FHIR Testing FAQ

Q: Why should I spend money on FHIR testing?
A: Because failing to do so is far more expensive.

Investing in FHIR testing from the outset isn’t an optional luxury—it’s a fundamental best practice for reducing implementation risk, accelerating project timelines, and ensuring interoperability across partners. FHIR testing is not just a technical check; it’s a business safeguard.

Touchstone, powered by AEGIS, provides a rigorous, standards-based testing platform that anchors a Zero Trust Conformance model. This means continuous validation—not one-and-done testing just for certification—ensuring that your FHIR implementation keeps pace with evolving specs and remains robust over time.

Q: What’s the business case for making FHIR testing a first-class citizen in my project lifecycle?
A: FHIR testing delivers clear ROI:
  • Accelerates velocity by catching defects early and guiding fixes before they snowball into production issues.
  • Reduces risk by providing objective proof that your implementation is doing what the IGs require.
  • Saves money by cutting costly rework, supporting faster go-lives, and minimizing the support burden downstream.
Q: Can’t we just test at the end?
A: No.

Interoperability isn’t something you “add” at the end—it’s something you build in from the beginning. Post-hoc testing is too late to influence design choices and too expensive to fix core issues. The only path to reliable, interoperable FHIR is to test iteratively throughout the lifecycle—just like modern software teams do for every other critical feature.

Q: How does FHIR testing help with interoperability?
A: FHIR testing provides the only objective measure of interoperability.

You can’t “guess” if your system will work with others. You need objective evidence. Touchstone serves as your interoperability scorecard, using the FHIR native TestScript resource to validate your implementation, as well as the FHIR implementations of your healthcare information exchange partners, provides actionable data that each can use to optimize interoperability.

Q: What does a mature FHIR implementation process look like?
A: It looks like this:
  • Start with “How do we test this?” as your first question during IG development.
  • Write clear, testable requirements.
  • Build a test package (test plan, cases, and scripts) alongside your implementation.
  • Use Touchstone to validate IG content, client implementations and server implementations continuously.
  • Ensure traceability from requirements to test outcomes.

These best practices eliminate ambiguity and transform testing into an asset—not an afterthought.

Q: How should I select a FHIR testing platform?
A: Start by asking one simple question: Does it test FHIR using FHIR? If the answer is no, walk away.

The HL7 FHIR specification includes a built-in testing framework: the FHIR TestScript resource. It’s not an optional extra—it’s part of the core standard. TestScript is the formal, machine-readable way to express how a FHIR implementation should behave. If your testing platform doesn’t use TestScript, it’s not built for FHIR.

Touchstone by AEGIS is the only testing platform that fully exercises FHIR implementations using TestScripts as defined by HL7. That’s not just a technical distinction—it’s a strategic advantage.

Q: Why does using TestScript matter?
A: Using TestScript means you’re testing with the same rules and constructs that define the FHIR specification itself.

This ensures:

  • Alignment with the FHIR standard—no translation or interpretation layer.
  • Reusability across projects and programs—TestScripts are portable assets, not throwaway code.
  • Community validation—TestScripts are authored and vetted by the same experts writing the IGs.

Touchstone supports thousands of TestScripts, spanning multiple versions of FHIR and IGs, and can test both client and server roles—even simultaneously.

Q: Can other tools test the same way?
A: No. Touchstone uniquely supports FHIR-native testing with a robust ecosystem built around TestScript.

This enables continuous, standards-aligned testing throughout the development lifecycle:

  • Automated regression tests on every code change.
  • Flexible testing scope: Test just what you need, free from “all-or-nothing” testing scope required by other tools.
  • Role-based access to execution results and logs.
  • TestScript traceability to requirements and capability statements.

This level of rigor and transparency simply doesn’t exist in ad hoc or black-box testing tools.

Q: What else should I look for in a testing platform?
A: Look for:
  • Comprehensive coverage of HL7 IGs and profiles.
  • 24/7 availability for on-demand, iterative testing.
  • Support for complex workflows (e.g., OAuth, multi-actor scenarios).
  • Secure, role-based test execution and results management.

