FHIR backend service

Have been looking at using a service for FHIR backend APIs. Here are some:


  • Azure API for FHIR
  • Health Samurai’s Aidbox
  • SmileCDR’s platform
  • Google Cloud Developer API

Open Source options:

Have experimented with Azure’s FHIR API service. Looks good so far. While Azure AFAIK is a stable and reliable cloud platform, I was looking for ways to prevent vendor lock-in. That goal can be most accomplished by HAPI’s FHIR.
Would to like to hear the community’s experience is using HAPI as a backend service in the terms of the following:

  • Server setup
  • Server Maintenance
  • Scalability
  • Backup and Restores
  • Error reporting/handling.

It would also be great if you can share your experience in using Azure’s API service.


you could also try reading this stream: https://chat.fhir.org/#narrow/stream/179167-hapi

Thanks, @grahamegrieve for linking the chat. Found some interesting topics being discussed.
However, did not find any discussions on making a choice between the available services.

You can also look into AWS HealthLake, which is in preview and has different approach than other providers. It does offer FHIR server support


Your question is impossible to answer without additional information.
Just to give you a rough idea what I am talking about and you might take into consideration:

  • Legal constraints
  • Technical constraints (deployment, authentication, security etc.)
  • Self development / involvement
  • Integration with existing infrastructure
  • many more

To give you a concrete example. We had to make the decision which server to use some months ago as well. We basically took a look on Azure FHIR API (we are customer there), IBM FHIR Server (which i really like), AWS HealthLake and HAPI.

At the end we made the decision based on the following reasons:

  1. It’s open source, so we can see what it is doing
  2. We have to possibility to adopt it to fit our needs. As nobody in my team knows C#/.NET it would be much harder with Azure’s OS Edition
  3. Data Security and Trust: We are a Munich based company with both hospitals and insurances as customers operating within the EU with a strong footprint in DACH. This made that point most crucial for us. It was clear that we want to host the server ourselves and have no external dependencies.
    Don’t get me wrong, I do believe that IBM or Microsoft have good PaaS solutions which are safe, fast and act according to GDPR, however if you followed the political discussions within Germany over the past months you understand the decision against them.

Conclusion is, we went with HAPI with respect to the points above. We are super happy with the support of the community over there and can’t confirm any negative performance leaks which were mentioned in other threads before.

I hope it helps to give u an rough idea how to come up with ur own decision :wink:

  • SmileCDR’s platform

Hi Patrick,

I’m currently tasked with a very similar task that you faced, and was wondering if you would be willing to chat about what tradeoffs you analyzed and how you ended up with HAPI FHIR as your solution. Feel free to shoot me an email at kyle@curai.com if you’re free to discuss! Appreciate it in advance :slight_smile: