HL7 FHIR

Synthea generates HL7 FHIR records using the HAPI FHIR library to generate a FHIR Bundle for each Patient. Currently, only JSON is supported.

Currently supported FHIR Resources:

• AllergyIntolerance
• Bundle
• CarePlan
• Claim
• Condition
• Coverage (R4 and STU3 only)
• DiagnosticReport (for labs)
• Encounter
• ExplanationOfBenefit (R4 and STU3 only, Blue Button 2.0 Implementation Guide in STU3)
• Goal
• ImagingStudy
• Immunization
• MedicationRequest
• MedicationAdministration
• Observation
• Organization
• Patient
• Practitioner
• Procedure

Resources only supported with R4 and when US Core is enabled:

• CareTeam
• Device
• DiagnosticReport (for clinical notes)
• DocumentReference (for clinical notes)
• Location
• Medication
• PractitionerRole
• Provenance

Supported versions of US Core:

• 6.1.0
• 5.0.1 (R5)
• 4.0.0 (R4)
• 3.1.1 (R3)

Configuring FHIR

The exporting of FHIR can be configured using the src/main/resources/synthea.properties:

# default FHIR R4 configuration.
exporter.fhir.export = true
# transaction bundle 'true' produces transaction Bundles
# else if 'false' produces collection Bundles.
exporter.fhir.transaction_bundle = true
# if bulk_data 'true' ndjson bulk format is exported
# else if 'false' (default) normal FHIR bundles are exported
exporter.fhir.bulk_data = false
# Whether or not resources should conform to the US Core Implementation Guide
exporter.fhir.use_us_core_ig = false
# Which version of the US Core IG to conform to (See list of supported versions above)
exporter.fhir.us_core_version = 5.0.1
# Use Standard Health Record (SHR) extensions for STU3?
exporter.fhir.use_shr_extensions = false
# Exporting FHIR DSTU2
exporter.fhir_dstu2.export = false
# Exporting FHIR STU3
exporter.fhir_stu3.export = false
# Exporting Hospital Provider data in separate file.
exporter.hospital.fhir.export = true
exporter.hospital.fhir_stu3.export = false
exporter.hospital.fhir_dstu2.export = false
# Exporting Practitioner data in separate file.
exporter.practitioner.fhir.export = true
exporter.practitioner.fhir_stu3.export = false
exporter.practitioner.fhir_dstu2.export = false

Producing and Using FHIR

In the synthea.properties file, make sure that exporter.fhir.export, exporter.fhir.transaction_bundle, exporter.practitioner.fhir.export and exporter.hospital.fhir.export are all set to true.

Next, produce some synthetic data:

./run_synthea -p 100

By default, FHIR JSON data should now exist in the ./output/fhir sub-directory. If you have a FHIR server and client, you can POST those bundles to the FHIR server. See FHIR Transaction Bundles for additional details and the recommended order that bundles are POSTed.

For example:

curl http://hapi.fhir.org/baseR4 
  --data-binary "@/Users/example/synthea/output/fhir/Maryetta775_Rowe323_2cb7e4dd-9d8b-49cf-b1e4-9839be8bc754.json" 
  -H "Content-Type: application/fhir+json"

The FHIR server should return a transaction-response Bundle:

{
  "resourceType": "Bundle",
  "id": "ca4d459f-b078-4c04-a152-c7ce76a25179",
  "type": "transaction-response",
  "link": [
    {
      "relation": "self",
      "url": "http://hapi.fhir.org/baseR4"
    }
  ],
  "entry": [
    {
      "response": {
        "status": "201 Created",
        "location": "Patient/4147259/_history/1",
        "etag": "1",
        "lastModified": "2018-06-06T18:26:06.038+00:00"
      }
    },
    ...abridged...
  ]
}

Other Examples of Using Synthea FHIR Data

• The Healthcare Services Platform Consortium (HSPC) has a developer sandbox environment that allows developers to spin-up FHIR servers and load them with Synthea data. They also host a FHIR server preloaded with Synthea data called HSPC Synthea STU3 (3.0.1) (authentication required).

• The SMART Health IT team has pregenerated datasets available for download including Synthea data, which are also available through https://dev.smarthealthit.org. They also provide a Docker version of the HAPI FHIR Server preloaded with Synthea data here: https://github.com/smart-on-fhir/hapi, and have used Synthea data with their Bulk Data Server.

• Algorex Health has used Synthea data to explore Open Clinical Analysis.

• The MITRE Corporation has used Synthea data to create SyntheticMass, a 1/7th scale simulated model of the Commonwealth of Massachusetts, including a FHIR server (FHIR STU3).

• An MSDN blog post illustrates Loading Synthea FHIR Data with Logic Apps and Functions in Azure Government.