIR_LOCO_PG_DSN and the postgres relmap assets in FHIR_LOCO_ASSETS) mounts fhir-postgresql instead — same HTTP surface, verified end to end by tests/pg_backend.rs against a live server (SV1.10). The other four ports are not wired: none carries the audited-write surface this crate calls. (Until 2026-08-10 this paragraph said the MySQL and MariaDB stores were "still being written in their own repositories" — stale twice over: all six ports have had stores since F-65/F-68, and they live in this monorepo, not sibling repos.)

serde_json is built with arbitrary_precision, and that is not a preference: without it a FHIR decimal of 9.60 is parsed into an f64 and handed back as 9.6, destroying on the way out the precision the storage layer works hard to preserve.

Tests#

cargo test runs the endpoint suite against a real SQLite database, installed through the library the same way an operator would. There is no mock store: the interesting behaviour is exactly the translation between the store's distinctions and HTTP's, and a mock would assert that the test author understands those rather than that the code does.

The suite needs fhir-sqlite checked out beside this repository, since it reads the relmap assets from there.

A note on Loco's hooks#

Store initialisation lives in Hooks::before_run, not Hooks::boot. boot is not on the path the start command takes, so initialising there leaves every request answering 503 while /_health stays green — a load balancer sees a healthy instance serving nothing. If you add startup work, put it in before_run and verify that it actually runs.

Getting help with Loco#

A quick tour or the complete guide.

Trademarks#

HL7®, and FHIR® are the registered trademarks of Health Level Seven International and their use of these trademarks does not constitute an endorsement by HL7.