FHIR R5 Roadmap


Now that we have published FHIR R4, our attention at our January 2019 meeting (in San Antonio) was focused on producing a roadmap for FHIR R5.

FHIR R5 will build on R4 by:

  • Moving more content to formal Normative status
  • Further improving the support for publishing implementation guides
  • Adding additional content in newly developing domains
  • Improving support for applications using multiple FHIR releases seamlessly, and also multi-language support and federated servers
  • Adding new facilities for migrating data to and from v2 messages and CDA documents

In addition, the community will continue to develop the adjunct specifications to FHIR – SMART App Launch, CDS Hooks, FHIRCast, CQL,  Bulk Data specification, and others – that build out a complete API-based eco-system for the exchange of healthcare data.

HL7 will also continue to collaborate with our many partners across industry, government, and academic communities to support the overall development of data exchange and health process improvement.

Implementation Guidance

We expect some specific implementation guidance to arise out of our collaborations and both ongoing and new projects that will lead to better processes in healthcare:

  • Use of Smart App Launch, FHIRCast and combinations of the FHIR and DicomWeb stacks to lead to better imaging related workflows
  • Build in on initial Public Health collaborations to further improve bio-surveillance and morbidly/mortality reporting
  • Improved integration around prior authorization and financial processes
  • Finalize detailed genomic reporting specifications ,and develop processes to integrate translational science into operational healthcare
  • Provide access to the complete medical record for a patient


Our normal cycle is about 20 months, so R5 would be expected to be published in Q3 2020.

We will be surveying our members and partners later this year to determine whether our normal cycle is appropriate, or whether the community would prefer for us to wait longer to publish so that there can be more convergence on a single version.

In addition, we may consider publishing patch releases that introduces changes only to the draft resources, since these are earlier in their maturity process, and changing more quickly.

Committee plans

FHIR is maintained by a set of committees, each responsible for a portion of the specification. Here are further details for the roadmap by committee:

  • Biomedical Research and Regulation aims to have the ResearchStudy and ResearchSubject advanced to maturity level 5 and will continue to work on the regulated product-related resources
  • Community Based Collaborative Care aims to bring Consent resource to Normative status for patient-privacy and will work on resolving the Research, Advance Directives and Treatment use cases
  • Clinical Decision Support and Clinical Quality Information aim to support the representation and sharing of clinical knowledge that enables a continuous quality improvement cycle and pilots of the same (e.g. business as usual)
  • Clinical Genomics will continue to work on refining MolecularSequence, rationalise the existing genomic content to the Genomics Reporting IG, and work with patient care on the family history pedigree representation/profile
  • FHIR Infrastructure’s focus will include reviewing the trial use parts of CapabilityStatement, improved facilities for managing Composition content (including use of GraphDefinition), Subscriptions, and Digital Signatures
  • Financial Management goals are to bring the eClaims resources to Normative status, and continue to be develop the other resource
  • Imaging Integration anticipates defining new resource “SpecificImageReference”, and profiling DiagnosticReports, Observations, and Procedures for imaging use cases, potentially producing formal profiles
  • Orders and Observations aims to bring DiagnosticReport and Device to Normative status, and to work on resource scope/boundaries for a number of resources
  • Patient Administration aims to bring several resources to normative status – including Encounter, improve the linkage between the administrative and financial domains, along with defining the patient merge/link functionality and completing the VhDir Implementation Guide.
  • Patient Care: Patient Care is targeting several resources to go normative, and working to increase the maturity of other resources, with a focus on care planning
  • Public Health will continue to evolve Immunization resources as experience is gathered by implementers and also support parties interested in writing FHIR IGs in the public health domain
  • Pharmacy continues work on the MedicationKnowledge resource and will work with the community to mature the existing medication resources. The Medication, MedicationRequest and MedicationStatement resources may be normative candidates in the R5 ballot.
  • Structured Documents: Consider DocumentReference for normative, and decide what to do with DocumentManifest
  • Security WG will focus on gaining confidence in AuditEvent Resource, Provenance Resource, and Signature datatype. New work will focus on Implementation Guides on Basic Provenance use, new operations to support GDPR (e.g. $erase), and Document Digital JSON Signature
  • Vocabulary: In addition to maintaining existing terminology content and processes, vocabulary will focus on finalising ConceptMap, business rules for Code System Supplements and terminology identifiers, and start working on support for Code system maintenance and development

Normative Resources

Normative resources are maintained for stability so that implementers do not have to rework existing software as new FHIR versions are published. Before bringing a resource to normative status, we require considerable real word experience to demonstrate that the design is robust and ready to be made stable.

We will work to bring the following resources to normative status for FHIR R5. Note that this is not a commitment; whether a resource will achieve normative status depends on how implementation experience unfolds.

  • AllergyIntolerance
  • AuditEvent
  • CareTeam
  • Claim
  • ClaimResponse
  • ConceptMap
  • Condition
  • Consent
  • CoverageEligibiltyRequest
  • CoverageEligibilityResponse
  • Device
  • DiagnosticReport
  • DocumentReference?
  • Encounter
  • ExplanationOfBenefit
  • ImagingStudy
  • ImplementationGuide
  • Location
  • Medication
  • MedicationRequest
  • MedicationStatement
  • Organization
  • PaymentNotice
  • PaymentReconciliation
  • Practitioner
  • PractitionerRole
  • Procedure
  • Provenance
  • Questionnaire
  • QuestionnaireResponse
  • SearchParameter
  • Subscription
  • VisionPrescription

FHIR R4 is published

HL7 is pleased to announce that FHIR R4 is now published.

R4 is the culmination of 18 months of extensive work to finalize the base parts of the specification, and incorporate changes and enhancement requests received from implementation partners across the world.

The most significant change in FHIR Release 4 is that the base platform of the standard has passed a normative ballot, and will be submitted to ANSI as a normative standard. This means that future changes should be backward compatible, so that applications that implement the normative parts of R4 no longer risk being non-conformant to the standard. The following portions of the standard are now normative:

  • The RESTful API, the XML and JSON formats, and the basic datatypes
  • The Terminology layer (CodeSystem and ValueSet)
  • The Conformance Framework (StructureDefinition and CapabilityStatement)
  • The key resources Patient and Observation

Thousands of other R4 updates and changes have been made in response to implementation experience and quality review processes.

FHIR Release 4 marks a significant milestone with the introduction of a normative base. This new maturity will help support our very active and growing community


Publishing a new Version of FHIR is a massive piece of work involving  a big community. It’s impossible to track – let alone acknowledge – everyone who’s contributed to publishing FHIR R4. We’ve given it a go in the credits page.