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(Originally published as a Firely blog post)

I've outlined the key insights from the talk below.

The Challenge

Joshua's application is designed to access patient data from hundreds of FHIR systems. You might think this could be solved by using the Patient/$everything operation to fetch all relevant patient data. However, this is complicated by the wide variability in FHIR implementation across different systems. As a result, Joshua's team is forced to use a primitive fallback option: fetching individual resources and ‘walking' the FHIR resource references.

Finding the Best Solution: Uploading Data to a FHIR CDR

Once they have pulled a patient's data from the 400+ source systems they need to upload it to a FHIR CDR. They found that Batch/Transaction bundles with PUT (upsert) was the was the most reliable method. While Bulk Data Import might have been a better solution, it remains in draft status, making it less practical for immediate use.

Why Not Use the 'Ideal' Solution?

A common reaction by FHIR implementers to the solution outlined above is: '..but can't we use X?' Yes, but X is rarely supported. This forces you to layer solutions and rely on the lowest common denominator. Joshua argues that the only way to avoid having to do this is to have much stricter conformance requirements.

-Rene

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Index of columns:

• EHDS Governance Models (May 06, 2026)
• Get ready for EHDS implementation - EHDS-on-FHIR training course (Apr 10, 2026)
• EHDS will have an impact well before 2029 (Feb 13, 2026)
• EHDS checklist for application vendors and provider organizations (Nov 11, 2025)
• New EHDS-on-FHIR training course (Oct 26, 2025)
• Gender Identity in Interoperability Standards (Aug 25, 2025)
• FHIR and Narrative content (Jun 11, 2025)
• 6 Rules for Successful Interoperability Projects (Feb 13, 2025)
• Deploying FHIR at Scale (Dec 18, 2024)
• 9 Key Problems When Connecting to 400+ Servers (Sep 25, 2024)
• FHIR for HL7v2 experts (Aug 18, 2023)
• The FHIR open license (Feb 18, 2022)
• Bye bye IHE XDS and CDA. (Sep 01, 2021)
• Combining the best of IHE XDS with HL7 FHIR (Jun 27, 2019)
• FHIR DevDays and the year in review (Dec 27, 2018)
• Creation and Curation of FHIR Profiles - process and governance (Dec 14, 2017)
• Impact of the GDPR on the use of interoperability standards (Jun 27, 2017)
• Next XDS Release (Oct 27, 2016)
• Five years of FHIR (Aug 11, 2016)
• Update from the trenches on CDA R2.1/R3 and HL7v2. (Oct 15, 2015)
• Most often implemented IHE Profiles (Jun 08, 2015)
• Mapping HL7v2 messages to FHIR. (Apr 13, 2015)
• Recent and Future developments of the DICOM standard (Mar 06, 2014)
• Documenting the history of HL7 (Sep 03, 2013)
• Interoperability Standards - the no-sales pitch (Jul 09, 2013)
• CDA Implementation Guides - (not) invented here (Apr 17, 2013)
• Usage of IHE Profiles (Feb 25, 2013)
• 10 year anniversary - Dutch Ringholm HL7 v2 training courses. (Feb 19, 2013)
• HL7 Connectathons (Sep 09, 2012)
• Frequency of use of HL7 message types (Jul 24, 2012)
• Reflections on the HL7 membership model - the affiliate life cycle (Dec 28, 2011)
• RFH (Resources for Health): HL7 version 3 taken to the next step (Aug 18, 2011)
• Timezone Hotel (Mar 29, 2011)
• The changing role of HL7 country organizations (Jul 16, 2010)
• How to lower the hurdle for HL7 v3 implementers (Jan 21, 2010)
• The HL7 roadmap for CDA R3 and the CCD (Jan 17, 2009)
• HL7 based Tree inventory system (Jan 30, 2007)
• Workflow Bribery (Sep 15, 2006)

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About Ringholm bv

Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
See https://www.ringholm.com for additional information.