FHIR-native applications: advancing healthcare data interoperability

Rebeca Sarai

April 17, 2025

Healthcare data interoperability has become increasingly critical as the industry continues its digital transformation. With patient data flowing between mobile apps, web platforms, smart devices, and traditional healthcare systems, the need for standardized communication protocols like FHIR (Fast Healthcare Interoperability Resources) has never been more apparent. FHIR provides the foundation for seamless data exchange that modern healthcare demands.

Building on this standard, FHIR-native applications offer significant advantages over retrofitted solutions. This article explores why the FHIR-native approach is optimal for modern healthcare software.

Understanding FHIR: the foundation of modern healthcare data exchange

FHIR is a standardized framework that enables different healthcare systems to communicate effectively. The regulatory landscape has embraced FHIR. The 21st Century Cures Act Final Rule requires healthcare systems to use standardized APIs — specifically naming the HL7 FHIR standard — for exchanging electronic health information. This government backing has accelerated FHIR adoption across the healthcare industry.

The 4 levels of healthcare interoperability

True interoperability requires more than just technology: it's about how systems, people, and processes work together.

Healthcare interoperability operates on four levels:

Foundational Interoperability - the basic ability to exchange data between systems (like sending lab results from one system to another);
Structural Interoperability - using standardized formats so the receiving system can process the data;
Semantic Interoperability - ensuring the meaning of the data remains consistent (a diagnosis code means the same thing in both systems);
Organizational Interoperability - the policies and processes that allow organizations to work together effectively.

FHIR excels at both structural and semantic interoperability through its consistent resource formats and built-in terminology services.

General FHIR architecture

The architecture of a FHIR-native application follows a clean, modular design pattern. At its core is the FHIR server, which acts as the central hub for processing and routing all healthcare data.

This architectural approach creates a three-tier system:

Client applications that interact with users;
A FHIR server that processes requests through standardized APIs;
A database optimized for storing FHIR resources.

FHIR-native applications typically include these essential components:

RESTful APIs - FHIR provides a standardized API framework that enables developers to build applications with RESTful endpoints. Software engineers can combine different FHIR resources to tailor solutions for specific clinical use cases;
FHIR Profiles and Resources - Resources represent the fundamental building blocks of FHIR — exchangeable content pieces that can include documents, images, and discrete data elements. Their primary function is facilitating information exchange between different EHR systems, conveying elements like patient demographics, care plans, or clinical observations. FHIR profiles extend these capabilities by providing rules that allow resources to include extensions;
Terminology Services and CodeSystems: FHIR includes terminology resources such as CodeSystem, ValueSet, and ConceptMap that help maintain consistent meaning across different systems. For example, when one system records a diagnosis using a SNOMED CT code, a FHIR-native application can ensure that this clinical concept is correctly understood by any receiving system, regardless of what terminology that system uses internally.

Benefits of FHIR-Native architecture

Easier Integration

FHIR-native solutions intrinsically connect with other FHIR-compliant systems, eliminating the need for complex interface engines or data transformation layers. For example: a FHIR-native patient portal can instantly display lab results from multiple healthcare providers without custom integration work for each source.

Better Data Preservation

The FHIR standard supports diverse healthcare data types, including clinical, administrative, and patient-generated information. The standard's built-in extensibility allows for storing new types of data while enabling customization based on specific needs. This makes FHIR particularly valuable for long-term data archiving.

Development Efficiency

FHIR provides ready-to-use data models that accelerate software development while ensuring compliance. Rather than building custom adapters or data transformation layers, developers can leverage FHIR's standardized components to create interoperable solutions in hours rather than weeks or months.

Cloud integration for FHIR-Native solutions

You don't have to build your FHIR infrastructure from scratch. Major cloud providers now offer ready-to-use FHIR services:

Microsoft Azure - The FHIR service in Azure Health Data Services enables rapid exchange of health data using the FHIR standard. This managed Platform-as-a-Service (PaaS) makes it easier to securely store and exchange Protected Health Information (PHI) in the cloud.
AWS HealthLake - a HIPAA-eligible service offering healthcare companies a complete view of individual and patient population health data using FHIR
Google Cloud - Google's Open Health Stack offers building blocks for creating next-generation healthcare applications. These open-source components accelerate adoption of modern healthcare standards (HL7 FHIR), enabling secure, offline-capable, data-driven solutions, especially valuable in low-resource settings.

These cloud-based options provide ready infrastructure for organizations implementing FHIR-native solutions, reducing the technical burden of maintaining compliant environments.

The future is FHIR-native

As healthcare continues its digital transformation, FHIR-native architecture represents the most forward-thinking approach to application development. Native implementation enables true interoperability, speeds development, and positions organizations for success in an increasingly connected healthcare ecosystem.

For healthcare technology leaders, the question isn't whether to adopt FHIR, but how to fully embrace it. By building truly FHIR-native solutions rather than adding compliance layers to existing systems, organizations can achieve seamless interoperability while reducing long-term technical debt and maintenance costs.