FHIR Development Guide


FHIR Development Guide

Adding the FHIR standard to your existing system is an arduous process. You must adhere to regulations like the 21st Century Cures Act and add new features to your system to increase its interoperability. But the challenge isn’t isolated to the technical side: you must choose whether to build those features or pick a solution from one of the FHIR vendors.

We recognized the need to simplify or altogether remove the entire process from your hands. Choosing the correct solution and its subsequent implementation can consume time and resources. That is why we decided to develop and share our FHIR implementation process and what we believe to be the optimal way to add a little FHIR to your system.

Select Optimal FHIR Server

Much like with similar integration or migration services, we must choose whether to complete the entire product development cycle and develop a custom software from scratch or go with one of the many FHIR vendors. The duration of this step is contextual, pending the client’s immediate needs and expectations related to budget, delivery time expectation, or service features.

Research Vendors

Choosing the correct vendor means understanding the purpose and necessary features of the product. It is essential to understand the client’s needs to develop a list of options and a way to create a layer to connect FHIR API to the client’s system.

Deploy FHIR Server

As members of Amazon and Microsoft partner networks, we have experience developing and implementing solutions using Firely, Amazon, Azure, and XYZ, among others. Following successful deployment, we map out how to connect the client’s database and FHIR resources.

Research and Implementation Between the Client’s Database and FHIR Resource

Understanding the client’s problems means understanding the client’s system. After determining the necessary features, it is time to find a way to connect the client’s database with the product. If the database is missing, we must have MUST SUPPORT elements with a plan showing how to add/hardcode those elements.

As part of our FHIR development, we make minor changes to the vendor product to ensure that it follows legislative requirements such as the 21st Century Cures Act and to make them eligible for ONC certification.

Selecting, Deploying, and Customizing Identity Server

We research the ideal server if the client doesn’t have one already. Our previous custom solutions relied on DUENDE, Amazon Cognito, and XYZ, among others.

Of course, it is necessary to customize the server based on the client’s needs and to ensure it supports essential features such as SMART on FHIR.

Integrate Identity Server with FHIR Server

The last part of the process is connecting the customized server with FHIR. Depending on the requirements and additional features, this step can last around two weeks.


Having the finished product doesn’t mean that everything will run smoothly. We use Inferno testing to determine whether all systems comply with the US Core Implementation guide and 21st Century Cures Act. The duration of this step of our FHIR development guide depends on the number of errors found in the test and the time it takes to resolve them.

FHIR Development Guide, Infographic