Azure API for FHIR - R4B and R5?

[NC-ulrl]

We are currently using the Azure API for FHIR which - as I understand it - is simply a managed version of the fhir-server.

While the fhir-server includes the newer versions R4B and R5 (snapshot 1), the Azure API for FHIR only offers R4 (or STU 3).

Are there any plans to bring R4B and R5 to the managed API? If so, does the plans include a timeline?

[EXPEkesheth]

We will look into R5 integration once it is published, right now it is a draft version. We hopefully should have concrete timeline by then.

[NC-ulrl]

Any news on this?

The final version of R5 has been out since the end of march, and it would be great to have a roadmap for the upgrade.

The upgrade to R5 would bring compatibility with the ISO IDMP standard for medications, which would be highly valuable for us as the IDMP-standard is mandated within EU.

[EXPEkesheth]

@NC-ulrl , this is in our backlog and do not have specific timeline defined. Is there a timeline you are targeting for compatibility with the mandate?

[NC-ulrl]

The mandate is from 2012 and is implemented at different paces in the various EU countries.

We are currently aiming to publish an IDMP compliant directory of medicinal products for the Norwegian market around Q1 2024. As such, it would be ideal for us if the managed FHIR API could handle R5 sooner rather than later (e.g., end of year 2023). In any case, it would be valuable for our data consumers to know when the change is expected, so they can plan accordingly.

[EXPEkesheth]

@NC-ulrl Are there specific resources or changes in R5 standard that enables to meet the mandate. Will you please be able to elaborate more?

[NC-ulrl]

Related to compatibility with IDMP, the main issue is probably related to the reuse of ManufacturedItem-resources. In R4 the Amount is found on ManufacturedItem itself instead of PackagedItem.Package.ContainedItem, which is introduced in R5. This means, that you cannot "put" the same manufactured item (e.g., a pill containing 500 mg Paracetamol) in a box containing 20 pills and a container with 100 pills even though it is the exact same pill in the two packages.

In addition, we have identified the following differences between R4 and R5:

• NutritionProduct: Missing entirely in R4
• PackagedProductDefinition (R4: MedicinalProductPackaged): ContainedItem is missing in R4.
• ManufacturedItemDefinition (R4: MedicinalProductManufactured): See above related to mandatory MedicinalProductManufactured.Quantity.
• AdministrableProductDefinition (R4: MedicinalProductPharmaceutical): Missing ProducedFrom in R4, which can be helpful for e.g., Combination Packages.
• SubstanceDefinition (R4: SubstanceSpecification): R4 only allows for 1 identifier and is missing classification.

It is possible to circumvent the points above through extensions and basic profiles, but it leads to a funky and somewhat non-descript API for the hospitals who will be using our data set, which is not ideal.

[EXPEkesheth]

Thanks for sharing the details @NC-ulrl , we have R5 support in our backlog. In this quarter unfortunately it is not prioritized, we will inform once we have defined timeline of delivery.

[aematteo]

I'm also interested in R5 final release for the same reasons as @NC-ulrl