In Bangladesh, the use of Fast Healthcare Interoperability Resources (FHIR) for exchanging healthcare data is in its early stages. FHIR is a standard describing data formats and elements (known as "resources") and an application programming interface (API) for exchanging electronic health records (EHR). The survey indicates a low level of FHIR usage currently, with only DSTU2 and STU3 versions actively being mentioned. Respondents expect a significant increase in FHIR adoption in the coming years across the country.

Rules and Support for Health Data Exchange

  • Regulation: There's no specific regulation mandating the use of standards in electronic health data exchange currently in place.
  • FHIR Requirements: No detailed FHIR requirements are mentioned due to the absence of specific regulations.
  • Deadlines and Fines: There are no deadlines or fines imposed for non-compliance, as regulations are not specified.
  • Funding: Government funds are available to stimulate the adoption of FHIR. More information about these regulations and funds can be found here.

National Setup

  • Standards Organization: There's no national organization responsible for health data standards currently established.
  • Implementation Guides: A base/core FHIR implementation guide for Bangladesh is under development but not officially published yet. Preliminary information can be found here.
  • Terminology Services: A national FHIR terminology server is in development, aiming to support standardized and interoperable health data exchange.

Active Use Cases

  • Local Implementations: Efforts are being made to implement Shared Health Records, although challenges persist due to people's mindset and other barriers.
  • International Standards Use: There is interest in using international patient summaries and learning from successful FHIR use cases in other countries.
  • Key Projects: The Ministry of Health seeks to deploy a central FHIR server and set up a terminology service with available funds.

Who's Using FHIR

  • Organizations: Management Information System (MIS), DGHS, MOHFW, and Bangladesh University of Health Sciences (BUHS) are notable entities working with FHIR.
  • Reasons for Adoption: Improving health outcomes, care workflows, and facilitating innovation are primary motivations.
  • Application: FHIR is utilized for messaging, documents exchange, and through APIs, including SMART on FHIR for app development.

Success Stories and Challenges

  • Benefits: Though specific success stories are not mentioned, anticipated benefits include better health system planning, resource mobilization, and improved healthcare outcomes.
  • Challenges: High investment costs, unclear benefits, regulations, lack of knowledge, and people's mindset are significant barriers.
  • Future Plans: Stakeholders are looking forward to learning from successful cases in other countries and are planning pilot projects to expand FHIR adoption.

Future Plans

  • Progress So Far: Adoption has made less progress than expected, with stakeholders expressing dissatisfaction but also strong belief in significant future benefits.
  • Next Steps: Continued development of national FHIR standards, establishment of a standards organization, and launching pilot projects are immediate priorities.
  • Expected Changes: Enhanced care coordination, cost savings, and a robust digital health ecosystem are strongly anticipated outcomes within the next three years.

Contributors

  • Md. Aminul Islam
  • Muhammad Asif Atick

This document summarizes the current state and future outlook of FHIR adoption in Bangladesh, based on responses from key stakeholders involved in healthcare information technology.

The above summary is based on the answers to the State of FHIR Survey 2025, organized by Firely and HL7 International.