5 things to consider before choosing a FHIR server

How do you choose a FHIR server?

Let’s assume you’re going for something off-the-shelf.

A third party offering. An external company who provide the underlying database as well as the API on top.

Here are 5 things that you should consider before choosing that company or server.

1. Cloud or on-prem
– If it’s cloud, how do they handle upgrades?
– Can they roll you back to a previous version if there’s a problem?
– If it’s on-prem, have you got the skills to manage it in-house?

2. How well does it handle Subscriptions
– You may not need them yet, but your future apps and partners will.
– Does adding a new Subscription require manual intervention?
– How does it handle undelivered notifications?

3. Does it scale?
– Can it handle 1 million or 10 million patient records?
– What is the underlying database structure?
– Does it slow down as you add more and more resources?

4. How well implemented is the FHIR standard?
– Look beyond the basics.
– Can it handle complex query parameters such as _element and iterate?
– How many $operations does it deliver?

5. Does it handle async operations without impacting regular activity?
– Bulk export
– Bulk data load
– You may not need them on Day 1, but you will need them.

How do you test for all these things? The sales pitch on the website is always positive.

Take it for a test run.

– Load in a lot of data. A LOT. https://github.com/synthetichealth/synthea
– Run complicated queries filled with _revInclude and _has modifiers.
– Create subscriptions and monitor the outputs.
– Load in data asynchronous and run your complicated queries while that data load is running.

Choosing a FHIR server is a big decision. Getting it wrong can cost your product and your company time, money and reputation.

Take the time and test each offering against the same benchmarks.

Don’t just pick the brand name solution. Choose the one that measures up to your tests and to your requirements.

The list above is not exhaustive. Leave a comment if you can add to it.



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