FHIR implementation


I am interested to find out whether there are real world examples of FHIR implementations in organisations, their experience and the middleware or integration platform used to handle FHIR messages.

Thank you.

Most FHIR implementations don’t use messaging at all - they use REST. So no middleware. Though middleware is certainly appropriate in some architectures. There are numerous (pretty much uncountable) implementations now, from country-scale EHRs to widespread adoption by EHR vendors to small apps used by local hospitals. If you google, there are videos from executives describing FHIR implementation experiences and strategies as well as press releases about implementations, RFP requirements, etc. You can also ask about experiences on chat.fhir.org.

Hey @Frodo,
I come from software integration and we do use messaging together with FHIR. Standard is well defined and is handy. It solves in reliable way data encoding and operations on domain resources.

There are some things which will never change - there are different versions of specification, multiple systems to communicate. In some situations it will makes sense to do things in, let say a traditional way, the way it would be done in “integration project”.
First of all, you may want to bring some legacy system to modern standard. Possibly system you interface with is based on HL7v2 or v3? If so, it means you will have to work with message based communication in order to bridge FHIR.
Secondly, you can move forward your apps to new version of standard without waiting for big EHR systems to support it.
We already used fhir with messaging in order to hide various glitches found in vendor implementations. We did transform data, uniform and aggregate it for mobile app, using messaging under the hood.

With transformation maps provided together with spec you can keep mapping in one place and let all applications and systems be free of differences between DSTU2, STU3 and R4.

It really depends on scenario you need to cover but FHIR definitely does not exclude any middleware, in fact due to dominant nature of synchronous communication promoted by it, it gives a lot of work to middleware behind it. :slight_smile:

Kind regards,


I’ve used Intersystems Ensemble/Healthsare to provide the RESTful API layer at two NHS (UK) organisations and the last (third) one I was at is also using Intersystems Ensemble/Healthshare . I believe they are also now using it for FHIR Messaging.

I’ve started moving to a micro-service architecture and in doing so I’ve moved to HAPI FHIR Servers with some back ended with Hibernate to talk to SQL databases but also Apache Camel (for the remainder). I now prefer to do the FHIR servers with HAPI (plus Apache Camel) in combination with Intersystems Healthshare doing business logic.