Only Touchstone checks every box. It’s not just a tool—it’s the backbone of the industry’s Zero Trust Conformance model.

Q: How does FHIR testing support better team coordination?
A: FHIR testing gives every stakeholder—from product managers to developers to testers—a shared source of truth.

When testing is integrated from day one, it shifts conversations from vague interpretations to clear, testable outcomes. Touchstone enables this shift by anchoring your development process to FHIR TestScripts—machine-readable expressions of the implementation guide’s requirements.

Q: What’s the impact of robust FHIR testing using Touchstone on project teams?
A: Better coordination across every role:
  • Product managers can track objective progress toward interoperability goals.
  • Developers get immediate, precise feedback when functionality breaks.
  • Testers have authoritative, reusable TestScripts aligned with HL7 standards.
  • Integration leads can validate partner readiness using the same test suite.

Everyone speaks the same language because everyone sees the same test results—automated, timestamped, and traceable.

Q: How do teams actually use Touchstone in practice?
A: High-performing teams incorporate Touchstone into their CI/CD pipelines, running regression tests automatically. They:
  • Build with confidence, knowing each commit is tested for conformance.
  • Share test plans and execution results across teams and vendors.
  • Use the Touchstone ecosystem—including WildFHIR reference implementations—for consistent partner testing and production readiness.

Touchstone doesn’t just test your system—it becomes a core part of how your team collaborates to deliver.

Q: What’s the coordination benefit for multi-organization projects?
A: When you use Touchstone to test against FHIR IGs, your tests and results are portable. That means your partners can:
  • Reuse the same TestScripts.
  • Compare results across environments.
  • Trust that what worked in your environment will work in theirs.

That’s how you move from “we think it works” to “we know it interoperates”—across systems, teams, and organizations.

Q: How do we scale FHIR testing across multiple programs?
A: The key is standardization.

When each program defines its own testing methods, results aren’t comparable, and duplication runs rampant. But when every program adopts FHIR-native testing using HL7 TestScript, your testing becomes portable, repeatable, and scalable.

Touchstone enables this at scale by serving as a centralized, standards-aligned testing platform. It supports multiple IGs, multiple actors (client/server), and multiple execution environments—all under one umbrella.

Q: What are the benefits of a shared testing platform like Touchstone?
A: You get:
  • Consistent test coverage across use cases, versions, and IGs.
  • Reusability of TestScripts between programs—write once, validate everywhere.
  • Unified results and analytics, making it easy to assess organizational readiness and community maturity.

This is how national-scale initiatives like CMS Payer-to-Payer and HL7 Accelerators avoid reinventing the wheel and accelerate timelines.

Q: How do we manage multiple versions and evolving specs?
A: Use Touchstone to evaluate cross-version impact:
  • Run the same test suite against implementations of different versions of a FHIR IG.
  • Use those test results to quickly identify impacts to your implementation roadmap.
  • Include this testing in your Continuous Testing cadence using Touchstone.

This accelerates your planning process and protects your downstream data consumers, promoting operational stability during change.

Q: What about cross-program metrics?
A: Touchstone lets you aggregate and report on:
  • TestScript pass/fail rates across implementations.
  • Adoption and maturity of specific IGs.
  • Common failure points—highlighting opportunities for training or IG refinement.

This data empowers executives, governance bodies, program managers, and regulators to make informed decisions and track interoperability progress with real evidence—not anecdotes.

Q: How do I justify the cost of investing in FHIR testing?
A: By recognizing the cost of not testing.

Without FHIR testing, errors go undetected until late in the development cycle—or worse, in production. That leads to:

  • Costly rework.
  • Delays in partner onboarding.
  • Failed conformance reviews or certification.
  • Damaged reputations from non-functional integrations.

By contrast, using Touchstone ensures issues are caught early, fixed quickly, and don’t recur. That’s real cost avoidance.

