fhir-runtime

A production-ready FHIR R4 runtime engine for TypeScript/Node.js

fhir-runtime is a structural FHIR R4 engine that provides comprehensive capabilities for parsing, validating, and manipulating FHIR resources — without requiring a running FHIR server, database, or external terminology service.

Designed as a lightweight runtime layer with a single dependency (fhir-definition), it's suitable for embedding in servers, CLIs, web applications, or custom platforms.

🎮 Live Demo: fhir-runtime-tools.vercel.app/ — Try fhir-runtime in your browser

Features

Core Capabilities

• FHIR R4 JSON Parsing — Full support for primitives, choice types, extensions
• Profile-Based Validation — 9 structural validation rules + FHIRPath invariants
• Validation Pipeline (STAGE-2) — Composable multi-step pipeline with hooks, batch validation, and enhanced error messages
• Terminology Binding (STAGE-3) — InMemoryTerminologyProvider, binding strength validation, CS/VS registries
• IG Package Loading (STAGE-4) — NpmPackageLoader, PackageManager, cross-package canonical resolution
• Server/Persistence Integration (STAGE-5) — SearchParameter parsing, search value extraction, reference extraction, CapabilityStatement generation
• fhir-definition Integration (STAGE-6) — DefinitionProvider interface, DefinitionBridge adapter, createRuntime() factory, DefinitionProviderLoader
• fhir-server Prerequisites (STAGE-B) — RemoteTerminologyProvider interface, validateMany() batch API, SnapshotCache lazy loading, warmupSnapshots()
• Profile Slicing & UI Utilities (STAGE-7) — SlicedElement/SliceDefinition types, matchSlice(), generateSliceSkeleton(), Choice Type helpers (isChoiceType(), resolveActiveChoiceType()), BackboneElement helpers (isBackboneElement(), getBackboneChildren()), inferComplexType fix
• IG Extraction API (v0.11.0) — extractSDDependencies() for SD dependency graphs, extractElementIndexRows() for element index table population, flattenConceptHierarchy() for CodeSystem concept tree flattening
• Provider Abstraction Layer (STAGE-1) — Terminology and reference contracts with default NoOp implementations
• Snapshot Generation — HAPI-equivalent differential expansion
• FHIRPath Engine — 60+ functions, Pratt parser with AST caching
• Bundle Loading — Load FHIR specification bundles and IGs
• Context Management — Registry, loaders, inheritance resolution
• InnerType Extraction — BackboneElement schema for UI/validation
• OperationOutcomeBuilder — Convert validation, parse, and snapshot results to FHIR R4 OperationOutcome

Quality & Testing

• ~4,277 tests across 117 test files — 100% passing
• US Core IG verified — 70 StructureDefinitions loaded from real US Core v9.0.0 package
• IG package tested — 138 package tests including real US Core integration
• Integration tested — 110 tests for SearchParameter, value extraction, references, capability builder
• Definition integration tested — 59 tests for DefinitionProvider, DefinitionBridge, createRuntime, E2E
• Batch validation tested — 28 new tests for validateMany, RemoteTerminologyProvider, SnapshotCache
• Profile slicing tested — 69 new tests for slicing extraction, matching, choice types, backbone elements
• IG extraction tested — 27 new tests for SD dependencies, element index rows, concept hierarchy flattening
• HAPI-equivalent — 35/35 snapshot fixtures match HAPI output
• Stress tested — Malformed input, deep nesting, large payloads, concurrency
• Single dependency — fhir-definition@0.6.0 (FHIR Knowledge Engine)
• Type-safe — Full TypeScript definitions for all FHIR R4 types

📦 Installation

npm install fhir-runtime

Requirements:

• Node.js ≥18.0.0
• TypeScript ≥5.0 (for TypeScript projects)

🎮 Try it Online

Live Demo: fhir-runtime-tools.vercel.app/

FHIR Runtime Tools — Developer toolset built on fhir-runtime, providing utilities for FHIR resource inspection, debugging, and development workflows.

� Related Projects

fhir-runtime-cli

Command-line interface for fhir-runtime — A powerful CLI tool for FHIR resource validation, IG package management, and development workflows.

Key Features:

• Validate — Validate FHIR resources against profiles with support for local IG packages
• IG Package Loading — Load and inspect FHIR Implementation Guide packages
• Search Parameters — List and explore SearchParameters for resource types
• Batch Operations — Validate multiple resources in batch mode
• Configuration Support — .fhir-runtime.json config file for project-specific settings

Installation:

npm install -g fhir-runtime-cli

Quick Example:

# Validate a Patient resource against US Core profile
fhir-runtime-cli validate \
  --file patient.json \
  --profile http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient \
  --ig-path ./fhir-packages/hl7.fhir.us.core

