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Navigating FHIR Application Deployment: On-Premises vs. Cloud Deployments

Michael Nikitin

CTO & Co-founder AIDA, CEO Itirra

Published on June 7, 2024

Navigating FHIR Application Deployment: On-Premises vs. Cloud Deployments

In the landscape of healthcare technology, the adoption of interoperability standards like Fast Healthcare Interoperability Resources (FHIR) has become a critical component for advancing patient care and streamlining healthcare operations. When considering deploying a FHIR application, one of the fundamental decisions to make is whether to host it on-premises as a single-tenant app or in the cloud as a multi-tenant app.

This comprehensive guide explores the practical differences between these deployment options, the potential hazards associated with each, and outlines the development, deployment, and management processes for both types of applications. 

Additionally, we’ll introduce Itirra, a Washington-based health tech lab specializing in bespoke FHIR app development, deployment, and management.

Understanding On-Premises and Cloud Deployments:

On-Premises Deployment (Single Tenant)

An on-premises deployment involves hosting the FHIR application within the organization’s physical infrastructure. This approach provides complete control over hardware, software, and security measures. Key characteristics of on-premises deployments include:

  1. Control and Security:

    • Organizations have full control over data security and compliance measures, allowing them to implement customized security protocols and adhere to regulatory requirements.

    • Data residency concerns are mitigated as all data remains within the organization’s premises, ensuring compliance with jurisdictional regulations.

  2. Scalability Challenges:

    • Scaling on-premises FHIR applications can be complex and expensive, often requiring significant upfront investments in hardware procurement and infrastructure expansion.

    • Predicting resource requirements accurately is crucial to avoid under-provisioning or over-provisioning, which can lead to performance issues or unnecessary costs.

  3. Maintenance and Upkeep:

    • IT teams are responsible for maintaining hardware, applying software updates, and ensuring the overall health of the infrastructure.

    • Regular maintenance tasks, including hardware upgrades and patch management, are necessary to optimize performance and security.

Cloud Deployment (Multi-Tenant):

Cloud deployment involves leveraging cloud computing platforms provided by vendors such as Amazon Web Services (AWS), Microsoft Azure, or Google Cloud Platform (GCP). Cloud deployments offer several advantages over on-premises solutions:

  1. Scalability and Flexibility:

    • Cloud-based FHIR applications benefit from the scalability and elasticity of cloud resources, allowing organizations to scale resources dynamically based on demand.

    • Auto-scaling capabilities enable seamless adjustment of resources, ensuring optimal performance and cost-efficiency.

  2. Reduced Operational Overhead:

    • Cloud providers manage infrastructure provisioning, software updates, and security patches, reducing the operational burden on IT teams.

    • Managed services offered by cloud providers streamline deployment processes and enable organizations to focus on application development rather than infrastructure management.

  3. Global Accessibility and Redundancy:

    • Cloud-based FHIR applications are accessible from anywhere with an internet connection, facilitating collaboration and data exchange across geographic regions.

    • Cloud providers offer global data centers and redundancy mechanisms, ensuring high availability and data resilience.

     4. Greater Business Development Capacity – can accommodate more customers:

  • Scalability: Multi-tenant cloud solutions can accommodate a larger number of users without significant infrastructure changes.

  • Cost-effectiveness: Shared resources reduce costs for individual clients, making the solution more appealing to a broader range of potential customers.

  • Ease of deployment: Single instance setups simplify the onboarding process for new clients, speeding up adoption.

  • Flexibility: Clients can start with a smaller package and scale up as their needs grow, making the solution accessible to businesses of varying sizes.

  • Community benefits: Clients benefit from shared updates, improvements, and support, creating a network effect that enhances the overall value proposition.

Developing and Deploying FHIR Applications:

Developing FHIR applications requires adherence to FHIR standards and best practices to ensure interoperability and data exchange capabilities. Whether deploying on-premises or in the cloud, consider the following:

  1. Compliance and Security:

    • Implement robust security measures, including encryption, access controls, and audit logging, to protect sensitive healthcare information.

