Setting Azure on FHIR

Let me start with the news…

Today I am please to announce the public preview of Azure API for FHIR® –  a new data service in the Microsoft Cloud for bringing together healthcare data from disparate systems and enabling new systems of engagement for patients, clinicians, and other healthcare professionals.

Now for the full story…

“Artificial intelligence represents one of technology’s most important priorities, and healthcare is perhaps AI’s most urgent application” – Satya Nadella, Microsoft CEO

Modern healthcare solutions face new challenges

Organizations building healthcare solutions face significant challenges as the data needed for modern solutions leveraging advanced analytics and machine learning can be difficult to access and is often segregated into different silos based on a variety of healthcare systems including electronic health records (EHR), financial/billing systems, customer relationship management (CRM) for marketing, picture archiving and communication systems (PACS) for imagery and more. To further complicate matters, evolving health data systems, including connected devices in the Internet of Medical Things (IoMT), genomics and immunomics systems, big data sets from government agencies and research institutions and more, make it difficult to get a complete view of a patient’s or population’s data. The desire is to bring all this data together to build modern healthcare solutions that can improve clinical, financial, operational, and population health analytics. The ability to digitally capture, annotate, and combine data to apply machine learning will transform the delivery of healthcare.

In order to successfully bring together the relevant data and apply machine learning, organizations require a platform that supports standards-based interoperability, the security and privacy needed when working with PHI, and the compute capability to process a large amount of data.

Health data interoperability is paramount

According to a paper published in JMIR Medical Informatics , limited health care data interoperability contributes to an estimated US $700 billion in wasteful spending annually in health care and leads to gaps in critical information at the point of care putting undue burden on patients and potentially leading to significant safety issues. As part of providing care for their patients, the typical primary care physician (PCP) coordinates care with 229 other physicians across 117 organizations, and an inpatient study found that 18% of medical errors leading to adverse drug events could be traced back to missing data in the patient’s medical record.

The healthcare industry has suffered from health data standards that are highly complex and often customized to a point that interoperability is too technically challenging for most. Interoperability based on previous standards has advanced only a little and has fallen far short of enabling the kind of interoperability required in today’s highly digitized world.


icon-fhir-720The introduction of the Health Level Seven International (HL7®) Fast Healthcare Interoperability Resources (FHIR®) specification provides a better, more reliable interoperability path. The specification defines an ontology for health data that is durable across systems, including entities (known as Resources) for key concepts such as Patient, Provider, Payer, Encounter, Observation and more. Thirteen Resource definitions have been validated and are considered normative in the latest release of the specification (over 100 additional Resource definitions are at various stages of maturity). FHIR is widely perceived as key to the future of interoperable health data in the industry.

A Commitment to Interoperability

In August 2018, Microsoft was a key catalyst to bring together the biggest tech companies in a pledge for health data interoperability. Notably Microsoft, Google, IBM, Oracle and Salesforce announced their intent to jointly commit “to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI.” Each of these companies has leveraged the FHIR specification in technology they provide, including Microsoft Teams Health Huddle , Dynamics 365 Healthcare Accelerator , and the Azure Security and Compliance Blueprint – HIPAA/HITRUST Health Data and AI from Microsoft. These companies made a commitment to supporting the FHIR specification to ensure health data interoperability across the clouds.

Announcing Azure API for FHIR

FIHR_largeMicrosoft is introducing a set of healthcare application programming interfaces (API) to enable modern healthcare solutions in the cloud. These APIs enable healthcare organizations to unlock the power of heath data so that systems can interoperate with each other and data can be used in new ways to drive better health outcomes more efficiently. Microsoft is adopting industry standard technical specifications like FHIR (Fast Healthcare Interoperability Resource ) to power this interoperability across multiple health systems and vendors. The first of our offerings, Azure API for FHIR, makes it easier for developers to leverage a single, consistent, secure, and authoritative ingestion and data management platform for extended health data and Protected Health Information (PHI) in the cloud, connecting multiple disparate systems. Azure API for FHIR will be followed by APIs for other health data standards like DICOM®, HL7v2 and more.

