FHIR servers: what’s really important?

Choosing a FHIR server provider should never be about features.

You can always build what you need on top of what’s already there.

So what’s really important?

• Cost
• Reliability
• Performance
• Support

In this respect FHIR servers should be no different to any other piece of technology. It needs to be affordable and it needs to work well and consistently.

We get bombarded on sites like LinkedIn with promotional material from server providers.

We’ve built a great new widget that does X!

While new features are a positive sign that a server provider is investing in future development, I’d be more impressed to be told:

We’ve fixed every bug and improved performance by 50%.

Stability and cost matter.

Here are 5 key questions to ask before you sign up.

1. How much is it going to cost us?
   There is great diversity in pricing models, running from 6 figure yearly pricing per production server to PAYG pricing from some of the managed cloud providers. Be careful – FHIR servers can appear cheap until you dig into the detail.
2. Will the pricing model change?
   Cloud providers in particular change their pricing structures frequently. If it looks cheap ask yourself if your use-case can handle a shift to a different pricing model. Switching server providers two years after a project goes live is next to impossible.
3. High data volumes and lots of concurrent requests?
   You will need to test this. It’s an investment you will have to make unless you want to get stuck with a low performing server for years. There are no truly independent metrics measuring FHIR servers. In some cases this will mean paying for a POC. Pay the money!
4. How are new releases handled?
   The key question here is: if a new release breaks your app, will the provider roll back to a previous working version for you? The answer is probably not. Is that an acceptable answer for you and for your customers? If it’s not, look elsewhere.
5. Are you working on FHIR R6?
   What you’re really asking here is: “Are you looking to the future?”. You do not want to get stuck with a server provider that is “just getting by” and has no resources to invest in future development leaving you stuck with what you bought 5 years ago.

Again, it’s not about features.

Do not get seduced by all the branded marketing and high level announcements from server providers.

When choosing a server provider, be boring.

• Cost
• Reliability
• Performance
• Support

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