FHIR R4 integration
Production-grade integration with EHR FHIR APIs across Epic, Cerner, Athenahealth, and others.
FHIR Integration
Modern FHIR integration for real-time healthcare interoperability
FHIR R4 integration across Epic, Cerner, Athenahealth, and modern health systems — RESTful architecture, HIPAA-ready pipelines, scoped correctly from day one.
FHIR R4SMART on FHIRBulk FHIREpic App Orchard
Trusted by global innovators
FHIR-native by default, HL7-capable by design
FHIR is the modern standard for health data exchange. Our FHIR practice is tuned for the production realities of Epic, Cerner, and the broader ecosystem.
14+
FHIR resource types in routine use
R4
Target FHIR version for new builds
100%
BAA-covered inference on FHIR data
What FHIR is
FHIR is the API layer healthcare finally has
FHIR (Fast Healthcare Interoperability Resources) is HL7's modern standard for how health data is structured, shared, and accessed across systems via RESTful APIs. It replaces — or augments — bulk message-based approaches with real-time, resource-oriented endpoints.
FHIR supports JSON, XML, and HTTP. It models clinical data as Resources (Patient, Observation, MedicationRequest, etc.), supports events, documents, and APIs, and enables developers to build mobile and cloud apps against any compliant system.
Core capabilities
What we ship on FHIR
A full-stack FHIR practice — integration, transformation, analytics, and app embedding.
HL7 ↔ FHIR transformation
Bidirectional transformation between HL7 v2 and FHIR R4 for hybrid legacy / modern deployments.
SMART on FHIR launch
Embedded apps with patient, user, and system-level launch contexts inside EHRs.
Bulk FHIR data export
Population-level extraction via FHIR $export for analytics and research platforms.
CDS Hooks
Decision-support triggers embedded in EHR workflows for real-time clinical guidance.
FHIR server deployment
Self-hosted or managed FHIR servers — Azure FHIR, AWS HealthLake, HAPI FHIR.
Terminology services
SNOMED, LOINC, ICD-10, RxNorm resolution and mapping.
Patient-facing apps
SMART-on-FHIR patient apps for access and engagement.
Analytics pipelines
FHIR data as source for analytics, population health, and ML pipelines.
Architecture options
Three FHIR integration architectures
We pick based on where data lives, message volume, and whether event-driven flows matter.
RESTful API-based integration
- Direct calls to EHR FHIR endpoints
- Simplest architecture, real-time access
- Best for single-EHR read-heavy workloads
Middleware-based integration
- FHIR gateway between your app and EHR
- Supports HL7 ↔ FHIR transformation
- Best for multi-EHR or legacy-mixed deployments
Event-driven architecture
- Subscribe to FHIR events and react
- Enables near-real-time downstream workflows
- Best for clinical decision support and RPM-style flows
FHIR vs HL7
FHIR vs HL7 v2 — key differences
FHIR builds on earlier HL7 standards but is fundamentally different in architecture. Here's when each fits.
| Dimension | HL7 v2 | FHIR R4 |
|---|---|---|
| Architecture | Message-based feeds | RESTful APIs |
| Data format | Pipe-delimited text | JSON, XML |
| Access pattern | Bulk / event-driven messages | On-demand resource access |
| Implementation effort | Mature tooling, rigid format | Easier to implement and scale |
| Fit | Legacy EHR, clinical events | Mobile, cloud, modern apps |
| Our default | Support where required | Target for new builds |
Most modern builds run FHIR-first with HL7 v2 as a compatibility surface for legacy systems.
Where it runs
FHIR integration use cases
EHR / EMR integration
Primary use case — bidirectional data flow between your app and the EHR of record.
Mobile health apps
SMART-on-FHIR patient apps with authenticated access to clinical data.
Cloud platforms
FHIR-native cloud deployments on Azure, AWS, and GCP health platforms.
Telehealth systems
FHIR-integrated telehealth with real clinical context during visits.
Healthcare analytics
FHIR bulk export as source for analytics and research.
Third-party APIs
Integration with payer, lab, and specialty APIs via FHIR.
How we ship
Agnotic FHIR Readiness Framework
A six-step process to de-risk FHIR integration before committing to engineering.
Step 01
System analysis & requirements
Target EHR, FHIR version, resources needed, and compliance posture.
Step 02
FHIR capability assessment
What resources does the target system support, with what coverage?
Step 03
FHIR API layer development
Gateway, authentication, and request orchestration layer.
Step 04
Data mapping & transformation
HL7 ↔ FHIR where relevant, terminology mapping, and custom extensions.
Step 05
Testing & validation
Synthetic and partner-assisted data validation, performance testing.
Step 06
Deployment & monitoring
Production rollout with observability, alert routing, and continuous compatibility monitoring.
Standards we build against
FHIR integration standards
FHIRHL7HIPAAHITECHHITRUST
Engineered for Healthcare Compliance, Backed by Global Standards
Every Agnotic healthcare build is architected for privacy, interoperability, and regulatory readiness from the first commit — not retrofitted before launch.
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, strict access controls, and traceable audit logs.
General Data Protection Regulation
Implement lawful consent flows, data minimization, retention controls, and secure processing for sensitive reproductive and health data.
Fast Healthcare Interoperability Resources
Enable standardized health data exchange across apps, care teams, and systems through robust FHIR-ready APIs and mappings.
Health Level Seven International
Support enterprise-grade interoperability with HL7-based integrations for records, events, and clinical messaging workflows.
Health Information Trust Alliance
Align security programs to healthcare-specific controls and risk management practices trusted by providers and partners.
Health Information Technology for Economic and Clinical Health Act
Design with breach notification readiness, digital record safeguards, and operational controls that support regulated care programs.
Food and Drug Administration Software as a Medical Device
Plan software quality, traceability, and documentation pathways for products that may require SaMD review and regulatory submission.
Medical Device Regulation (European Union)
Prepare EU market-ready processes for risk classification, evidence tracking, and lifecycle governance under MDR expectations.
Substance Abuse and Mental Health Services Administration (42 CFR Part 2)
Apply confidentiality controls and consent-aware sharing models for behavioral and mental health related data experiences.
We Are Technology-Agnostic
With a diverse technology stack, we deliver solutions using a technology-Agnostic approach to meet your unique needs.
Wireframe & Ideation
User Experience
Real-Time Projects
Voices of Success
We don't just build products; we forge lasting partnerships. See how we've helped industry leaders transform their vision into technical reality.
"I can clearly see how Agnotic has a unique way of handling end-to-end development. They are always active on quick chat and provide support quickly."
Aaron Phelan
Founder, Benchmark
"Agnotic is the best technical team we evaluated. Their engineering excellence made our work dramatically easier and allowed us to stay focused on what matters most for maternal care outcomes. They took full ownership of the technical execution, and we are always happy to continue working together."
Kim Smith
Founder, My Lauren
"Agnotic combines deep technical expertise with strong domain knowledge. They understand the business context, anticipate challenges, and make collaboration smooth and effective."
John Pasmore
Founder, Latimer
Frequently Asked Questions
FHIR R4 is the version most major EHRs support in production and what payer and regulatory initiatives (US Core, USCDI) target. Newer versions exist but aren't yet the production target. We build to R4 with an eye on newer versions for future migration.
Ready to modernise your healthcare systems with FHIR?
Unlock real-time interoperability. Tell us your target EHRs and resource needs, and we'll return a scoped FHIR integration plan.