Enabling interoperability of health data

According to the paper published in JMIR Medical Informatics “despite the relatively rapid nationwide adoption of electronic health records (EHRs), the industry’s ability to successfully exchange computable health data has not kept pace. A recent study found that less than 35% of providers report data exchange with other providers within the same organization or affiliated hospitals. The exchange of data across organizations is even more limited, with less than 14% of providers reporting they exchange data with providers in other organizations or unaffiliated hospitals.” These systems have been developed using older standards, including HL7 v2.x, Clinical Document Architecture (CDA) and proprietary APIs that make it challenging for healthcare solution developers to leverage these systems across healthcare providers. This has significantly limited access to healthcare data across providers and made it far too difficult to gain insight that can be derived from analytics and machine learning.
Azure API for FHIR implements the HL7 FHIR specification, enabling interoperability based on an emerging industry standard data model and RESTful interface for health data. The cloud-based API supports SMART on FHIR integration with Azure Active Directory to enable 3rd party application developers to leverage existing application development.

FHIR heats up interoperability

FHIR is an evolving standard from HL7, with participation from major EHR vendors, provider and payer organizations, and technology companies. HL7 describes FHIR as follows:

The philosophy behind FHIR is to build a base set of resources that, either by themselves or when combined, satisfy the majority of common use cases. FHIR® resources aim to define the information contents and structure for the core information set that is shared by most implementations. There is a built-in extension mechanism to cover the remaining content as needed.

FHIR defines the ontology, data model and API for the exchange of health data between systems. The specification takes advantage of common paradigms and standards for cloud-based and Internet-enabled systems, such as JSON and XML to ensure human-readable content, and RESTful APIs to ensure universal access and interoperability. These are the same standards that the modern Web relies on for financial services, retail, and social media.

Key use cases for Azure API for FHIR

Azure API for FHIR is designed around three primary use cases – health system interoperability, research, and startup/innovation health projects. Across these use cases is a similar pattern – data from one or more systems-of-record coming together in a single persistence model through Azure API for FHIR and being enriched through analytics and machine learning. New systems-of-engagement interact with the data through the Azure API for FHIR.


Managed for you, so you can focus on your business

Our team has been working on the Azure API for FHIR in an effort to bring to market a FHIR service that reduces the burden to developers and organizations building healthcare solutions. Along the way we released the FHIR Server for Azure – an open source project on GitHub. FHIR Server for Azure is essentially the same FHIR server code used in the Azure API for FHIR – the big difference is that we run it for you.

The open source project is great because you have access to all of the code, so if you want to make changes or access the data in Cosmos DB directly you can. However, if you want a turn-key FHIR server and you want our team to ensure it is up and running, maintained, and responsive to issues 24/7, then the Azure API for FHIR is what you are looking for.

Both offerings support the compliance requirements for protected health information (PHI):

  • FHIR Server for Azure runs on Azure services that are ISO 27001:2013 certified and Microsoft offers a Business Associates Agreement (BAA) for Covered Entities supporting HIPAA compliance, however you are responsible for ensuring compliance of the FHIR Server for Azure implementation and an application in your Azure subscription.
  • Azure API for FHIR is itself ISO 27001:2013 certified, and can be used in your healthcare solutions. When the service reaches the General Availability stage later this year, it will be covered by the Azure BAA, to support HIPAA compliance. This reduces your compliance overhead and enables you to leverage a managed FHIR server in your solutions.


But we’re not done yet

I am incredibly proud of our team for what we have accomplished so far by providing you options for using Azure for health data. You can run your own FHIR server with FHIR Server for Azure, or we can run it for you with Azure API for FHIR. 

We have a lot of ideas about how we will build out this service and the space around it. Fundamentally we recognize the following three things:

  1. You need to incorporate more than just FHIR data
  2. You need to give data scientists access to data for research
  3. You need to integrate medical imagery with FHIR resources

We have a roadmap that will ensure you are able to achieve these goals. Later this year you will see us expand the Azure healthcare APIs to include data adapters for other standards (e.g. HL7v2, CDA), add capabilities for connecting FHIR data to machine learning and artificial intelligence workloads (e.g. de-identification), and the integration of non-FHIR data, specifically medical imagery through the addition of an Azure API for DICOM.

Our team is looking forward to bring you more technology to help you create new healthcare solutions that enable new insights, better care, and increased efficiencies.

You can learn more about both FHIR Server for Azure and Azure API for FHIR in our documentation at

HL7® FHIR® and the FHIR FLAME DESIGN are the registered trademark of HL7 and are used with the permission of HL7.

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