FHIR R4 Implementation
Full-stack FHIR R4 implementation — from FHIR server deployment and US Core conformance through SMART on FHIR authentication, EHR integration, and production operations.
The Challenge
Building a FHIR Platform Is Complex — Most Teams Underestimate It
A FHIR R4 implementation is not just exposing a REST API. It requires deep knowledge of the specification, US Core profile constraints, SMART on FHIR OAuth 2.0 flows, bulk data export mechanics, CDS Hooks integration, and the specific non-standard behaviours of every EHR vendor you need to connect to. Teams that attempt FHIR implementations without this expertise spend months debugging profile validation failures, authentication edge cases, and EHR vendor quirks that are not documented anywhere in the official specs. The result is delayed certification, failed integration testing, and expensive rework.
Deliverables
FHIR Implementation Deliverables
- FHIR R4 server deployment on Azure Health Data Services or HAPI FHIR — configured, secured, and production-ready
- US Core profile implementation (Patient, Observation, Condition, MedicationRequest, DiagnosticReport, and all required resources)
- SMART on FHIR v2 authorization server — standalone launch, EHR launch, and backend services (server-to-server) flows
- EHR connectivity — Epic, Cerner, Athena FHIR API integration with full error handling and retry logic
- Bulk FHIR export — Group/$export and Patient/$export with NDJSON output and async polling
- CDS Hooks integration — prefetch template design, card response implementation, and EHR hook registration
- FHIR validation pipeline — Inferno Test Kit integration, profile validation, and automated conformance testing in CI/CD
- Terminology service integration — SNOMED CT, LOINC, RxNorm code system support with expansion and validation endpoints
- FHIR subscriptions — topic-based subscriptions for real-time event notifications to downstream systems
- Operational documentation — API reference, integration guide, capability statement, and operational runbook
Stack
FHIR Implementation Stack
Process
FHIR Implementation Process
A clear, predictable engagement model with no surprises.
Requirements & Scope Definition
Define the FHIR resources required, US Core profiles in scope, EHR vendors to connect, authorization flows, and regulatory requirements. Produce a detailed technical specification before any development begins.
Server Setup & Core API
Deploy and configure the FHIR server. Implement core CRUD operations and search parameters for required resource types. Configure RBAC, private networking, and audit logging.
US Core Conformance & SMART Auth
Implement US Core profile constraints on all required resource types. Build SMART on FHIR authorization server with all required grant types. Validate conformance against Inferno Test Kit.
EHR Integration & Bulk Export
Implement connectivity to target EHR systems. Build bulk export capability. Integration test against sandbox environments for each EHR vendor. Document all vendor-specific quirks discovered.
Production Hardening & Go-Live
Load testing, security review, monitoring configuration, runbook creation. Support ONC certification testing if required. Go-live with hypercare period and documented escalation paths.
FAQ
Frequently Asked Questions
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