# List SearchParameters for Patient resource type
fhir-runtime-cli search-params Patient

# Load and inspect an IG package
fhir-runtime-cli load-package ./fhir-packages/hl7.fhir.us.core

Repository: github.com/medxaidev/fhir-runtime-cli

�🚀 Quick Start

Parse a FHIR Resource

import { parseFhirJson } from "fhir-runtime";

const result = parseFhirJson(`{
  "resourceType": "Patient",
  "id": "example",
  "name": [{ "family": "Doe", "given": ["John"] }]
}`);

if (result.success) {
  console.log(result.data.resourceType); // "Patient"
  console.log(result.data.name[0].family); // "Doe"
}

Validate Against a Profile

import {
  StructureValidator,
  buildCanonicalProfile,
  parseStructureDefinition,
} from "fhir-runtime";

// Load a profile
const sdResult = parseStructureDefinition(profileJson);
const profile = buildCanonicalProfile(sdResult.data);

// Validate a resource
const validator = new StructureValidator();
const result = validator.validate(patientResource, profile);

if (!result.valid) {
  result.issues.forEach((issue) => {
    console.error(`${issue.severity}: ${issue.message} at ${issue.path}`);
  });
}

Validate with Pipeline + Terminology (v0.5.0)

import {
  ValidationPipeline,
  StructuralValidationStep,
  TerminologyValidationStep,
  InvariantValidationStep,
  InMemoryTerminologyProvider,
  generateReport,
} from "fhir-runtime";

// Set up terminology provider
const terminology = new InMemoryTerminologyProvider();
terminology.loadFromBundle(terminologyBundle);

const pipeline = new ValidationPipeline({
  terminologyProvider: terminology,
  failFast: true,
  minSeverity: "warning",
});
pipeline.addStep(new StructuralValidationStep());
pipeline.addStep(new TerminologyValidationStep());
pipeline.addStep(new InvariantValidationStep());

const result = await pipeline.validate(resource, profile);
const report = generateReport(result);

createRuntime() — One-step Setup (v0.8.0)

import { createRuntime } from "fhir-runtime";

// Pattern 1: With fhir-definition (recommended)
import { InMemoryDefinitionRegistry, loadFromDirectory } from "fhir-definition";
const registry = new InMemoryDefinitionRegistry();
await loadFromDirectory("./definitions", registry);
const runtime = await createRuntime({ definitions: registry });

// Pattern 2: Bare minimum (auto-loads R4 core definitions)
const runtime2 = await createRuntime();

// Validate
const result = await runtime.validate(
  patient,
  "http://hl7.org/fhir/StructureDefinition/Patient",
);

// Get search parameters
const sps = runtime.getSearchParameters("Patient");

Generate a Snapshot

import { FhirContextImpl, SnapshotGenerator } from "fhir-runtime";

const ctx = new FhirContextImpl({ loaders: [] });
await ctx.preloadCoreDefinitions();

const generator = new SnapshotGenerator(ctx, { generateCanonical: true });
const result = await generator.generate(myProfile);

if (result.success) {
  console.log(
    `Generated ${result.structureDefinition.snapshot.element.length} elements`,
  );
}

Evaluate FHIRPath

import { evalFhirPath, evalFhirPathBoolean } from "fhir-runtime";

const patient = { resourceType: "Patient", name: [{ given: ["John"] }] };

const names = evalFhirPath("Patient.name.given", patient);
// → ['John']

const hasOfficial = evalFhirPathBoolean(
  "name.where(use='official').exists()",
  patient,
);
// → false

📚 Documentation

• Technical Overview — Architecture, design principles, capabilities
• API Reference — Public API reference for the v0.7.0 release surface
• Capability Contract — Behavioral guarantees and release contract for v0.7.0
• Release Notes v0.7.0 — Detailed v0.7.0 release notes

🧪 Testing & Quality

Test Coverage

✅ 3,376 tests across 88 test files
✅ 100% pass rate on HAPI snapshot fixtures (35/35)
✅ All 11 modules fully tested (model, parser, context, profile, validator, fhirpath, provider, terminology, package, pipeline, integration)
✅ IG package tested — 138 package tests including real US Core v9.0.0 integration
✅ Integration tested — 110 tests for SearchParameter, value extraction, references, capability

v0.7.0 Integration Coverage

✅ 110 new tests across 6 integration test files
✅ SearchParameter parser — 24 tests
✅ Search value extractor — 21 tests (string, token, reference, date, number, quantity, uri)
✅ Reference extractor — 22 tests (literal, contained, absolute, logical, bundle)
✅ CapabilityStatement builder — 12 tests
✅ Resource type registry — 16 tests
✅ End-to-end integration — 15 tests

v0.6.0 Package Coverage

✅ 138 new tests across 7 package-focused test files
✅ Package manifest parser — 13 tests
✅ Package index parser — 14 tests
✅ NpmPackageLoader — 32 tests (index, scan, load, filter, bulk)
✅ Dependency resolver — 15 tests (graph, topo sort, cycle detection)
✅ Canonical resolver — 22 tests (version-aware, multi-loader)
✅ PackageManager — 17 tests (register, discover, resolve)
✅ Integration — 25 tests (11 mock + 14 real US Core v9.0.0)

