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The SHR Specification

The Standard Health Record is a rapidly evolving specification under active development. Ultimately, an individual's SHR will consist of a series of entries relevant to the health of that person. The entries are divided among the categories below, and each entry always includes basic information about itself (e.g. who created it and when). Click on the entries below to explore details of the Standard Health Record. Go to the SHR GitHub or email the collaborative to get involved. To view documentation for the SHR SPEC (CIMPL) and the underlying JSON model (CIMCORE) go to the SHR GitHub Wiki. Go to the SHR Reference Model to see an alternate representation of the SHR Spec.

Relationship to HL7 Clinical Information Modeling Initiative (CIMI)

The SHR model presented here, especially the components labeled “CIMI”, have NOT been approved by the HL7 CIMI Work Group. The CIMI components here should NOT be taken as the official version of CIMI. While a serious attempt has been made to align SHR to the CIMI Reference Model, CIMI is a moving target, undergoing significant, continual revision as part of ongoing development and ballot reconciliation. The last release of the CIMI was Version 0.0.4, for the January 2018 ballot, and many unreleased changes have occurred since then – some of which are reflected in the SHR model. SHR and CIMI are working together to converge to a single reference model.

SHR largely conforms to the evolving class hierarchy of CIMI, and adopts CIMI’s clinical statement topic-context pattern. SHR models can also be written out as Basic Metamodel (BMM) and Archetype Description Language (ADL) files, currently the “gold standard” serialization format of CIMI models. However, there are differences between SHR and CIMI:

  1. SHR uses FHIR data types.
  2. SHR includes mappings to FHIR.
  3. SHR adds terminology bindings that do not exist in CIMI.
  4. SHR modifies CIMI model structures that are particularly difficult to map to FHIR.
  5. SHR classes may have different attributes than CIMI classes, reflecting requirements not addressed in CIMI.


This specification may contain and/or reference intellectual property owned by third parties ("Third Party IP"). Acceptance of the FHIR Licensing Terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise.

Any actions, claims or suits brought by a third party resulting from a breach of any Third Party IP right by the Licensee remains the Licensee’s liability. Following is a non-exhaustive list of third-party terminologies that may require a separate license:


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