An Open FHIR R4 Implementation Guide for Structured Rural Heart-Failure Research Workflows

Background: The HEARTLAND Protocol translates evidence-based heart-failure management into operational workflows for rural and resource-limited settings. Interoperable representations are needed to study whether those workflows can be exchanged consistently across research systems without claiming clinical validation. Objective: To describe the architecture, resource inventory, reproducible build, and responsible-use boundaries of the open HEARTLAND FHIR Implementation Guide. Methods: Clinical concepts were represented in FHIR R4 using FHIR Shorthand and compiled with SUSHI against US Core 6.1.0. The implementation guide models risk assessment, facility tier, monitoring track, care planning, remote monitoring, and rural-access context using synthetic examples only. Results: SUSHI 3.19.0 compiled 26 authored artifacts with zero errors and zero warnings. The generated ImplementationGuide manifest produced a 27-resource distribution. Conclusions: The implementation guide provides a transparent, machine-readable starting point for synthetic-data testing and future implementation research. It has not been HL7-balloted, clinically validated, production-tested, FDA-cleared, or certified for privacy or security compliance.