fhirsmith 0.7.1 → 0.7.3

package/tx/ocl/vs-ocl.cjs

@@ -15,20 +15,19 @@ const { computeValueSetExpansionFingerprint } = require('./fingerprint/fingerpri
 const { ensureTxParametersHashIncludesFilter, patchValueSetExpandWholeSystemForOcl } = require('./shared/patches');
 
 ensureTxParametersHashIncludesFilter(TxParameters);
-patchValueSetExpandWholeSystemForOcl();
+//patchValueSetExpandWholeSystemForOcl();
 
 function normalizeCanonicalSystem(system) {
   if (typeof system !== 'string') {
     return system;
   }
 
-  const trimmed = system.trim();
+  let trimmed = system.trim();
   if (!trimmed) {
     return trimmed;
   }
 
-  // Treat canonical URLs with and without trailing slash as equivalent.
-  return trimmed.replace(/\/+$/, '');
+  return trimmed;
 }
 
 class OCLValueSetProvider extends AbstractValueSetProvider {
@@ -94,10 +93,42 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
             dependencyChecksums: cached.dependencyChecksums || {},
             createdAt: Number.isFinite(createdAt) ? createdAt : null
           });
-
+          // Instancia ValueSet para garantir jsonObj
+          // Reconstrói compose.include se não existir
+          let compose = cached.expansion?.compose;
+          if (!compose || !Array.isArray(compose.include)) {
+            // Reconstrói a partir dos sistemas/códigos em expansion.contains
+            const systemConcepts = new Map();
+            if (Array.isArray(cached.expansion?.contains)) {
+              for (const entry of cached.expansion.contains) {
+                if (!entry.system || !entry.code) continue;
+                if (!systemConcepts.has(entry.system)) {
+                  systemConcepts.set(entry.system, []);
+                }
+                systemConcepts.get(entry.system).push({ code: entry.code });
+              }
+            }
+            compose = { include: Array.from(systemConcepts.entries()).map(([system, concepts]) => ({ system, concept: concepts })) };
+          }
+          const valueSetObj = new ValueSet({
+            resourceType: 'ValueSet',
+            url: cached.canonicalUrl,
+            version: cached.version || null,
+            expansion: cached.expansion,
+            compose,
+            id: cached.canonicalUrl // ou outro identificador se necessário
+          }, 'R5');
+          this.#applyCachedExpansion(valueSetObj, paramsKey);
+          // Indexa o ValueSet restaurado para torná-lo disponível via fetchValueSet
+          this.valueSetMap.set(valueSetObj.url, valueSetObj);
+          if (valueSetObj.version) {
+            this.valueSetMap.set(`${valueSetObj.url}|${valueSetObj.version}`, valueSetObj);
+          }
+          this.valueSetMap.set(valueSetObj.id, valueSetObj);
+          this._idMap.set(valueSetObj.id, valueSetObj);
           this.valueSetFingerprints.set(cacheKey, cached.fingerprint || null);
           loadedCount++;
-          console.log(`[OCL-ValueSet] Loaded ValueSet from cold cache: ${cached.canonicalUrl}`);
+          console.log(`[OCL-ValueSet] Loaded ValueSet from cold cache into memory: ${cached.canonicalUrl}`);
         } catch (error) {
           console.error(`[OCL-ValueSet] Failed to load cold cache file ${file}:`, error.message);
         }
@@ -221,9 +252,10 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
     let key = `${url}|${version}`;
     if (this.valueSetMap.has(key)) {
       const vs = this.valueSetMap.get(key);
-      await this.#ensureComposeIncludes(vs);
+      // await this.#ensureComposeIncludes(vs);
       this.#clearInlineExpansion(vs);
-      this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset' });
+      console.log(`[OCL-ValueSet] fetchValueSet cache hit for ${url} (version: ${version || 'none'})`);
+      this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset', userRequested: true });
       return vs;
     }
 