    • Adhere to regulatory requirements such as HIPAA and GDPR to ensure compliance with data privacy and security standards.

  2. Modular Architecture:

    • Adopt a modular architecture that promotes scalability, maintainability, and flexibility. Microservices architecture can facilitate decomposition of complex FHIR applications into smaller, manageable components.

  3. API Design and Documentation:

    • Design FHIR APIs following RESTful principles and adhere to FHIR resource definitions and profiles.

    • Provide comprehensive API documentation and developer resources to facilitate integration with third-party systems and applications.

Managing FHIR Applications:

Effective management of FHIR applications is crucial to ensure optimal performance, reliability, and security. Management practices include:

  1. Performance Monitoring and Optimization:

    • Implement robust monitoring and logging mechanisms to track application performance metrics and identify performance bottlenecks.

    • Continuously optimize application performance to ensure responsiveness and scalability.

  2. Disaster Recovery and High Availability:

    • Develop and test disaster recovery plans to minimize downtime and data loss in the event of system failures.

    • Leverage redundancy and failover mechanisms offered by cloud providers to ensure high availability and data resilience.

Let’s break down how these issues would vary between a single-tenant on-premises solution and a multi-tenant cloud solution:

Performance Monitoring and Optimization:

Single-Tenant On-Premises Solution:

  • Implementation: Monitoring and logging mechanisms need to be set up within the infrastructure, often requiring additional hardware or software installations.

  • Resource Management: Optimizing performance involves managing dedicated resources solely for the client’s use, potentially requiring manual adjustments to hardware configurations.

  • Scalability: Scaling resources to handle increased loads may involve purchasing and installing additional hardware, which can be time-consuming and costly.

Multi-Tenant Cloud Solution:

  • Built-in Monitoring: Cloud providers typically offer built-in monitoring and logging services, simplifying the implementation process.

  • Resource Allocation: Performance optimization is managed by the cloud provider, who dynamically allocates resources among multiple tenants based on demand, optimizing utilization.

  • Auto-Scaling: Cloud solutions can automatically scale resources up or down based on demand, ensuring responsiveness without manual intervention.

Disaster Recovery and High Availability:

Single-Tenant On-Premises Solution:

  • Customized Plans: Disaster recovery plans need to be developed and tested individually for each client, often requiring dedicated hardware and infrastructure.

  • Limited Redundancy: Achieving high availability typically involves setting up redundant systems on-site, which can be costly and complex to maintain.

Multi-Tenant Cloud Solution:

  • Provider Assistance: Cloud providers offer standardized disaster recovery options and assistance in developing and testing plans, leveraging their expertise and infrastructure.

  • Redundancy Features: Cloud environments inherently provide redundancy and failover mechanisms across multiple data centers, ensuring high availability without additional setup.

  • Scalable Solutions: Cloud solutions can easily scale resources to handle disaster recovery scenarios, ensuring minimal downtime and data loss for all tenants.

Introducing Itirra: Your Partner in FHIR Application Development and Management

Itirra is a leading health tech lab based in Washington, specializing in bespoke FHIR application development, deployment, and management. With a team of experienced developers, healthcare experts, and cloud architects, Itirra delivers tailored solutions to meet the unique needs of healthcare organizations. From conceptualization to deployment and ongoing management, Itirra provides comprehensive support to drive innovation and transformation in healthcare delivery.


Deploying FHIR applications requires careful consideration of on-premises versus cloud deployment options, each offering distinct advantages and challenges. By understanding the practical differences and adopting best practices in development, deployment, and management, healthcare organizations can harness the power of FHIR to improve interoperability, enhance patient care, and drive innovation. With Itirra as your partner, you can navigate the complexities of FHIR application deployment and management with confidence and expertise. Contact us today to learn how we can help!

Contact us today to learn more about FHIR applications!