Q: What’s the ROI of a FHIR testing platform like Touchstone?
A: Touchstone saves money three ways:
  1. Faster project completion—continuous feedback accelerates builds and reduces rework.
  2. Higher reliability—automated testing catches regressions before they ship.
  3. Reusable test assets—TestScripts are portable across teams, vendors, and programs.

It’s not just that you spend less fixing bugs—you invest once and scale testing across your ecosystem.

Q: Isn’t testing just a compliance checkbox?
A: No. If you’re testing just to “check the box,” you’re doing it wrong—and paying more for less.

Touchstone supports a Zero Trust Conformance model: continuous, standards-aligned validation that reduces downstream risk and ensures long-term interoperability. That’s the difference between transactional compliance and strategic readiness.

Q: How can testing reduce my partner integration costs?
A: Partners that use Touchstone can validate their systems before integration starts. That means:
  • Fewer test cycles.
  • Fewer support calls.
  • Faster go-lives.

And with Touchstone’s confidential testing results and shared test scripts, you have a trusted baseline to evaluate partner readiness without duplicating effort.

Q: What role does testing play in FHIR governance?
A: Testing is the foundation of FHIR governance.

Without testing, governance becomes subjective—relying on self-attestation and inconsistent interpretations of implementation guides (IGs). With Touchstone, governance becomes objective, repeatable, and defensible.

Touchstone provides authoritative proof of conformance through standards-based TestScripts, linked directly to IG requirements. This enables governance stakeholders to:

  • Enforce uniform expectations.
  • Track adoption progress.
  • Audit interoperability readiness with hard data.
Q: How does Touchstone support conformance oversight?
A: Touchstone enables transparent and consistent oversight by:
  • Maintaining a single source of truth for test definitions.
  • Capturing test execution history with full traceability.
  • Supporting both public and private test execution to balance transparency and confidentiality.

This helps governance teams enforce policies without manual review or guesswork.

Q: Can governance teams use Touchstone to assess implementation maturity?
A: Absolutely. Touchstone provides data-driven insights into:
  • Which organizations have passed which tests.
  • Which IG requirements are frequently misunderstood or failed.
  • How maturity evolves over time for specific workflows or actors.

This supports program dashboards, compliance scorecards, and funding decisions with real-world evidence.

Q: What’s the long-term value of testing governance?
A: Strong testing governance enables:
  • Sustained interoperability—not just at launch, but through version changes.
  • Faster partner onboarding—with pre-approved tests and known baselines.
  • Lower support costs—because systems don’t regress or drift out of spec.

Touchstone turns testing into a governance asset that aligns your ecosystem around shared, enforceable expectations.

Q: When did AEGIS receive recognition from Gartner for its innovation in interoperability?
A: In April 2015.

Gartner named “Scalable Interoperability” one of its Top Ten Strategic Technology Trends for Government, specifically mentioning AEGIS. This industry validation came just as FHIR adoption was accelerating, and it highlighted AEGIS as a strategic technology provider—not just a healthcare IT vendor.

Q: When was the Touchstone platform launched, and what is its historical significance?
A: Touchstone (DIL v2.0) launched in September 2015.

It built upon the original Developers Integration Lab (DIL), which launched in April 2012. AEGIS filed its DIL patent in 2013, demonstrating that the technology was already operational well before most of the healthcare industry had even begun to grapple with FHIR testing.

Q: How long has Touchstone been in operation, and what has it achieved in that time?
A: As of September 2025, Touchstone is celebrating its 10th anniversary.

In that decade, it has:

  • Supported enterprise customers like Mayo Clinic and McKesson
  • Enabled international adoption (e.g., Nictiz in the Netherlands)
  • Contributed to FHIR TestScript specification development
  • Accumulated over 16,000 test scripts in active use
  • Been validated in a peer-reviewed JMIR study in 2018

Q: Why is this innovation timeline important for FHIR testing today?

A: The AEGIS innovation timeline demonstrates that Touchstone didn’t follow the trend—it set it.

The platform existed before FHIR’s first standard release and helped define what “measurable interoperability” should look like. Any discussion of FHIR testing tools that omits Touchstone misses a decade of foundational work that shaped the field.