@@ -233,7 +265,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
         key = `${url}|${majorMinor}`;
         if (this.valueSetMap.has(key)) {
           const vs = this.valueSetMap.get(key);
-          await this.#ensureComposeIncludes(vs);
+          // await this.#ensureComposeIncludes(vs);
           this.#clearInlineExpansion(vs);
           this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset-mm' });
           return vs;
@@ -243,7 +275,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
 
     if (this.valueSetMap.has(url)) {
       const vs = this.valueSetMap.get(url);
-      await this.#ensureComposeIncludes(vs);
+      // await this.#ensureComposeIncludes(vs);
       this.#clearInlineExpansion(vs);
       this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset-url' });
       return vs;
@@ -251,7 +283,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
 
     const resolved = await this.#resolveValueSetByCanonical(url, version);
     if (resolved) {
-      await this.#ensureComposeIncludes(resolved);
+      // await this.#ensureComposeIncludes(resolved);
       this.#clearInlineExpansion(resolved);
       this.#scheduleBackgroundExpansion(resolved, { reason: 'fetch-valueset-resolved' });
       return resolved;
@@ -262,7 +294,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
     key = `${url}|${version}`;
     if (this.valueSetMap.has(key)) {
       const vs = this.valueSetMap.get(key);
-      await this.#ensureComposeIncludes(vs);
+      // await this.#ensureComposeIncludes(vs);
       this.#clearInlineExpansion(vs);
       this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset-init' });
       return vs;
@@ -274,7 +306,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
         key = `${url}|${majorMinor}`;
         if (this.valueSetMap.has(key)) {
           const vs = this.valueSetMap.get(key);
-          await this.#ensureComposeIncludes(vs);
+          // await this.#ensureComposeIncludes(vs);
           this.#clearInlineExpansion(vs);
           this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset-init-mm' });
           return vs;
@@ -284,7 +316,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
 
     if (this.valueSetMap.has(url)) {
       const vs = this.valueSetMap.get(url);
-      await this.#ensureComposeIncludes(vs);
+      // await this.#ensureComposeIncludes(vs);
       this.#clearInlineExpansion(vs);
       this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset-init-url' });
       return vs;
@@ -296,7 +328,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
   async fetchValueSetById(id) {
     const local = this.#getLocalValueSetById(id);
     if (local) {
-      await this.#ensureComposeIncludes(local);
+      // await this.#ensureComposeIncludes(local);
       this.#clearInlineExpansion(local);
       this.#scheduleBackgroundExpansion(local, { reason: 'fetch-valueset-by-id' });
       return local;
@@ -305,7 +337,7 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
     await this.initialize();
 
     const vs = this.#getLocalValueSetById(id);
-    await this.#ensureComposeIncludes(vs);
+    // await this.#ensureComposeIncludes(vs);
     this.#clearInlineExpansion(vs);
     this.#scheduleBackgroundExpansion(vs, { reason: 'fetch-valueset-by-id-init' });
     return vs;
@@ -370,17 +402,15 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
       || this._idMap.get(vs.id)
       || null;
 
-    // Preserve hydrated cold-cache expansions on first index; invalidate only on replacement.
-    if (existing && existing !== vs) {
-      this.#invalidateExpansionCache(vs);
-    }
-
-    this.valueSetMap.set(vs.url, vs);
-    if (vs.version) {
-      this.valueSetMap.set(`${vs.url}|${vs.version}`, vs);
+    // Só indexa se não existe ou se for o mesmo objeto
+    if (!existing || existing === vs) {
+      this.valueSetMap.set(vs.url, vs);
+      if (vs.version) {
+        this.valueSetMap.set(`${vs.url}|${vs.version}`, vs);
+      }
+      this.valueSetMap.set(vs.id, vs);
+      this._idMap.set(vs.id, vs);
     }
-    this.valueSetMap.set(vs.id, vs);
-    this._idMap.set(vs.id, vs);
   }
 
   #toValueSet(collection) {
@@ -415,11 +445,11 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
       json.meta = { lastUpdated };
     }
 
-    if (preferredSource) {
-      json.compose = {
-        include: [{ system: preferredSource }]
-      };
-    }
+    // if (preferredSource) {
+    //   json.compose = {
+    //     include: [{ system: preferredSource }]
+    //   };
+    // }
 
     const conceptsUrl = this.#normalizePath(
       collection.concepts_url || collection.conceptsUrl || this.#buildCollectionConceptsPath(collection)
@@ -484,7 +514,15 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
     if (pathValue.startsWith('http://') || pathValue.startsWith('https://')) {
       return pathValue;
     }
-    return `${this.baseUrl}${pathValue.startsWith('/') ? '' : '/'}${pathValue}`;
+    // Remove extra slashes and normalize full URL
+    let base = this.baseUrl.replace(/\/+$/, '');
+    let path = pathValue.replace(/^\/+/, '');
+    let url = `${base}/${path}`;
+    // Remove all duplicate slashes except after protocol
+    url = url.replace(/([^:])\/+/g, '$1/');
+    // Remove trailing slashes
+    url = url.replace(/\/+$/, '');
+    return url;
   }
 
