FHIR Server Testing Best Practices

Testing an FHIR server is critical for minimizing errors during data exchange, enhancing accuracy, and achieving healthcare interoperability. Discover the best methods and tools for testing an FHIR server and ensuring its compliance with the FHIR specification.

FHIR servers are the backbone of data exchange, facilitating efficient data exchange among all healthcare stakeholders. The significance of testing an FHIR server cannot be emphasized enough, as it shapes its functionality, ensures compliance with the FHIR specification or ONC certification criterion, and ultimately determines the success of health information exchange systems.

After reading this article, you will learn about the role of FHIR server testing in healthcare data exchange. You will find the best tools for comprehensive testing of an FHIR server and compare these tools and their approaches. 

Ultimately, you will discover where to elevate FHIR server performance and ensure seamless health data exchange.

The importance of testing an FHIR server

The accurate and uninterrupted operation of FHIR servers becomes fundamental in delivering timely, accurate, and patient-centric care. FHIR servers must be thoroughly examined, scrutinized, and validated to ensure they align with the FHIR specification, adhere to an FHIR Implementation Guide, and seamlessly interact with any FHIR-first healthcare system. 

Comprehensive testing guarantees FHIR servers respond accurately and consistently to data requests, ensuring smooth data exchange and minimizing disruptions in the healthcare delivery process.

By embracing tools for testing FHIR servers, stakeholders can craft FHIR implementations that adhere to the FHIR standard’s specification and ensure healthcare data interoperability. Let’s discover the best tools for comprehensive FHIR server testing and unlock the power of the future of health information exchange.

The FHIR community spread the word about the importance of electronic health records (EHR) interoperability and provided open-source tools to achieve it, like FHIR Public Test Servers on HL7 Confluence. These servers aid developers, testers, and healthcare organizations in evaluating FHIR implementations within a controlled environment; however, we can’t guarantee their functionality.


Touchstone and Inferno provide extensive testing functionality, ensure best practices for testing an FHIR server, and determine conformance to the FHIR or ONC certification criterion. We highly recommend reading our article How to Get ONC Certification: A Detailed Guide to the G(10) Criterion since it provides valuable insights for entering the healthcare market with innovative health IT products. 

Even though the tools are dedicated to testing FHIR servers, there are differences in the functions supported by each tool and in testing practices in the foundation for reliable and standardized health information exchange systems.

Functionality and FlexibilityHighly flexible, with customizable
settings and many text options. Works best for sequential tests as more extended processing may lead to erroneous results
Streamlined and straightforward process yet with fewer adjustments
Subscription plan and Support Offers multiple support levels and a variety of plans for different needsProvides a single approach for all types of projects yet may lack advanced options when it comes to support
Supposed Users Organizations with diverse testing requirementsThose who require a quick, simpler, and clear testing process
Touchstone VS. Inferno


Inferno offers the Inferno Community Edition tests designed for various FHIR Implementation Guides (IGs). It offers flexibility—run the pre-made Community Edition tests or create your own using Inferno’s user-friendly testing language.

Inferno testing steps:

  1. Registration: Begin by registering on the Inferno platform.
  2. Defining Test Systems: Define your Test System by providing details like system name, version, and supported formats.
  3. Running Tests: Inferno simplifies interoperability testing by automatically evaluating the FHIR server and client implementations.

By embracing Inferno, you’re choosing a testing partner that prioritizes simplicity without compromising accuracy in evaluating FHIR servers. So, whether you’re a seasoned developer or new to the FHIR landscape, Inferno can handle your FHIR server testing needs.


Touchstone is an accessible cloud-based testing platform that adopts the FHIR Testing Framework. Designed to facilitate interoperability testing of the HL7® FHIR® specification, Touchstone harmonizes Test-Driven Development (TDD) methodologies with Natural Language Processing (NLP) Test Scripts.

