FHIR Data Mapping Quality Assessment: A Scoping Review and Expert-Informed Requirements for Future Pre-Mapping Frameworks

Review article, 2026

Background: Healthcare systems increasingly rely on effective data sharing to support safe and efficient care. The fast healthcare interoperability resources (FHIR) standard provides a widely adopted framework for interoperability. However, many existing healthcare information systems predate FHIR and require translation or mapping of their data models and data elements to the FHIR standard to enable interoperability. Despite growing FHIR adoption, robust approaches for assessing mapping quality remain limited.

Objective: This scoping review aimed to identify and synthesize existing tools and approaches for evaluating FHIR data mapping quality, examine methodological challenges and gaps, and formulate and refine requirements for more consistent and transparent assessment.

Methods: A scoping review was conducted across IEEE Xplore, ACM Digital Library, PubMed, and the JMIR journal family. Studies were screened using predefined eligibility criteria and analyzed through thematic synthesis focusing on mapping tools, validation approaches, challenges, and quality assessment dimensions. FHIR mapping quality was conceptualized using 7 quality dimensions adapted from data quality literature. Candidate framework requirements were formulated and refined through expert consultation (n = 4).

Results: A total of 742 studies were screened and 39 included. The literature revealed fragmented practices with limited consensus on FHIR mapping quality assessment. Most studies relied on manual evaluation of the transformed data, while few considered source-to-target relationships before transformation. Six requirements for future pre-mapping quality assessment frameworks were formulated and refined.

Conclusions: Current FHIR mapping quality assessment approaches remain fragmented and largely rely on manual evaluation. The findings highlight the need for more transparent and formalized pre-mapping assessment approaches to support future FHIR implementations.