US core profile support in Azure FHIR service

Rajat Singhal 25 Reputation points
2026-03-28T08:35:33.62+00:00

Is there a way to find out which all FHIR artifacts from US core 6.1 IG are not supported by Azure FHIR R4. I need to know which all custom implementation I need to have to support all the artifacts from US core 6.1

Azure Health Data Services
Azure Health Data Services

An Azure offering that provides a suite of purpose-built technologies for protected health information in the cloud.

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  1. Siddhesh Desai 8,210 Reputation points Microsoft External Staff Moderator
    2026-03-30T02:20:41.36+00:00

    Hi @Rajat Singhal

    Thank you for reaching out to Microsoft Q&A.

    Azure Health Data Services (FHIR service) supports US Core 6.1.0 on FHIR R4, but it does not provide a built‑in or published list of supported vs unsupported US Core artifacts. While the platform is compatible with US Core 6.1, the service does not preload US Core profiles, extensions, search parameters, or operations by default. As a result, many implementers assume full conformance out of the box, but in practice, conformance depends on what artifacts you explicitly load and what capabilities the Azure FHIR server exposes. Because of this design, any gaps (such as missing profiles, unsupported search parameters, or operations not advertised in the capability statement) must be identified through validation and testing, and those gaps typically require custom implementation or external handling.

    Refer below points to resolve this issue or as a workaround:

    Upload the complete US Core 6.1 Implementation Guide and dependencies Azure FHIR does not store implementation guide artifacts automatically. You must upload the US Core 6.1 package (hl7.fhir.us.core#6.1.0) along with all required dependent packages (for example terminology and extension packages). Any profile or extension that fails to upload or resolve cleanly should be treated as unsupported and handled via custom logic.

    • Review the FHIR server capability statement ($metadata) Use the capability statement to compare Azure FHIR’s advertised capabilities with the US Core 6.1 requirements. 
        HTTP
  GET https://<your-fhir-endpoint>/metadata
      Check for required US Core search parameters, supported resource interactions, _include / _revinclude, and operations such as $docref and $expand. Missing capabilities indicate areas where custom implementation is required.
    • Validate US Core–conformant resources using $validate Submit sample US Core 6.1 resources to the $validate 
        HTTP
  POST /Patient/$validate
      Validation warnings or errors (for example, unresolved US Core extensions like race or ethnicity) indicate unsupported or missing artifacts that must be explicitly loaded or handled outside the FHIR server. Run Inferno US Core 6.1 test suites for gap analysis Inferno tests validate US Core “MUST SUPPORT” behavior, required searches, and interactions. Azure FHIR may fail certain tests by design (for example, advanced search combinations or reverse includes). Each failing test should be mapped to a required custom implementation or architectural workaround. Treat test and validation failures as your custom‑implementation list Since Microsoft does not publish an official unsupported‑artifacts matrix, the authoritative way to determine gaps is:
      • What fails to upload
        • What is missing from $metadata
          • What fails $validate
            • What fails Inferno US Core 6.1 tests
            These collectively define which US Core 6.1 artifacts require custom development to achieve full conformance.

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