The Path to a FHIR-based Clinical Data Repository: Achieving Data Sovereignty and Next-Generation Healthcare Infrastructure

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Modern hospital IT is undergoing a structural transformation that goes far beyond mere digitization of paper records. Historically, medical data was trapped in closed silos within individual departments. Moving forward, the Clinical Data Repository (CDR), based on the FHIR standard, is becoming central. The CDR aggregates data from diverse sources—such as Electronic Health Records (EHRs), functional departments, and medical devices—enabling not just temporary exchange but permanent and structured long-term storage. Technologically, the key is the native use of FHIR. Unlike older systems that stored proprietary formats requiring complex translation when needed, a FHIR-native CDR uses the same open standard for both storage and exchange/analysis. This significantly reduces complexity and improves data quality. The CDR functions as an active platform, not just an archive. By providing standardized interfaces, it allows third-party or in-house applications to access real-time data. This independence from single software vendors is crucial, ensuring the hospital maintains its data sovereignty. This is a strategic move for flexibility and resilience. For clinical care, this means creating intelligent dashboards for decision support (e.g., sepsis or medication error warnings) using unified data. Furthermore, it is essential for research and AI applications, preparing hospitals for future initiatives like the European Health Data Space by providing high-quality, automated data sets without burdening primary systems.