Touchstone testing steps:

  1. Registration: All participants must register on Touchstone before proceeding.
  2. Organization Membership: User accounts must be associated with an organization.
  3. Defining Test Systems: To execute tests, define a Test System by providing details like the system’s name, specification version, and supported formats.
  4. Executing Tests: Touchstone automates interoperability testing, evaluating FHIR server and client implementations.

Through Touchstone’s user-friendly approach, developers can comprehensively assess FHIR server performance, spot compliance challenges, and ensure smooth health data exchange.


Inferno and Touchstone offer valuable solutions for FHIR server testing, yet their approaches differ.

Touchstone’s Advanced Test’s Management Functionality

Touchstone conducts many tests, providing instructions and expecting valid outcomes from the FHIR server. Its advanced versions offer flexibility in modifying test settings, enhancing adaptability. However, testing FHIR server with Touchstone can become intricate due to certain factors.

Tests in Touchstone occur sequentially, meaning longer processes can lead to test failures. In this case, failure doesn’t necessarily indicate non-compliance with the FHIR specification, as each FHIR server’s architecture plays a role.

To tackle this, opting for an advanced Touchstone version with customized settings can offer a solution. You guarantee accurate outcomes aligned with the server’s specifications by manually adjusting tests.

Touchstone subscription plans

  • Open: This plan provides a starting point for users to explore Touchstone’s fundamentals. It includes features such as Basic and Connectathon Test Scripts, along with support for FHIR Sandbox Test Scripts.
  • Starter: This plan offers enhanced testing abilities with Priority Support Level 3. It also facilitates functionalities such as Test Script Upload, Peer-To-Peer Testing, and Conformance-based Testing and includes features like Supported Advanced Test Scripts and the Test Script Editor.
  • Project: This plan comes with Priority Support Level 2, more Free Training Seats, and the ability to conduct up to 25 Max Test Executions per day The Project plan suits organizations with more ambitious testing requirements.
  • Enterprise: Designed for organizations seeking advanced testing capabilities and comprehensive support. It supports up to five Max Organization Reps and 10 Max Concurrent Test Executions. With Priority Support Level 1, this plan offers comprehensive assistance and scalability to meet the evolving needs of any enterprise. 
  • Program: Tailored for large-scale implementations with intricate testing needs and high-tier support. The plan comes with Priority Support Level 1, Max Users, and Max Concurrent Test Executions set at 100. The Program plan accommodates extensive testing scenarios while ensuring high-tier support.

Touchstone subscription options cover varying needs for different projects, ensuring there’s an option for comprehensive FHIR testing suitable for organizations of all sizes and testing requirements.

Inferno’s Streamlined Approach

Inferno offers a different testing journey than Touchstone and focuses on simplicity and clarity in testing. While it offers fewer options for adjusting the testing process compared to Touchstone, it empowers developers to ensure FHIR server adherence effectively.

Inferno’s journey centers on a straightforward path, aiding developers to evaluate FHIR server performance, pinpoint compliance concerns, and ensure seamless health data exchange. Ultimately, Inferno and Touchstone present valuable choices, each with strengths, designed to aid the FHIR server testing process.

Despite useful resources and tools available for FHIR testing, the process can be challenging due to server-specific nuances. Hence, certified FHIR experts should run the tests. 


Edenlab’s team strives for excellence in health data interoperability. Our Kodjin FHIR server has high performance, scalability, and compliance with the ONC certification criterion, proven by comprehensive testing of the Kodjin FHIR server conducted by our certified FHIR experts. Contact us today to ensure 100% FHIR compliance.


Why is testing an FHIR server essential?

By validating FHIR servers’ alignment with specifications, we ensure seamless interaction with all FHIR-first healthcare systems. It minimizes disruptions in data exchange and shapes the success of health information exchange.

What are the best practices for testing open source FHIR servers?

Best practices involve ensuring alignment with FHIR specifications and adherence to FHIR Implementation Guides for seamless interaction with FHIR-first healthcare systems. Tools like Inferno and Touchstone provide extensive testing functionality and conformance determination.

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