US Core IG Verification

✅ 70 US Core StructureDefinitions parsed
✅ 55 resource profiles converted to CanonicalProfiles
✅ 15 extension definitions processed
✅ Official examples validated against declared profiles
✅ FHIRPath evaluation on US Core resources
✅ Profile-to-example matching verified

Stress Testing

✅ Malformed input resilience — graceful error handling
✅ Deep nesting stress — recursive structure validation
✅ Large payload stress — bundle processing performance
✅ FHIRPath complexity — complex expression evaluation
✅ Memory pressure — batch processing stability
✅ Concurrent safety — parallel operation validation

🏗️ Architecture

Module Structure

src/
├── model/        ← FHIR R4 type definitions (branded primitives, enums, complex types)
├── parser/       ← JSON parsing & serialization
├── context/      ← SD registry, loaders, inheritance resolution, bundle loading
├── profile/      ← Snapshot generation, canonical builder, constraint merging
├── validator/    ← Structural validation (9 rules + FHIRPath invariants)
├── fhirpath/     ← FHIRPath expression engine (Pratt parser, 60+ functions)
├── provider/     ← Terminology/reference abstractions, NoOp providers, OperationOutcomeBuilder
├── terminology/  ← Binding validation, InMemoryTerminologyProvider, CS/VS registries
├── package/      ← IG package loading, NpmPackageLoader, PackageManager, canonical resolution
├── integration/  ← SearchParameter, search value extraction, references, CapabilityStatement
└── pipeline/     ← Composable validation pipeline, hooks, batch, reports, enhanced messages

HAPI FHIR Equivalence

🎯 Use Cases

• FHIR Servers — Validation layer for REST operations
• FHIR Server Foundations — Start fhir-server development with NoOp providers before terminology is implemented
• CLI Tools — Parse, validate, generate snapshots, evaluate FHIRPath
• Web Applications — Client-side FHIR processing without server dependency
• IG Publishers — Profile validation and snapshot generation
• Testing Frameworks — FHIR resource validation in test suites
• Data Pipelines — ETL with FHIR validation and transformation

📄 License

MIT License - see LICENSE file for details.

📊 Package Details

🆕 Release Highlights

v0.7.0

• SearchParameter Parsing — parseSearchParameter() and parseSearchParametersFromBundle() for typed SearchParameter resource parsing
• Search Value Extraction — extractSearchValues() and extractAllSearchValues() using FHIRPath to extract indexable values from resources
• Reference Extraction — extractReferences() walks resource tree to find all Reference elements (literal, logical, contained, absolute)
• CapabilityStatement Builder — buildCapabilityFragment() generates REST fragments from profiles and search parameters
• Resource Type Registry — ResourceTypeRegistry with FHIR_R4_RESOURCE_TYPES (148 R4 resource types)
• Reference Validation — validateReferenceTargets() checks reference target types against profile constraints
• 110 new tests — 3,376 total across 88 test files

v0.6.0

• IG Package Loading — NpmPackageLoader for loading FHIR IG packages from extracted NPM directories
• PackageManager — Register, discover, and manage multiple IG packages with dependency resolution
• Canonical Resolution — Version-aware cross-package canonical URL resolution (url|version)
• Dependency Graph — Topological sorting with circular dependency detection
• US Core verified — Real US Core v9.0.0 package loaded and validated (70 SDs, 20 ValueSets)
• 138 new tests — 3,266 total across 82 test files

v0.5.0

• Terminology Binding Validation — InMemoryTerminologyProvider with full TerminologyProvider interface
• Binding strength — required / extensible / preferred / example validation
• Registries — CodeSystemRegistry (hierarchical) + ValueSetRegistry for in-memory terminology storage
• ValueSet membership — expansion, compose include/exclude, hierarchical filters

v0.4.0

• Validation Pipeline — Composable ValidationPipeline with pluggable steps, priority ordering, and failFast mode
• Built-in steps — StructuralValidationStep, TerminologyValidationStep, InvariantValidationStep
• Hook system — Lifecycle events for monitoring and customizing validation flow
• Batch validation — Validate multiple resources in a single pipeline run
• Enhanced errors — Fix suggestions, documentation links, expected/actual values
• Validation reports — Structured reports with multi-axis issue grouping

v0.3.0

• Provider Abstraction Layer landed — TerminologyProvider and ReferenceResolver are now part of the public API
• Default NoOp implementations — Safe placeholders for higher-level services and integration work
• OperationOutcomeBuilder support — Convert structured engine results into FHIR-native error payloads
• Backward compatible — Existing validation flows continue to work with optional provider hooks

🔗 Related Projects

• FHIR Runtime Tools — Developer toolset built on fhir-runtime (GitHub)
• HAPI FHIR — Reference Java implementation
• HL7 FHIR Specification — Official FHIR R4 spec
• US Core IG — US Core Implementation Guide

⚡ Performance

• Zero dependencies — Minimal bundle size, fast installation
• AST caching — FHIRPath expressions cached (LRU, 128 entries)
• Deterministic — Same input always produces same output
• Memory efficient — Streaming bundle loading, lazy evaluation

Made with ❤️ for the FHIR community