   #buildCollectionConceptsPath(collection) {
@@ -868,7 +906,9 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
     if (!base) {
       return null;
     }
-    return `${base}|${paramsKey || 'default'}`;
+    const crypto = require('crypto');
+    const hash = crypto.createHash('sha256').update(`${base}|${paramsKey || 'default'}`).digest('hex');
+    return hash;
   }
 
   #invalidateExpansionCache(vs) {
@@ -986,7 +1026,8 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
           const meta = this.#getCollectionMeta(vs);
           queuedJobSize = await this.#fetchConceptCountFromHeaders(meta?.conceptsUrl || null);
           return queuedJobSize;
-        }
+        },
+        userRequested: !!options.userRequested
       }
     );
   }
@@ -1071,10 +1112,10 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
     }
 
     const contains = [];
-    let offset = 0;
-
-    // Pull all concepts in fixed-size pages until exhausted.
-    // eslint-disable-next-line no-constant-condition
+    let offset = 0; // Moved this line up
+    // Agrupa conceitos por system
+    const systemConcepts = new Map();
+    // Removed duplicate offset declaration
     while (true) {
       const batch = await this.#fetchCollectionConcepts(meta, {
         count: CONCEPT_PAGE_SIZE,
@@ -1083,17 +1124,14 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
         filter: null,
         languageCodes: []
       });
-
       const entries = Array.isArray(batch?.contains) ? batch.contains : [];
       if (entries.length === 0) {
         break;
       }
-
       for (const entry of entries) {
         if (!entry?.system || !entry?.code) {
           continue;
         }
-
         const out = {
           system: entry.system,
           code: entry.code
@@ -1116,18 +1154,28 @@ class OCLValueSetProvider extends AbstractValueSetProvider {
             }));
         }
         contains.push(out);
+        // Agrupa por system
+        if (!systemConcepts.has(entry.system)) {
+          systemConcepts.set(entry.system, []);
+        }
+        systemConcepts.get(entry.system).push(entry.code);
       }
-
       if (progressState) {
         progressState.processed = contains.length;
       }
-
       if (entries.length < CONCEPT_PAGE_SIZE) {
         break;
       }
       offset += entries.length;
     }
-
+    // Popular compose.include para cada system
+    if (!vs.jsonObj.compose) {
+      vs.jsonObj.compose = { include: [] };
+    }
+    vs.jsonObj.compose.include = Array.from(systemConcepts.entries()).map(([system, codes]) => ({
+      system,
+      concept: codes.map(code => ({ code }))
+    }));
     return {
       timestamp: new Date().toISOString(),
       identifier: `urn:uuid:${crypto.randomUUID()}`,

package/tx/workers/expand.js

@@ -549,6 +549,7 @@ class ValueSetExpander {
   }
 
   async importValueSet(vs, expansion, imports, offset) {
+    let count = 0;
     this.canBeHierarchy = false;
     for (let p of vs.expansion.parameter || []) {
       let vn = getValueName(p);
@@ -559,14 +560,17 @@ class ValueSetExpander {
 
     for (const c of vs.expansion.contains || []) {
       this.worker.deadCheck('importValueSet');
-      await this.importValueSetItem(null, c, imports, offset);
+      count += await this.importValueSetItem(null, c, imports, offset);
     }
+    return count;
   }
 
   async importValueSetItem(p, c, imports, offset) {
+    let count = 0;
     this.worker.deadCheck('importValueSetItem');
     const s = this.keyC(c);
-    if (this.passesImports(imports, c.system, c.code, offset) && !this.map.has(s)) {
+    if (this.passesImports(imports, c.system, c.code, offset) && !this.map.has(s) && !this.isExcluded(c.system, c.version, c.code)) {
+      count++;
       this.fullList.push(c);
       if (p != null) {
         if (!p.contains) {p.contains = [] }
@@ -578,8 +582,9 @@ class ValueSetExpander {
     }
     for (const cc of c.contains || []) {
       this.worker.deadCheck('importValueSetItem');
-      await this.importValueSetItem(c, cc, imports, offset);
+      count += await this.importValueSetItem(c, cc, imports, offset);
     }
+    return count;
   }
 
   excludeValueSet(vs, expansion, imports, offset) {
@@ -636,8 +641,8 @@ class ValueSetExpander {
             throw new Issue('error', 'business-rule', null, null, 'The code system definition for ' + cset.system + ' defines a supplement, so this expansion cannot be performed', 'invalid');
           } else {
             this.addParamUri(exp, cs.contentMode(), cs.system() + '|' + cs.version());
-            Extensions.addString(exp, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed",
-              "This extension is based on a fragment of the code system " + cset.system);
+            Extensions.addBoolean(exp, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", true);
+            Extensions.addString(exp, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed-reason","This extension is based on a fragment of the code system " + cset.system);
           }
         }
 
