FHIR service concepts and data model
The Fast Healthcare Interoperability Resources (FHIR®) service in Azure Health Data Services allows for rapid exchange of health data by using the FHIR data standard. As part of a managed platform as a service (PaaS), the FHIR service helps make it easier for healthcare professionals to more securely store and exchange Protected Health Information (PHI) in the cloud.
The FHIR service offerings include:
A managed FHIR-compliant server, which you can provision in the cloud in minutes. With the FHIR service, you can quickly create and deploy a FHIR server to the cloud for ingesting, persisting, and querying FHIR data.
The FHIR API in the FHIR service allows any FHIR-compliant system to connect and interact with FHIR data in a more secure manner.
More secure management of Protected Health Information (PHI) in a compliant cloud environment.
Control over your health data at scale. The FHIR service's role-based access control (RBAC) is based on Microsoft Entra identities management. You can grant or deny access to health data based on the roles given to individuals in your organization.
Audit log tracking for access, creation, and modification events in the FHIR service data store.
Azure services that power the FHIR service are designed for high performance, regardless of the amount of data that you're working with. Because the FHIR service is a PaaS offering, Microsoft deals with the operations, maintenance, update, and compliance requirements for the FHIR service. As a result, your operational and development resources can focus on other tasks. Because it belongs to the Azure family of services, the FHIR service helps protect your organization's PHI with an unparalleled level of security. In Azure Health Data Services, FHIR data is isolated to a unique database for each FHIR service instance. Furthermore, the FHIR service implements a layered, in-depth defense and advanced threat detection for health data.
Use cases for the FHIR service
FHIR servers are essential for interoperability of health data. The FHIR service is designed as a managed FHIR server with a RESTful API for connecting to a broad range of client systems and applications.
Some key use cases for the FHIR service are:
Startup app development - Customers who are developing a patient or provider-centric app (mobile or web) can use the FHIR service as a fully managed database for health data transactions. The FHIR service allows for a more secure transfer of PHI. With SMART on FHIR, app developers can take advantage of the robust identities management in Microsoft Entra ID for authorization of FHIR RESTful API actions.
Healthcare ecosystems - Although electronic health records (EHRs) are the primary source of truth in many clinical settings, it's common for providers to have multiple databases that aren’t connected to each other (often because the data is stored in different formats). Organizations can standardize data in the FHIR format by using the FHIR service as a conversion layer between these systems. Ingesting and persisting in FHIR format helps organizations with health data querying and exchange across multiple disparate systems.
Research - Health researchers use the FHIR standard because it gives the community a shared data model and removes barriers to assembling large datasets for machine learning and analytics. With the data conversion and PHI de-identification capabilities in the FHIR service, researchers can prepare HIPAA-compliant data for secondary use before sending the data to Microsoft Azure Machine Learning and analytics pipelines. The FHIR service's audit logging and alert mechanisms also play an important role in research workflows.
FHIR platforms from Microsoft
Managed FHIR capabilities from Microsoft are available in two offerings:
The FHIR service is a managed platform as a service (PaaS) that operates as part of Azure Health Data Services. FHIR service in Azure Health Data services is an evolved version of its predecessor Azure API for FHIR.
Azure API for FHIR is a managed FHIR server that's offered as a PaaS in Azure, and you can deploy it in the Azure portal. Azure API for FHIR isn't part of Azure Health Data Services and lacks some of the features of the FHIR service. Azure API for FHIR is scheduled for deprecation in September 2026.
The following table lists the difference between Azure API for FHIR and FHIR service in Azure Health Data Services.
| Capabilities | Azure API for FHIR | Azure Health Data Services |
|---|---|---|
| Data ingress | Tools available in OSS | $import operation. For more information, see Import operation |
| Autoscaling | Supported on request and incurs charge | Autoscaling is turned on by default at no extra charge |
| Search parameters | Bundle type supported: Batch | Bundle type supported: Batch and transaction |
| Include and revinclude; iterate modifier not supported | Selectable search parameters | |
| Sorting supported by first name, last name, birthdate, and clinical date | Include, revinclude, and iterate modifier is supported | |
| Sorting supported by string and dateTime fields | ||
| Events | Not Supported | Supported |
| Convert-data | Supports turning on "Allow trusted services" in Account container registry | A known issue has occurred - Activating the private link with Azure Container Registry might result in access issues when you're attempting to use the container registry from the FHIR service. |
| Business continuity | Supported: | Supported: |
| Cross region DR (disaster recovery) | PITR (point in time recovery) | |
| Availability zone support |