There are upwards of 30 FHIR server providers.
The decision of which one to use usually starts with investigating one of the five provider categories listed below — often without realizing you’re doing so.
It’s rare for a company or organization looking for a server provider to spend serious effort in examining providers from different categories.
The companies named in each category are a sample only. Apologies in advance if any company listed feels they belong in another category, but this is my perception of the market as it is today.
1. The “Big 3” managed cloud providers
- Microsoft Azure
- AWS
- Google Cloud
I separate these out into their own category even though there are other providers of managed cloud servers.
What distinguishes these three is how decisions are often made when selecting them. A typical decision to use one of these providers starts with:
All of our cloud infrastructure is on Azure. [or AWS or Google]
At this point the decision — for good or ill — is made. There may be some half-hearted attempts to look at other independent providers, often for the purposes of documenting the decision in an ADR (Architectural Design Record), but it tends to be little more than a checkbox exercise.
Expect a mixture of pricing models from pay-as-you-go to monthly fees per server.
2. On-premises “enterprise” servers
- Firely
- Smile Digital Health
I see these as Enterprise solutions, usually involving the typical Enterprise sales process and pricing along with a possible paid-for POC. Start-to-finish you could be looking at a 12 month cycle from initial investigation to signing on the dotted line.
Many of the other providers also offer “on-prem” solutions using containerized instances of their servers, but it’s not a market they’re known for or aggressively pursuing.
3. Independent providers
- Health Samurai Aidbox
- Medplum
- Kodjin
- Oystehr
Smaller companies offering FHIR servers of similar or greater quality than the “Big 3”.
I’m a huge fan of these companies and believe they offer far superior servers to the bigger named companies, but they suffer from their smaller size.
I know from my own experience consulting with multi-national MedTech and health insurance companies that many would be reluctant to “take the chance” on a smaller company as the fear of them disappearing in a few years would be a risk too large to accept.
These same companies will usually choose one of the Big 3, if only because “No one ever got fired for buying Microsoft.”
As with category 1, expect a range of different pricing models.
4. “All-in-one” solutions
- InterSystems
- Infor
- Enovacom
More than just a FHIR server, these providers offer all encompassing solutions for your healthcare data needs, with a FHIR server as one part of that larger solution.
They may include HL7 integrations, OMOP conversions and direct hospital integrations as part of the package. As with category 2, expect Enterprise pricing.
5. Open source servers
- HAPI
- IBM
- Incindi
- Microsoft
If you want to “own” your own server and manage its updates and improvements, the above OS servers are a good starting point.
I’ve spoken to a number of companies who have done this with varying degrees of success. One of the primary problems they report is that there are real differences between the OS servers and their commercial counterparts from the same companies.
The “good stuff” that helps with scaling and security are often not part of the OS projects. Some companies have taken the decision to migrate from OS to commercial servers for these reasons.
Conclusion
If you’re exploring FHIR server providers, start by asking the hard questions you need to ask to determine which category of provider you’re REALLY looking for.
Then drill down from there.
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