@@ -647,7 +652,8 @@ class ValueSetExpander {
           } else if (filter.isNull) {
             if (cs.isNotClosed()) {
               if (cs.specialEnumeration()) {
-                Extensions.addString(exp, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
+                Extensions.addBoolean(exp, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", true);
+                Extensions.addString(exp, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed-reason", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
               } else {
                 throw new Issue("error", "too-costly", null, null, 'The code System "' + cs.system() + '" has a grammar, and cannot be enumerated directly', null, 422).withDiagnostics(this.worker.opContext.diagnostics());
               }
@@ -692,7 +698,7 @@ class ValueSetExpander {
         this.addParamUri(expansion, 'used-valueset', this.worker.makeVurl(ivs.valueSet));
         valueSets.push(ivs);
       }
-      await this.importValueSet(valueSets[0].valueSet, expansion, valueSets, 1);
+      this.addToTotal(await this.importValueSet(valueSets[0].valueSet, expansion, valueSets, 1));
     } else {
       const filters = [];
       const prep = null;
@@ -721,14 +727,16 @@ class ValueSetExpander {
           if (cs.specialEnumeration() && filters.length === 0) {
             this.worker.opContext.log('import special value set ' + cs.specialEnumeration());
             const base = await this.expandValueSet(cs.specialEnumeration(), '', filter, notClosed);
-            Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
+            Extensions.addBoolean(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", true);
+            Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed-reason", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
             await this.importValueSet(base, expansion, valueSets, 0);
             notClosed.value = true;
           } else if (filter.isNull) {
             this.worker.opContext.log('add whole code system');
             if (cs.isNotClosed()) {
               if (cs.specialEnumeration()) {
-                Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
+                Extensions.addBoolean(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", true);
+                Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed-reason", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
               } else {
                 throw new Issue("error", "too-costly", null, null, 'The code System "' + cs.system() + '" has a grammar, and cannot be enumerated directly', null, 422).withDiagnostics(this.worker.opContext.diagnostics());
               }
@@ -815,7 +823,8 @@ class ValueSetExpander {
           }
 
           if (cs.specialEnumeration()) {
-            Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
+            Extensions.addBoolean(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", true);
+            Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed-reason", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
             notClosed.value = true;
           }
 
@@ -942,7 +951,8 @@ class ValueSetExpander {
         } else {
           if (cs.isNotClosed(filter)) {
             if (cs.specialEnumeration()) {
-              Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
+              Extensions.addBoolean(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", true);
+              Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed-reason", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
             } else {
               throw new Issue("error", "too-costly", null, null, 'The code System "' + cs.system() + '" has a grammar, and cannot be enumerated directly', null, 422).withDiagnostics(this.worker.opContext.diagnostics());
             }
@@ -991,7 +1001,8 @@ class ValueSetExpander {
 
         if (cs.specialEnumeration()) {
           await cs.specialFilter(prep, true);
-          Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
+          Extensions.addBoolean(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed", true);
+          Extensions.addString(expansion, "http://hl7.org/fhir/StructureDefinition/valueset-unclosed-reason", 'The code System "' + cs.system() + " has a grammar and so has infinite members. This extension is based on " + cs.specialEnumeration());
         }
 
         for (let fc of cset.filter) {

package/tx/workers/search.js

@@ -32,15 +32,18 @@ class SearchWorker extends TerminologyWorker {
 
   // Allowed search parameters
   static ALLOWED_PARAMS = [
-    '_offset', '_count', '_elements', '_sort', '_summary', '_total',
+    '_offset', '_count', '_elements', '_sort', '_summary', '_total', '_format',
     'url', 'version', 'content-mode', 'date', 'description',
     'supplements', 'identifier', 'jurisdiction', 'name',
     'publisher', 'status', 'system', 'title', 'text'
   ];
 
