This overview is based on the insights gathered from the DevDays 2024 State of FHIR survey.
Regulation
Belgium has robust regulations in place that specifically mandate the use of FHIR (Fast Healthcare Interoperability Resources) for electronic health data exchange. The most pivotal regulation, the EHealth Action Plan, clearly prescribes the adoption of FHIR standards. While specific compliance deadlines are not well-documented, the absence of fines for non-compliance is counterbalanced by the availability of governmental funds aimed at stimulating FHIR adoption, fostering a supportive regulatory environment.
Adoption
The adoption of FHIR in Belgium is prominently advanced, nearing mainstream status with an overall adoption score of 4 out of 5. The prevalent use of FHIR version R4 signifies a mature implementation landscape, while the anticipation of significant growth in adoption underscores a highly optimistic trajectory for FHIR expansion in the coming years.
Authoritative Bodies
Belgium consist of three regions (Flanders, Wallonia and Brussels) with a high degree of autonomy, however health standards are foremost managed on a federal level. The Belgian federal governement has declared that for e-health, FHIR is the "Preferred standard to use for e-health".
Leading the charge in the standardization and implementation of FHIR in Belgium are organizations such as HL7 Belgium and IHE Belgium. These entities serve as central meeting grounds for various stakeholders, fostering collaboration and widespread adoption of FHIR standards across the healthcare ecosystem.
Relevant Institutes
Key stakeholders in the adoption of FHIR include care providers, payers/insurers, EHR vendors, and app developers. The eHealth Platform, RIZIV-INAMI, and regional health vaults like Vitalink, RSW, and RSB have also been identified as crucial players, driving forward the national agenda on FHIR adoption.
National Standards Development
Belgium has an active landscape for the development of FHIR standards, with several specific use cases already leveraging these standards. A national FHIR data model is under development: HL7 Belgium FHIR specification. While it is not yet published, it promises to further streamline and harmonize electronic health data exchange across the country.
Belgium has defined several Implementation Guides, ranging from Core, Vaccination, Allergy Intolerance, