Asymmetrik is on FHIR!
Simplifying Access to Patient Records
Jan 30, 2018

Asymmetrik is proud to announce our open-source FHIR® server solution built in NodeJS. Recently, we submitted our solution as part of the Office of the National Coordinator for Health Information Technology (ONC’s) Secure FHIR® Server Challenge [Updated February 7, 2018 – and we won!]

Asymmetrik’s solution is:

  • Built from the ground up with security as the #1 priority
  • An extensible, vendor-agnostic platform for FHIR@ interaction

It consists of two open-source projects that are available for download and use on Github under an MIT License.

The Standard

HL7®’s FHIR® (pronounced “fire”) stands for Fast Healthcare Interoperability Resources. This emerging healthcare industry standards framework allows providers, payers and patients to aggregate, manage and share their health data using a set of standard, unified APIs. To make sure APIs are working to full capacity, a stress test may need to be administered. Visiting sites such as can help with requests such as this.
ONC FHIR Challenge logo

Establishing a unified set of interoperability standards promises to make it easier for patients to access their own health records. Consequently, patients should be able to move records more easily between healthcare providers and share them with insurance companies, caretakers and loved ones.

However, adoption of the FHIR® standards has been slow. This is due to both business concerns (what benefit does a hospital or medical record system gain from sharing their records with competitors?) and limited available technology.

ONC FHIR Challenge logo

Starting this year, healthcare laws in the U.S. (the “Meaningful Use” clause of the Affordable Care Act) require medical providers to share information more widely. Because of this, the healthcare industry is beginning to address the business concerns. Meanwhile, the ONC FHIR® challenges are steering the technology industry toward better solutions.

Ultimately, the goal is to make the standards more accessible for hospitals and electronic medical records (EMR) vendors to implement.

Asymmetrik’s Approach

Currently, most open-source FHIR® server solutions focus strictly on conforming to the (extremely large) specs and serving as reference implementations. Unfortunately, they seem to treat security, extensibility and ease-of-use as an afterthought. The assumption is that when an EMR company adds a FHIR® interface to its own data, it will use one of the existing reference implementations as a guide but modify everything to work with the vendor’s own data and add whatever security is necessary.

However, Asymmetrik chose to incorporate security, extensibility and ease-of-use into our design process. We provided a reference implementation, which uses a MongoDB backend to serve up sample patient records. And, we additionally include a core library that provides API conformance, OAuth support, and endpoint security. It’s simple to connect our FHIR® Server Core to an existing datasource. All a developer needs to do is implement some data retrieval methods and return data in a predetermined format. After that, Asymmetrik’s framework will handle the rest.

Asymmetrik FHIR Server Architecture ONC Secure Challenge

To satisfy the needs of modern developers, we chose the NodeJS platform using Javascript ES6 standards. The core framework is installed as an npm package, and uses express, cors, helmet and static code analysis tools to provide security at several levels. In addition, our Mongo reference implementation comes pre-configured to run in Docker if desired, and comes bundled with a basic OAuth server to simplify testing.

Next Steps

For the competition, our team built out a minimal set of read-only API endpoints, to support the Patient and Observation record types from the DSTU2 version of the FHIR® spec. Next, we plan to extend our core functionality to cover the remaining parts of the specification and support the more recent STU3 version. We’ll also introduce write and revisioning functionality. Watch this blog for updates.

Now, you too can be on FHIR®! Take a look through our extensive README documentation in both repositories and let us know what features you’d like next.

Healthcare Solutions

At Asymmetrik, we’re working to improve the patient experience through thoughtful UX design, technology interoperability, and analytics. So, if we can help your organization promote better outcomes supported by better technology, contact us to get started.