Azure FHIR Services Vs. Google Cloud Healthcare API – Which one is right for you?

| Author , tagged in healthcare data interoperability, fhir
Cloudticity, L.L.C.

Exchanging health data between systems has historically been plagued by interoperability issues. Disparate systems and differing encoding systems, like HL7 and CCDA, make it difficult for health systems to talk to one another.

The good news is that the FHIR data standard significantly improves interoperability in healthcare by providing a rich and consistent data format for systems to exchange information. However, implementation can be a challenge, as FHIR is still a nescient standard, so most teams don’t have the expertise to implement FHIR efficiently and correctly.

Fortunately, cloud-based FHIR services from Microsoft and Google make FHIR adoption simpler and easier, saving teams time they would otherwise have to spend managing physical infrastructure, building APIs, or even creating components of a new application. In this article, we are going to look at FHIR solutions from two major public cloud service providers (CSPs) and compare them head-to-head, so you can decide which one is right for you.

What is FHIR?

Fast Healthcare Interoperability Resources (FHIR) is an interoperability standard for the electronic exchange of healthcare information. It was developed by the not-for-profit organization Health Level Seven International (HL7) to facilitate the interoperability of electronic health records (EHRs). FHIR is designed specifically for the web and its use has been mandated by the U.S. Centers for Medicare & Medicaid Services (CMS) for payers and providers since mid-2021.

The foundational elements of FHIR frameworks are known as resources. These are modular components that can be used to construct working systems to resolve data exchange issues in healthcare. CSPs need to address the FHIR standards when hosting healthcare-related businesses. Companies can take advantage of cloud-based FHIR services to minimize the complexity and cost of processing EHRs.

What are Azure FHIR Services?

Microsoft Azure Health Data Services offers its customers an FHIR service that facilitates the exchange of health data using the FHIR standards. It’s a platform-as-a-service (PaaS) offering that lets anyone securely store and exchange ePHI in the cloud. The main features of this service include:

  • A high-performance, low latency managed FHIR-compliant server provisioned in the cloud

  • Enterprise-grade FHIR API endpoint for FHIR data access and storage

  • A compliant environment for secure ePHI management

  • SMART on FHIR for mobile and web clients

  • Azure Active Directory Role-Based Access Controls for access to FHIR data

  • Audit logs for tracking events within the FHIR service data store.

Azure FHIR Services enables organizations to rapidly deploy a FHIR server that takes advantage of the scalability of the cloud for storing and processing health data. Microsoft handles the operations, maintenance, and compliance requirements of the PaaS offering.

What is Google Cloud Healthcare API?

Google Cloud Healthcare API enables the standardized exchange of healthcare data between applications and solutions built on Google Cloud. It’s a fully-managed and highly scalable development environment designed for building secure clinical and analytical solutions using Google Cloud. Some of its main features are:

  • Full support for HIPAA compliance

  • Access to advanced analytics to unlock the value of your data

  • Managed scalability that matches usage patterns

  • Integration with the Apogee life cycle API management

  • Developer-friendly REST and RPC interfaces

  • Enhanced data liquidity with bulk import and export of FHIR data

Azure FHIR Service and Google Cloud Healthcare API Comparison

There are several things to consider when choosing between the two services, such as deployment options, customization, management, scalability, security, and integration with other services.

Let’s take a look at how these two FHIR services compare in these specific areas.

Deployment options

  • Microsoft offers three FHIR Services that allow companies to balance their managed service and customization requirements.

  • Azure Health Data Services is a managed, turnkey PaaS offering that includes a provisioned database.

  • Azure API for FHIR is a streamlined, managed PaaS server in Azure that has fewer features than FHIR in Azure Health Data Services.

  • FHIR Server for Azure is an open source FHIR server that can be deployed into an Azure environment.

  • Google Cloud Healthcare API is a fully managed service that bridges existing healthcare systems and apps hosted on Google Cloud. Three interfaces are available to support FHIR, HL7v2, and DICOM.


  • Azure FHIR Services enables customization with the FHIR Server for Azure offering which provides administrative access to all underlying services.

  • Google Cloud Healthcare API cannot be customized and does not provide access to the underlying datastore.


  • Azure FHIR Services eliminates the need for customer management with the two PaaS options. The Azure Health Data Services and Azure API for FHIR offerings are managed by Microsoft.

  • Google Cloud Healthcare API is a fully managed service that does not require the customer to manage or maintain any infrastructure.


  • Azure FHIR Services offers automatic scaling with its two PaaS offerings. Customers opting for the open source server can leverage standard cloud scalability.

  • Google Cloud Healthcare API is a serverless offering that scales automatically to address usage patterns. There is no need to specify initial capacity requirements or make manual changes to expand capacity.


  • Azure FHIR Services provides multiple layers of security that include:

  • Role-based access control

  • Data isolation for each organization

  • Cybersecurity defenses and threat detection capabilities

  • Audit logs and tracking of all data stores

  • Google Cloud Healthcare API also provides layered security with:

  • Control over data location

  • De-identification of data to facilitate research or analytics while protecting sensitive information

  • Identity and access management

  • Audit logging to track data access

Integration with other services

  • Azure FHIR Services is designed to integrate with other Azure services such as Synapse Analytics, Machine Learning, and Power BI to obtain actionable insights from your data.

  • Google Cloud Healthcare API enables connections with multiple Google services such as the BigQuery data warehouse, AI/ML services, and PUB/Sub services.


Azure FHIR Services and Google Cloud Healthcare API both provide managed environments that adhere to the FHIR standards. The offerings are designed to support processing health information on the Azure or Google Cloud platforms, and both services easily integrate with other of the CSP’s products and services. Generally speaking, if you are already invested in Azure or Google Cloud, the choice between the two is fairly simple.

Azure’s open source offering is the most customizable option and is a good choice for organizations that want to manage the environment themselves. Google’s service is not customizable, which may influence your organization’s selection.

Microsoft and Google are only two providers of cloud-based FHIR services. While both are good options, there are other comparable solutions available on the market, too. Download the full white paper FHIR Solutions Comparison for an in depth comparison of five leading cloud-based FHIR solutions.

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TAGGED: healthcare data interoperability fhir

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