Selecting a FHIR platform beyond "pick a server" involves several architectural components. Understanding what a production-ready platform looks like avoids gaps.
Full FHIR platform components
1. FHIR server — resource storage and REST API. 2. Terminology server — code system operations. 3. Authorization server — SMART launch, Backend Services. 4. Form authoring/rendering — SDC-based Questionnaire. 5. Bulk export storage — S3-compatible with lifecycle management. 6. Event delivery — Subscription with reliable delivery. 7. Observability — Prometheus metrics, dashboards.
Platform completeness comparison (mid-2026)
| Vendor | Server | Term | Auth | Forms | Bulk | Events | Metrics |
|---|---|---|---|---|---|---|---|
| Aidbox | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Medplum | Yes | Basic | Yes | External | Yes | Yes | Yes |
| HAPI JPA | Yes | Yes | External | External | Yes | External | Partial |
| Firely Suite | Yes | Yes | Yes | Yes | Yes | Partial | Yes |
| Microsoft FHIR | Yes | External | Azure AD | External | Yes | External | Azure Monitor |
Build-vs-buy decision
1. All-in-one platform (Aidbox, Firely Suite): faster time-to-value, single-vendor lock-in. 2. Best-of-breed assembly (HAPI + Ontoserver + Keycloak + LHC-Forms): more flexibility, higher assembly cost. 3. Cloud-managed (Microsoft FHIR + Azure services): vendor-managed ops, cloud-specific integrations.
Total 3-year cost estimate (moderate ambulatory)
| Approach | Year 1 | 3-year total |
|---|---|---|
| All-in-one commercial | $250k-500k | $750k-1.5M |
| Best-of-breed assembly | $150k dev + infra | $600k-1M |
| Cloud-managed | $200k | $900k+ |
FHIR platform is 5-year commitment. Evaluate completeness across all seven components, not just the FHIR server.
