Streamlining Health Data Integration with FHIR

Digital health solution providers face increasing pressure to integrate complex health data systems while ensuring scalability, security, and compliance with standards like HL7® FHIR®. Fast Healthcare Interoperability Resources (FHIR) has revolutionized health data exchange by offering a standardized framework that allows diverse health IT systems to communicate effortlessly. But simply adhering to FHIR standards isn’t enough to overcome the intricacies of health data integration. Solution partners must leverage advanced architectural components like FHIR brokers, façades, and repositories to build scalable and efficient solutions. InterSystems offers all the essential features you need to implement FHIR for your health data, whether on-premises, in a public cloud, or as a cloud-based service managed by InterSystems.

InterSystems IRIS® for Health is a comprehensive, digital health development platform that provides all the building blocks needed to work with FHIR data and develop FHIR applications. The InterSystems platform includes a reliable, efficient data management stack and implements FHIR seamlessly, enabling developers to create scalable, interoperable healthcare solutions.

To support these capabilities, InterSystems IRIS for Health includes the following suite of robust features designed to simplify FHIR integration and maximize interoperability:

• FHIR Server – A fully compliant FHIR server out of the box that can also serve as the front end of a FHIR façade. This server can accept, process, and translate FHIR requests into the legacy formats that the underlying system uses, and vice versa.
• Bulk FHIR – A unique set of features that import and export large FHIR data sets for research, analytics, data migration, and other uses. Bulk FHIR lets you easily retrieve major FHIR resources in one efficient request and manage large data sets across many systems and locations.
• FHIR Transformation – A unique set of tools that allow for seamless transformation between FHIR resources and legacy data formats (for example, HL7 v2, CDA, custom schemas). The platform can map these legacy formats into FHIR in real time, enabling efficient data retrieval and updates.
• FHIR SQL Builder – A unique tool that lets analysts and developers securely query FHIR data in real time with such familiar tools as ANSI SQL, Power BI, or Tableau. Encoded in complex directed graphs, FHIR cannot be queried with standard SQL. With FHIR SQL Builder, you can create custom SQL schemas based on the FHIR repository itself, without the costly moving of data to an additional SQL repository.
• Data Normalization and Access – Support for data normalization, so that data retrieved from legacy systems is structured and accessible in FHIR format. This is essential for ensuring that data from different systems can be aggregated and presented consistently.
• FHIR Object Model – Custom code programming with FHIR model classes, which offer code completion and IntelliSense support.

FHIR offers a flexible and scalable framework for healthcare data interoperability. Effectively leveraging FHIR requires understanding the key components, architectures, and patterns that enable data integration and data exchange. At a high level, the capabilities of FHIR are organized into the following components:

• A FHIR broker serves as a multi-routing intermediary, streamlining the flow and exchange of health data among various systems. It enables seamless interoperability by managing transactions, coordinating disparate systems, and ensuring that data moves efficiently and securely. For digital health solution partners, FHIR brokers simplify data exchange, acting as “clearing houses” and making it easier to integrate and scale applications in a complex ecosystem, without requiring additional retrieval of FHIR data from a database.
• A FHIR façade acts as a single interface that abstracts the complexity of an underlying non-FHIR database, enabling developers to focus on application functionality rather than low-level data management. The façade stands “in front of” a single non-FHIR system so that FHIR-based operations can work with that system.
• A FHIR repository provides a centralized data store that manages and serves health data natively in FHIR format and that ensures data integrity, security, and access control. A repository offers the advantages of easier integration and management, as well as better performance and more efficient queries and updates.

Together, these FHIR components enable developers to create flexible, high-performing, and secure healthcare applications, enhancing patient outcomes while reducing development and maintenance overhead.

The InterSystems FHIR stack offers a choice to FHIR implementers, leveraging robust data integration and management expertise to support all major FHIR architectural patterns that combine the preceding FHIR components in different ways. InterSystems comprehensive suite of FHIR features facilitates not only compliance with FHIR standards but enhances data interoperability across diverse systems. By combining technical prowess with deep industry knowledge, InterSystems helps developers navigate the complexities of FHIR adoption and implement those FHIR solutions that best suit their needs.

Security is a critical aspect of healthcare data management, and InterSystems provides robust tools to ensure that its FHIR interfaces are secure. These include role-based access control (RBAC), OAuth2 support for FHIR, and audit logging to ensure compliance with healthcare regulations like HIPAA.

Let’s examine how each of these FHIR components work together within InterSystems software to help you select an architectural pattern that best fits your needs.

A FHIR Broker is a multi-routing intermediary that facilitates the exchange of healthcare data using the FHIR standard. It acts as a connector between disparate health information systems, enabling them to communicate effectively by transforming and routing FHIR resources. A FHIR Broker is essential in environments where multiple systems—such as electronic health records (EHRs), clinical applications, and patient management systems—need to share data seamlessly while still adhering to the FHIR standard.

