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

> FR Core 2.2.0 is the community FHIR baseline. INS is national identity via INSi. CI-SIS volets are ANS exchange specifications. Implement all three; they are not one API.

Author: Ala Ben Aicha

Canonical page: https://alabenaicha.me/insights/fhir-fr-core-ins-cisis

Updated: 2026-09-19

## 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.

| Layer                                      | Owner / home                                                                                                                                                                           | Canonical / package                                                                                                                                                                       | What it is                                                                                                                       | What it is not                                                                        |
| ------------------------------------------ | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------- |
| **FR Core** 2.2.0 (trial-use, 25 Mar 2026) | HL7 France / Interop'Santé; [hl7.fr/ig/fhir/core](https://hl7.fr/ig/fhir/core/)                                                                                                        | Official URL `https://hl7.fr/ig/fhir/core/ImplementationGuide/hl7.fhir.fr.core`; package `hl7.fhir.fr.core#2.2.0` on FHIR R4                                                              | Community **base** for Patient, Practitioner, Organization, Encounter and vitals, including how INS and RPPS appear on resources | Not an ANS volet, not a Mon Espace Santé certificate, not EEHRxF                      |
| **INS** (Identité Nationale de Santé)      | ANS / CNAM INSi teleservice; [référentiel INS](https://esante.gouv.fr/produits-services/referentiel-ins)                                                                               | INS-NIR `urn:oid:1.2.250.1.213.1.4.8`; INS-NIA `urn:oid:1.2.250.1.213.1.4.9`. Profiled on [FR Core Patient INS](https://hl7.fr/ig/fhir/core/StructureDefinition-fr-core-patient-ins.html) | **National health identity**: qualified traits plus matricule retrieved from INSi                                                | Not a local MPI, not NIR-as-free-text, not an EU Patient identifier                   |
| **CI-SIS** volets                          | ANS; [espace de publication CI-SIS](https://esante.gouv.fr/offres-services/ci-sis/espace-publication); [doctrine d'interopérabilité](https://esante.gouv.fr/doctrine/interoperabilite) | Each volet is its own specification in the ANS publication space                                                                                                                          | **National exchange specifications** (documents, services, FHIR IGs where ANS has published them)                                | Not FR Core. A CI-SIS volet names the payload; FR Core names how French Patient looks |

Primary sources: [FR Core 2.2.0](https://hl7.fr/ig/fhir/core/), [ANS interoperability doctrine](https://esante.gouv.fr/doctrine/interoperabilite). The French-language [EHDS product-team guide](https://alabenaicha.me/insights/ehds-product-team-calendar) 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](https://alabenaicha.me/insights/fhir-eu-core-ehds-implementation) and the [French product-team overlay](https://alabenaicha.me/insights/ehds-product-team-calendar). 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](https://alabenaicha.me/insights/hl7-fhir-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](https://alabenaicha.me/insights/fhir-eu-core-ehds-implementation)
* [EHDS pour les équipes produit](https://alabenaicha.me/insights/ehds-product-team-calendar)
* [FHIR implementation guides by country](https://alabenaicha.me/insights/fhir-implementation-guides-by-country)

For R4 mapping work against FR Core or a named CI-SIS volet, use [HL7 FHIR integration](https://alabenaicha.me/services/hl7-fhir-integration) or [start a project](https://alabenaicha.me/contact?intent=project).