Microsoft Azure is the most commonly chosen FHIR server provider.
This comes from a survey I ran a couple of months ago where I asked “Who provides your FHIR servers?”
34% said Microsoft.
The second most popular answer was: “We built our own.”
There were over a hundred responses. Not a large sample, and in no way definitive, but leaning heavily in one direction.
Let’s jump back to Microsoft and their managed FHIR servers.
The decision to buy Microsoft is seldom made by developers. It’s often a business decision that has little to do with the quality of the FHIR server.
But it falls on developers to implement that decision.
Where’s the best place to start?
First, be aware that where you start doesn’t have to be where you end up.
Microsoft’s managed FHIR servers are a quick and easy introduction to FHIR. They’re well documented and implement most of the FHIR R4 spec.
But they have their drawbacks.
- No support for FHIR Subscriptions
- R4 only
- Result truncation above 100 included resources
- Difficult to implement Smart-on-FHIR
- No built in Implementation Guide support
On the plus side, getting a server up and running so you can start writing code and building your app takes less than an hour.
They integrate well with the rest of the Microsoft ecosystem, and form one part of Azure’s Health Data Services, which includes managed DICOM servers in the same workspace.
What if you’re unhappy with a managed service and the business insists on going with Microsoft?
You should take a look at their open source server.
Microsoft’s managed FHIR servers run the same code (almost) as their open source FHIR server.
Essentially, it functions as a ‘test bed’ for the code in their managed servers. Bug fixes, improvements and new features all get rolled out to the OS repository first.
If you’re worried about storing critical healthcare data in a server and environment you don’t manage or control, then running your own instance of a stable version of Microsoft’s OS server is a real alternative.
You control the upgrades and you control the environment.
And it’s still Microsoft, which makes it an easier sell to the business.
Microsoft Open Source FHIR server: https://github.com/microsoft/fhir-server
Azure’s managed FHIR server: https://learn.microsoft.com/en-us/azure/healthcare-apis/fhir/overview
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