Ask Not What Your Server Can Do For You: A Fast Query Compatibility Strategy for Navigating FHIR Implementation Gaps

The Fast Healthcare Interoperability Resources (FHIR) standard aims to improve clinical data interoperability, but real-world implementations often fall short of full compliance, creating significant deployment hurdles. A tiered compatibility strategy for Momo, a clinical microbiology software, is presented to circumvent these server-side limitations. The strategy utilizes an adaptive query framework featuring three search resolvers (Basic, Advanced, and Full) tailored to a target server's specific capabilities. This approach was evaluated during a pilot integration with an institution's severely restricted FHIR server. Despite missing resources and minimal query parameters, the adaptive framework enabled successful operational deployment in just two weeks, requiring only 52 person-hours of custom development and minimal institutional coordination. Integration time can be effectively reduced through this approach, though restrictions in system functionality show that availability of search parameters remains essential.