Uploading or referencing binary files (PDF, image, XML) via Epic SMART on FHIR APIs

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Kirill Lukianov

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Nov 6, 2025, 10:29:29 AM (2 days ago) Nov 6

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Hi everyone,

I’m currently developing a SMART on FHIR app that integrates with Epic and I’ve run into some uncertainty regarding the handling of binary data (e.g., PDFs, images, or XML documents).

From my review of Epic’s public FHIR documentation (https://fhir.epic.com/Specifications), it appears that while many FHIR resources support read and search operations, create/update capabilities are limited.

What I’m trying to confirm is:

Can SMART on FHIR apps upload binary files (e.g., PDF, XML, image) directly into Epic? For example, to be stored as part of a patient’s chart or associated with a specific encounter?
If direct upload isn’t possible, can an app instead reference an external URL (e.g., using DocumentReference.content.attachment.url) and link that reference to an Encounter or Patient resource in a way that appears meaningfully inside Epic’s system (for clinicians or patients)?
If there are alternative Epic APIs that allow pushing files or attachments (for example, via Bridges or App Orchard integrations), I’d appreciate any guidance or examples on that approach.

So far, I haven’t found a confirmed workflow in the public documentation or sandbox environments that supports file uploads or external link references tied to encounters.

Any pointers, implementation examples, or confirmation from those who’ve integrated this before would be greatly appreciated.