InterSystems FHIR Broker capabilities together act as a cornerstone in a FHIR architecture by providing robust tools for data transformation, validation, and aggregation. This eases the implementation of FHIR-based solutions that can address specific challenges, such as integrating multiple legacy systems. For example, a hospital network might integrate patient data from various EHR systems, and the InterSystems FHIR Broker can aggregate information from these systems, standardize it to the FHIR format, and present it as a unified view. Clinicians can then access comprehensive patient information in real time, improving care coordination and reducing the risk of errors. Additionally, a FHIR broker can facilitate secure and scalable data sharing for population health management, allowing healthcare providers to analyze trends and improve outcomes—for example, for heart disease, smoking cessation, and childhood obesity—across different patient demographics.

InterSystems SDA (Summary Document Architecture) data model is designed to make the process of converting legacy healthcare data formats into modern standards like FHIR more efficient. SDA provides a unified data representation for various legacy healthcare data formats, such as HL7 v2, CDA (Clinical Document Architecture), or custom flat file formats. This intermediate format bridges the gap between the highly structured legacy systems and the more modular, flexible structure of FHIR and works ideally as part of a FHIR Broker solution.

SDA also acts as an abstraction layer that standardizes data from different sources into a common format. This abstraction reduces the complexity of transforming each format directly into FHIR, as SDA provides a normalized structure.

Once data is transformed into SDA format, it can be reused across multiple systems. The conversion to SDA needs to be done only once for each legacy format. From SDA, data can be exported into various modern standards, including FHIR, thus reducing the need for multiple point-to-point conversions.

InterSystems provides built-in tools and connectors that facilitate the conversion from legacy formats to SDA and from SDA to FHIR. This includes predefined mappings, parsers, and transformation logic. InterSystems also supports custom FHIR profiles, allowing SDA data to be transformed into FHIR profiles that meet specific organizational or regulatory requirements.

A FHIR façade is an architectural pattern used in healthcare systems to provide a FHIR-compliant interface on top of an existing non-FHIR-compliant system. It acts as an enabling interface that exposes data and services from legacy non-FHIR systems in a standardized FHIR format, enabling interoperability with modern healthcare applications without requiring major changes to the underlying legacy systems. Unlike a FHIR broker coordinating multiple systems, a FHIR façade stands “in front of” a single non-FHIR system.

Many healthcare systems are built on older standards like HL7 v2, CDA (Clinical Document Architecture), or custom data formats not compatible with FHIR. FHIR façades provide a solution by transforming data in older formats into FHIR on demand, meeting modern interoperability standards and integrating with new applications, such as electronic health record (EHR) systems, health information exchanges (HIE), and patient apps.

• Real-Time Data Transformation – A FHIR façade converts data in real time, translating requests and responses between the legacy system’s native format and FHIR resources.
• No Disruption to Existing Systems – The underlying system continues operating as it always has, while the façade handles FHIR interactions, minimizing the need for costly and disruptive changes to legacy infrastructure.
• Incremental Modernization – A FHIR façade allows organizations to modernize incrementally by exposing a FHIR-compliant API for external use without having to overhaul legacy systems in one step.
• Interoperability – By translating legacy formats into FHIR, a FHIR façade enables interoperability with other healthcare systems, applications, and platforms which require FHIR compliance.

InterSystems IRIS for Health offers an ideal set of tools and technologies for implementing a FHIR façade since it natively supports FHIR and FHIR data transformations.

InterSystems IRIS for Health supports the use of custom FHIR profiles and extensions, enabling organizations to adapt the FHIR façade to their specific needs. This flexibility allows the FHIR façade to accommodate regional or organizational requirements for data exchange while adhering to FHIR standards.

A FHIR repository offers a more convenient and efficient way of managing healthcare data compared to a FHIR façade. While both approaches aim to provide interoperability and facilitate the use of FHIR, a FHIR repository provides numerous advantages in terms of data management, performance, and ease of integration. A FHIR repository stores, manages, and serves healthcare data natively in FHIR format, offering a centralized platform where data can be efficiently queried and updated. This stands in contrast to a FHIR façade, which serves as a front end to legacy systems, translating between non-FHIR formats and FHIR format in real-time.

InterSystems FHIR repository is specifically designed to store and manage data in the FHIR format and eliminates the need for real-time data conversion. By natively storing FHIR resources, the repository can handle complex FHIR queries and updates more efficiently.

Direct queries against FHIR repositories, without the need for intermediate mappings, are particularly useful for complex searches, such as patient record queries that span multiple FHIR resources (e.g., Patient, Condition, Observation). All data is stored in one place in FHIR format. This improves the consistency, efficiency, and reliability of data storage and access.

