FR Core, INS and CI-SIS: implementing FHIR for French health software

Direct answer

FR Core 2.2.0 is the community FHIR baseline. INS is national identity via INSi. CI-SIS volets are ANS exchange specs. They are three layers, not one French FHIR API.

Three names, three owners

French FHIR conversations collapse Interop'Santé's community IG, the Identité Nationale de Santé, and ANS CI-SIS volets into “the French profile”. They do not share a CapabilityStatement, a legal mandate, or a package id. Implement the layer the contract names.

Primary sources: FR Core 2.2.0, ANS interoperability doctrine. The French-language EHDS product-team guide on this site is the overlay of EHDS dates onto FR Core; this page does not restatement-dump NIS2 or MDR.

FR Core is explicit that new French FHIR work should stay on R4 unless a published norms-and-standards study says otherwise. Do not bid “French FHIR on R5” because a library defaulted to R5.

The identifier: INS-NIR / INS-NIA

Country-specific identifier for a qualified French Patient is the matricule INS. FR Core Patient INS slices it:

• INS-NIR (definitive NIR): urn:oid:1.2.250.1.213.1.4.8, type code INS-NIR
• INS-NIA (temporary): urn:oid:1.2.250.1.213.1.4.9

The INS identifier may be conveyed only when identity is qualified (INS référentiel 2.1, EXI 12). That is why the slices live on FRCorePatientINS, not on the looser FR Core Patient. Retrieve traits from the INSi teleservice; do not mint an INS from a hospital chart.

Do not publish a real INS. Keep the system URL and a dummy value in fixtures. A local IPP / NIP is an additional slice — it does not replace INS when the receiver is a national or cross-organisation French FHIR endpoint.

RPPS (IDNatPS) belongs on Practitioner, not on Patient. FINESS / SIREN belong on Organization. Mixing those systems onto Patient is how French matching fails.

What to implement first

1. If the buyer needs a French Patient that other IGs can inherit: FR Core 2.2.0, package hl7.fhir.fr.core#2.2.0, plus the INS profile when identity is qualified.
2. If the buyer names a CI-SIS volet: implement that volet from the ANS publication space, on top of FR Core — not a private “French US Core”.
3. If the buyer is selling into EHDS category 1: read EU Core and EHDS and the French product-team overlay. EU Core does not replace INS-NIR.
4. Pin FHIR R4. Annuaire Santé FHIR is an example of FR Core in production; it is not a substitute for the volet you were contracted to ship.

The HL7 FHIR R4 integration guide is the generic REST primer. FR Core search parameters and INS reliability extensions override generic R4 examples.

What this is not

This article is not an ANS homologation, not an INS certification, not a CI-SIS conformance report, and not legal advice. Implementing FR Core profiles in a lab does not authorise you to claim “logiciel compatible INS” or to call INSi in production. I do not issue ANS certificates. English is used here because this cluster is English; the binding text is the French IG and the ANS référentiels. Nothing here is clinical advice.

Related reading

• EU Core and EHDS
• EHDS pour les équipes produit
• FHIR implementation guides by country

For R4 mapping work against FR Core or a named CI-SIS volet, use HL7 FHIR integration or start a project.