FHIR Interoperability Guide — Status and Plan

Purpose#

This document summarises the current state of FHIR interoperability within INHERIT, the planned work for a full mapping guide, and the strategic context for healthcare-estate integration.

Current State#

FHIR Connection Points Already in the Schema#

INHERIT v6 includes four optional URI fields designed for cross-referencing with FHIR resources:

These are lightweight reference points — INHERIT does not depend on FHIR, but provides connection points for systems that use both standards.

Published Documentation#

• docs/releases/fhir-maturity-mapping.md — Maps INHERIT’s maturity model (Draft/Candidate/Stable) to FHIR’s FMM (FMM 0–5 + Normative). Published in the standard repo.

Internal Analysis (Strategy Repo — Private)#

• strategy/orgs/fhir/monetisation-analysis.md — Detailed comparison of FHIR’s ecosystem monetisation ($10.5M HL7 revenue, billions in ecosystem companies) with lessons for INHERIT.
• strategy/orgs/fhir/graham-grieve.md — Profile of FHIR’s creator. No direct relationship yet. Strategic contact for future.
• strategy/orgs/delegation/fhir-of-us-probate-thesis.md — Analysis of digital estate delegation as “FHIR of US probate”, with implications for INHERIT’s positioning.

Planned Work: FHIR Interoperability Guide (v6.6)#

Objective#

Create a full mapping guide at docs/integrations/fhir/ showing how FHIR resources map to INHERIT entities. This is work item v6.6 in the v7 work plan, estimated at half a day.

Planned Mappings#

Guide Structure (Planned)#

docs/integrations/fhir/
├── README.md                    ← Overview and when to use this guide
├── patient-to-person.md         ← Patient → person mapping with field table
├── coverage-to-insurance.md     ← Coverage → insurance-policy mapping
├── consent-to-delegation.md     ← Consent → proxy-authorisation mapping
├── observation-to-death.md      ← Observation → deathVerification mapping
└── examples/
    ├── fhir-patient-to-inherit.json   ← Worked example
    └── inherit-to-fhir-coverage.json  ← Reverse mapping example

Each mapping document will include:

• Field-level mapping table (FHIR field → INHERIT field, with transformation notes)
• Code system mappings (FHIR value sets → INHERIT enums)
• Worked JSON example showing a complete transformation
• Edge cases and gaps (fields that exist in one standard but not the other)

Key Design Decisions#

1. INHERIT does not import FHIR types. The mapping is a translation guide, not a dependency. Systems convert between formats at integration points.

2. URI references, not embedded objects. INHERIT links to FHIR resources by URI (e.g. fhirPatientRef: "https://fhir.hospital.example/Patient/12345"), not by embedding FHIR JSON inside INHERIT documents.

3. Unidirectional by default. Most mappings flow FHIR → INHERIT (healthcare data enriching estate records). The reverse (INHERIT → FHIR) is less common but supported for insurance and consent scenarios.

4. Code system alignment. Where FHIR uses SNOMED CT or ICD-10 codes and INHERIT uses plain enums, the mapping documents will include a translation table. INHERIT will not adopt FHIR’s code system approach — the domains are different enough that forced alignment would compromise both.

Why FHIR Interoperability Matters#

The Intersection#

Healthcare and estate planning overlap at several critical points:

• Death verification — a healthcare event that triggers estate administration
• Insurance claims — life insurance, health cover, and death benefits span both domains
• Capacity assessment — testamentary capacity is both a medical and legal determination
• Care home residents — estates of people in long-term care involve healthcare providers as stakeholders
• Medical records access — executors may need medical records for insurance claims or inquest proceedings

The Audience#

The FHIR interoperability guide is primarily for:

• Health insurers — mapping policyholder data between claims and estate settlement
• Hospital IT teams — death notification workflows that feed into probate systems
• Care home platforms — resident estate management alongside care records
• Government systems — death registration services that bridge vital records and estate administration
• Integration vendors — building middleware between healthcare and legal/estate platforms

Strategic Positioning#

FHIR is the most widely adopted open data standard in healthcare (mandated in the US since 2020). Demonstrating clean interoperability with FHIR signals to the healthcare-adjacent market that INHERIT is serious about integration. It also provides a concrete example of how INHERIT works alongside existing standards rather than competing with them.

Timeline#

References#

• HL7 FHIR R4: https://hl7.org/fhir/R4/ ↗
• INHERIT Standard: https://github.com/openinherit/standard ↗
• INHERIT Governance Charter: docs/policies/governance-charter.md