-  // Summary elements for _summary=true (common metadata fields)
-  static SUMMARY_ELEMENTS = ['resourceType', 'id', 'meta', 'url', 'version',
-    'name', 'title', 'status', 'date', 'publisher', 'description'];
+  // Summary elements for _summary=true (marked elements per resource type)
+  static SUMMARY_ELEMENTS = {
+    CodeSystem: ['meta', 'url', 'version', 'name', 'title', 'status', 'experimental', 'date', 'publisher', 'description', 'jurisdiction', 'content'],
+    ValueSet: ['meta', 'url', 'version', 'name', 'title', 'status', 'experimental', 'date', 'publisher', 'description', 'jurisdiction'],
+    ConceptMap: ['meta', 'url', 'version', 'name', 'title', 'status', 'experimental', 'date', 'publisher', 'description', 'jurisdiction']
+  };
 
   // Sortable fields
   static SORT_FIELDS = ['id', 'url', 'version', 'date', 'name', 'vurl'];
@@ -67,7 +70,7 @@ class SearchWorker extends TerminologyWorker {
       let elements;
       switch (summary) {
         case 'true':
-          elements = SearchWorker.SUMMARY_ELEMENTS;
+          elements = SearchWorker.SUMMARY_ELEMENTS[resourceType] || [];
           break;
         case 'text':
           elements = ['resourceType', 'id', 'meta', 'text'];
@@ -110,7 +113,7 @@ class SearchWorker extends TerminologyWorker {
       const bundle = this.buildSearchBundle(
         req, resourceType, matches, offset, count, elements, summary, totalMode
       );
-      req.logInfo = summary === 'count' ? `count: ${bundle.total}` : `${bundle.entry.length} matches`;
+      req.logInfo = `${bundle.entry ? bundle.entry.length : 0} matches`;
       return res.json(bundle);
 
     } catch (error) {
@@ -336,15 +339,15 @@ class SearchWorker extends TerminologyWorker {
   /**
    * Build a FHIR search Bundle with pagination
    */
-  buildSearchBundle(req, resourceType, allMatches, offset, count, elements, summary = 'false', totalMode = 'accurate') {
-    const total = allMatches.length;
+  buildSearchBundle(req, resourceType, allMatches, offset, count, elements, summary, totalParam) {
+    const totalCount = allMatches.length;
 
-    // For _summary=count, return just the count
+    // Handle _summary=count - only return total, no entries
     if (summary === 'count') {
       return {
         resourceType: 'Bundle',
         type: 'searchset',
-        total: total
+        total: totalCount
       };
     }
 
@@ -396,7 +399,7 @@ class SearchWorker extends TerminologyWorker {
     }
 
     // Next link (if more results)
-    if (offset + count < total) {
+    if (offset + count < totalCount) {
       const nextParams = new URLSearchParams(searchParams);
       nextParams.set('_offset', offset + count);
       links.push({
@@ -406,7 +409,7 @@ class SearchWorker extends TerminologyWorker {
     }
 
     // Last link
-    const lastOffset = Math.max(0, Math.floor((total - 1) / count) * count);
+    const lastOffset = Math.max(0, Math.floor((totalCount - 1) / count) * count);
     const lastParams = new URLSearchParams(searchParams);
     lastParams.set('_offset', lastOffset);
     links.push({
@@ -416,7 +419,7 @@ class SearchWorker extends TerminologyWorker {
 
     // Build entries
     const entries = pageResults.map(resource => {
-      // Apply _elements filter if specified
+      // Apply _elements or _summary filter if specified
       let filteredResource = resource;
       if (elements) {
         filteredResource = this.filterElements(resource, elements);
@@ -437,8 +440,9 @@ class SearchWorker extends TerminologyWorker {
       link: links,
       entry: entries
     };
-    if (totalMode !== 'none') {
-      bundle.total = total;
+    // Add total unless _total=none
+    if (totalParam !== 'none') {
+      bundle.total = totalCount;
     }
     return bundle;
   }
@@ -459,6 +463,13 @@ class SearchWorker extends TerminologyWorker {
       }
     }
 
+    // Mark as SUBSETTED per FHIR spec
+    filtered.meta = filtered.meta ? { ...filtered.meta } : {};
+    filtered.meta.tag = [
+      ...(filtered.meta.tag || []),
+      { system: 'http://terminology.hl7.org/CodeSystem/v3-ObservationValue', code: 'SUBSETTED' }
+    ];
+
     return filtered;
   }
 }