Scaling up: Customer-driven enhancements in the FHIR service enable better healthcare solutions
Published Mar 04 2024 09:15 AM 772 Views

This blog has been authored by Ketki Sheth, Principal Program Manager, Microsoft Health and Life Sciences Platform


We’re always listening to customer feedback and working hard to improve the FHIR service in Azure Health Data Services. In the past few months, we rolled out several new features and enhancements that enable you to build more scalable, secure, and efficient healthcare solutions. 

Let’s explore some highlights. 


Unlock new possibilities with increased storage capacity up to 100 TB 

In January 2024 we increased storage capacity within the FHIR service to enable healthcare organizations to manage vast volumes of data for analytical insights and transactional workloads. Previously constrained by a 4 TB limit, customers can build streamline workflows with native support for up to 100 TB of storage. 

More storage means more possibilities for analytics with large data sets. For example, you can explore health data to improve population health, conduct research, and discover new insights. More storage also allows Azure API for FHIR customers who have more than 4 TB of data to switch to the evolved FHIR service in Azure Health Data Services before September 26, 2026, when Azure API for FHIR will be retired. 


If you need storage greater than 4 TB, let us know by creating a support request on the Azure portal with the issue type Service and Subscription limit (quotas). We’d be happy to enable your organization to take advantage of this expanded storage capacity. 


Connect any OpenID Connect (OIDC) identity provider to the FHIR service with Azure Active Directory B2C 

In January 2024 we also released the integration of the FHIR service with Azure Active Directory B2C. The integration gives organizations a secure and convenient way to grant access with fine-grained access control for different users or groups – without creating or comingling user accounts in the same Microsoft Entra ID tenant. Plus, along with the support for Azure Active Directory B2C (Azure AD B2C), we announced the general availability of the integration with OpenID Connect (OIDC) compliant identity providers (IDP) as part of the expanded authentication and authorization model for the FHIR service.  


With Azure AD B2C and OIDC integration, organizations building SMART on FHIR applications can integrate non-Microsoft Entra identity providers with EHRs (Electronic Health Records) and other healthcare applications.  

Learn more: Use Azure Active Directory B2C to grant access to the FHIR service 


Ingest FHIR resource data at high throughput with incremental import 

The incremental import capability was released in August last year. With incremental import, healthcare organizations can ingest FHIR resource data at high throughput in batches, without disrupting transactions through the API on the same server. You can also ingest multiple versions of a resource in the same batch without worrying about the order of ingestion. 

Incremental import allows healthcare organizations to:  

  • Import data concurrently while executing API CRUD operations on the FHIR server. 
  • Ingest multiple versions of FHIR resources in single batch while maintaining resource history. 
  • Retain the lastUpdated field value in FHIR resources during the ingestion process, while also maintaining the chronological order of resources. In other words, you no longer need to pre-load historical data before importing the latest version of FHIR resources. 
  • Take advantage of initial and incremental mode import. Initial mode import can be used to hydrate the FHIR service. Also, call out using Execution of initial mode import operation does not incur any charge. For incremental import, a charge is incurred per successfully ingested resource, following the pricing model of the API request. 

Visit pricing page for more details Pricing - Azure Health Data Services | Microsoft 


Why incremental import matters 

Healthcare organizations using the FHIR service often need to run synchronous and asynchronous data flows simultaneously. The asynchronous data flow includes receiving batches of large data sets that contain patient records from various sources, such as Electronic Medical Record (EMR) systems. These data sets must be imported into a FHIR server simultaneously with the synchronous data flow to execute API CRUD (Create, Read, Update, Delete) operations in the FHIR service.  


Performing data import and API CRUD operations concurrently on the FHIR server is crucial to ensure uninterrupted healthcare service delivery and efficient data management. Incremental import allows organizations to run both synchronous and asynchronous data flows at the same time, eliminating this issue. Incremental import also enables efficient migration and synchronization of data between FHIR servers, and from the Azure API for FHIR service to the FHIR service in Azure Health Data Services. 

Learn more: Import data into the FHIR service in Azure Health Data Services 


Delete FHIR resources in bulk (preview) 

In late 2023, the ability to delete FHIR resources in bulk became available for preview. We heard feedback from customers about the challenges they faced when deleting individual resources. Now, with the bulk delete operation, you can delete data from the FHIR service asynchronously. The FHIR service bulk delete operation allows you to delete resources at different levels – system, resource level, and per search criteria. Healthcare organizations that use the FHIR service need to comply with data retention policies and regulations. Incorporating the bulk delete operation in the workflow enables organizations to delete data at high throughput.  

Learn more: Bulk-delete operation for the FHIR service in Azure Health Data Services 


Selectable search parameters (preview) 

As of January 2024, selectable search parameters are available for preview. This capability allows you to tailor and enhance searches on FHIR resources. You can choose which standard search parameters to enable or disable for the FHIR service according to your unique requirements. By enabling only the search parameters you need, you can store more FHIR resources and potentially improve performance of FHIR search queries. 


Searching for resources is fundamental to the FHIR® service. During the provisioning of FHIR service, standard search parameters are enabled by default. The FHIR service performs efficient searches by extracting and indexing specific properties from FHIR resources during the ingestion of data. Search parameters indexes may take majority of the overall database size. 

This new capability gives you the control to enable or disable search parameter according to your needs. 


 Selectable search parameters help healthcare organizations:  

  • Store more data at reduced cost. Reduction in search parameter indexes provides space to store more resources in the FHIR service. Depending on your organization’s need for search parameter values, on average the efficiency gained in storage is assumed to be 2X-3X. In other words, you’ll be able to store more resources and save on any additional storage cost. 
  • Positively impact performance. During API interactions or while using the import operation, selecting a subset of search parameters can have significant positive performance impact. 

Learn more:  Selectable search parameters for the FHIR service in Azure Health Data Services  


In conclusion 

We are constantly working to improve the FHIR service to meet your needs and expectations. With new features such as increased storage capacity up to 100 TB, integration with Azure Active Directory B2C, and incremental import, we are excited to see how you leverage these new capabilities to create innovative healthcare solutions that improve outcomes and experiences for patients and providers. 


Do more with your data with the Microsoft Cloud for Healthcare 

In the era of AI, Microsoft Cloud for Healthcare enables healthcare organizations to accelerate their data and AI journey by augmenting the Microsoft Cloud with industry-relevant data solutions, templates, and capabilities. With Microsoft Cloud for Healthcare, healthcare organizations can create connected patient experiences, empower their workforce, and unlock the value from clinical and operational data using data standards that are important to healthcare. And we’re doing all of this on a foundation of trust. Every organization needs to safeguard their business, their customers, and their data. Microsoft Cloud runs on trust, and we’re helping every organization build safety and responsibility into their AI journey from the very beginning. 

We’re excited to help your organization gain value from your data and use AI innovation to deliver meaningful outcomes across the entire healthcare journey. 



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