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This is the clinic’s choice, never yours. You cannot ask for it, switch it on, or see beforehand whether it is on. Plan for both outcomes: an item that waits for review, and an item that is already on the chart.
Allergies, conditions, reported medicines and referrals normally wait in the clinic’s review queue until a clinician decides (Reviewing outside submissions). A clinic’s owner or manager can choose, for one key or for one connected organization and for each kind separately, to accept new items from it straight away. It is off until the clinic turns it on.

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What the answer looks like

Sending an item is still POST, and the answer is still 202 Accepted with a Location header. Read the body, not the status code. When the clinic accepts automatically, the submission in the body is already decided:
  • review_status is confirmed and result_record_id is the new record.
  • accepted_automatically is true. It is false for every item a person at the clinic decided, and for an item that is still waiting.
  • If you send the same item again with the same Idempotency-Key, you get the same answer back, not a second record.

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What the record shows

The allergy, condition, reported medicine or referral you read afterwards carries these fields: An item accepted automatically is on the chart, and for an allergy or a reported medicine it takes part in the clinic’s medicine checks. Only its claim to have been checked is different. In FHIR, verificationStatus reads unconfirmed and an accepted_by extension says why.

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What is never automatic

A clinic that switches this on still reviews:
  • Every change to something already on the chart (PATCH), including resolving, stopping or ending an item.
  • Every retraction.
  • Every “no known allergies” statement.
  • Anything the clinic’s chart would refuse, such as an allergy the patient already has. A duplicate waits for a clinician, who can decline it.
Because an item accepted automatically is already decided, you can no longer change or withdraw it. The attempt answers 409 submission_not_pending. Send a new item, or ask the clinic.

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When it pauses

If you send an unusually large number of items in a short time, the clinic’s automatic acceptance pauses itself for your key or connection. The limit is the clinic’s own and you cannot read it. While it is paused, your items wait for review exactly as before, and nothing resumes by itself. A clinic owner or manager must turn it back on. Expect a first bulk load of history to pause it, and send backfills expecting them to be reviewed.

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Starts off again

A rolled or replaced key, or a new connection after a revoked one, starts with automatic acceptance off. The clinic must choose it again.

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Test keys

A test key never reaches a clinic’s real chart and is never accepted automatically.

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What to build

  • Read review_status and accepted_automatically in the answer to every send.
  • Tell a person an item is on a record only when review_status is confirmed.
  • Show items with accepted_by: "automatic" and no reviewed_at as not yet reviewed by a clinician.
  • Treat reviewed_at and reviewed_by_staff_id as the sign that a clinician has now looked at it.
  • Do not try to detect the setting by sending a test item to a real patient.