FHIR integration checklist: 10 decisions before you build

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FHIR integration projects become difficult when teams begin writing code before agreeing on interfaces, responsibilities and acceptance criteria. Use these ten questions to establish a useful project baseline.

Ten decisions to document

1. What is the clinical or operational outcome? Identify which workflow needs improvement and what “working” means.
2. Which systems are in scope? Identify system owners, source of truth, environments and integration constraints.
3. Which FHIR version and implementation guides apply? Confirm version compatibility and jurisdiction-specific profiles.
4. Which resources and interactions are required? Identify required endpoints, read/search/write operations and constraints.
5. How will users and systems authenticate? Agree on authorisation, least-privilege access and any applicable SMART on FHIR patterns.
6. How is patient identity resolved? Define identifiers, matching assumptions and exception handling before exchanging records.
7. What mapping and terminology rules apply? List coding systems, value sets and source-to-target transformations.
8. How will data quality be tested? Use synthetic and approved test data to check missing values, dates, units and duplicates.
9. What happens when integrations fail? Plan retries, idempotency, monitoring, error queues and support ownership.
10. What proves acceptance? Agree on conformance tests, test cases, performance expectations and sign-off criteria.

What to prepare for a discovery call

Bring architecture diagrams that do not contain confidential credentials or patient information, product documentation, intended workflows and a list of known dependencies. Avoid sending real patient data through a public website form.

Working on a similar problem?

Get a preliminary assessment to help identify likely technical workstreams and the next questions to resolve.