HL7 is an ANSI Accredited Standards Development Organization.
As such, ANSI reviews HL7 processes both in general, and also specifically with regard to each
standard. While ANSI certified that portions of this release of FHIR (Release 4) met its
requirements for development of a formal standard, this version (R4B) is a trial use
version, and ANSI will not be asked to certify R4B. HL7 has still treated these portions of
the specifications as Normative, and no breaking changes have been made to the specifications.
Given that many areas of the FHIR specification are still undergoing Trial Use by the HL7
Community, and hence are not ready for balloting as a formal ANSI standard, and in order to
manage the processes around the ballot process, four specific portions of this specification
are considered as Normative Specifications:
The terminology infrastructure and the base resources that define FHIR implementations and that represent how the specification, and conformance to it, is defined
Given that the Normative parts of the standard are still a subset of what implementers
need to use, implementers are generally focusing on conforming to FHIR R4 as a whole
rather than the formal standards. Future versions of this specification will extend
the coverage of format standards.