InterSystems FHIR repositories are designed to scale efficiently as healthcare organizations grow and handle increasing volumes of data. Since a repository stores pre-converted FHIR data, the system is optimized for performance when handling concurrent requests from multiple systems. InterSystems operates a scalability lab for FHIR performance benchmarking. The lab regularly runs a complete suite of FHIR benchmarks, showing marked improvement in complex FHIR search queries. Simple repository searches can retrieve over 160,000 FHIR resources per second, with similar performance in more demanding cases (Jamieson & Banand, 2024).¹

InterSystems provides a fully compliant FHIR repository out of the box. This eliminates the need for complex setup and allows healthcare organizations to quickly deploy a FHIR repository that is compliant with the latest FHIR standards. This stack supports all major FHIR interactions, including resource creation, retrieval, updating, and deletion. InterSystems ensures that its FHIR repository remains conformant with evolving FHIR standards, offering support for the latest FHIR resources and capabilities. This ensures compatibility with other FHIR-based systems and futureproofing for evolving healthcare standards.

The built-in FHIR repository is natively integrated with the InterSystems IRIS for Health data platform, enabling seamless interaction with other healthcare systems and applications. This makes it easier to ingest, store, and retrieve FHIR resources without additional complexity.

InterSystems IRIS for Health contains a multi-model database and supports advanced analytics, AI, and machine learning models. This platform’s FHIR repository can be used as the foundation for building analytics solutions that draw from structured and normalized healthcare data. InterSystems’ unique FHIR SQL Builder tool enables developers to “project” FHIR resources in a relational format, making it easy to use ANSI SQL or BI tools for analytics. Because this platform is a true multimodel database it can do these projections in real time, analytics users always have up-to-date information without needing to duplicate their data in a data warehouse.

InterSystems IRIS for Health enables organizations to apply population health analytics, predict patient outcomes, and optimize clinical operations by storing and querying data in FHIR format.

Whether you’re building a FHIR Broker, FHIR Façade, or FHIR Repository, the choice of technology stack can significantly impact your success. Here’s why InterSystems FHIR Stack should be your top choice:

• Comprehensive and Scalable FHIR Support – InterSystems provides full support for the latest FHIR standards across all versions. With a proven record in handling large volumes of clinical data, InterSystems IRIS for Health is designed for scalability. Whether you’re developing a simple FHIR Broker or a complex FHIR Repository, InterSystems ensures you can scale efficiently without compromising performance, even in high-volume environments. Our unique InterSystems Bulk FHIR coordinator enables Bulk Export from other FHIR servers and EMRs that support Bulk FHIR, making it easy to manage all your FHIR data in one place.
• Seamless Integration with Existing Systems – One of the greatest challenges in healthcare IT is integrating new solutions with legacy systems. InterSystems’ FHIR Stack offers a seamless bridge between modern FHIR-based applications and older HL7 v2, HL7 v3, and CDA standards. This interoperability ensures continuous communication across your organization’s IT landscape without overhauling your existing infrastructure, making it ideal for FHIR Façades and our unique FHIR Transformation services.
• Proven Performance and Reliability – In healthcare, reliability is non-negotiable. InterSystems has a long-standing reputation for delivering enterprise-grade performance with high availability and low latency. The FHIR stack is built on InterSystems IRIS for Health, a data platform specifically designed for healthcare workloads. It ensures consistent uptime and efficient real-time data exchange, whether you’re managing a FHIR Repository or serving as a FHIR Broker.
• Advanced Data Management and Security – Data security and patient privacy are paramount in healthcare. InterSystems FHIR Stack offers robust, built-in security features to protect sensitive healthcare data. It is fully compliant with HIPAA and other global standards, providing role-based access controls, audit logging, and encryption capabilities. For organizations building FHIR Repositories, this compliance means peace of mind when storing and exchanging large datasets.
• Extensive Development and Customization Tools – With comprehensive development environments, including APIs, SDKs, and FHIR SQL Builder, InterSystems helps you customize and extend your FHIR solution according to your specific needs. Whether you need a lightweight FHIR Broker or a feature-rich FHIR Repository, our tools and robust support services allow for quick customization, reducing time-to-market.
• Exceptional Vendor Support and Ecosystem – InterSystems is renowned for its outstanding customer support, which includes 24/7 access to technical resources and an extensive developer community. Our strong ecosystem of partners and solutions ensures that you’re never working in isolation. Whether you need consultation on best practices for FHIR Façades or technical troubleshooting for your FHIR Repository, help is always readily available.

1- FHIR Performance Benchmarking, Patrick Jamieson MD, Product Manager, and Anarsh Banand, FHIR Performance Engineer, InterSystems Corporation, 2024. Full video available here.