SQL on FHIR WG Meetings
SQL on FHIR WG Meeting — September 30, 2025
Nikolai Ryzhikov
Nikolai Ryzhikov
CTO at Health Samurai
Arjun Sanyal
Arjun Sanyal
Principal Antidote Solutions
Steve Munini
Steve Munini
CEO and CTO, Helios Software
Eugene Vestel
Eugene Vestel
Software Engineer
Sep 30, 2025

Topics discussed:

  • Nikolai admitted mixed feelings about the whole backport approach, using the R4 subscriptions backport IG as the example: it's all Basic resources and a pile of extensions, and he's not sure it doesn't bring more mess to implementations than value. What servers actually do — his own included — is support R6 subscriptions with R4 resources and quietly accept it isn't conformant. He wonders whether saying that out loud is the cleaner path. The consensus for SQL on FHIR was still to go R4-compatible, on the grounds that it isn't nearly as messy a case as subscriptions.
  • The core is being modularised, and the direction matters. FHIR-I has started stripping resources out of core and into incubation IGs — the test resources have already been pulled out and turned into additional resources. The driver is compatibility: from R6 onwards, core should hold only resources mature enough not to break, so anything at risk of breaking is better off outside. Nikolai also noted the encouraging part he sees at FHIR-I now: people are deprecating elements and adding new ones instead of breaking things outright.
  • Nikolai's ambition follows from that: SQL on FHIR should live outside core forever. Listed in the core spec as an official additional resource — since additional resources have to be registered with HL7 — but not part of core and not tied to core's release cycle, so the group keeps control of its own versioning. Separately, Graham has been asking for SQL on FHIR to plug into the FHIR test ecosystem, which could mean eventually rewriting the group's tests into the new test resource format.
  • Steve Munini brought two concrete asks. He tried the run sandbox against his own server and it works, but his server is stateless, and the sandbox runs views over whatever's in its own database — he'd like a mode where you feed it a resource inline, and offered to write it. He also wants the SQL on FHIR tester in FHIRPath Lab moved onto the current $run operation so that everybody is testing the same way.
  • There's a small Rust pile-up: Steve released his FHIRPath implementation in Rust, and Nikolai pointed out that three of the organisations doing anything in Rust were on the call, plus at least one more building the same primitives elsewhere. His suggestion was that they get together and pool the libraries in one direction rather than each maintaining a parallel version of the same hard thing.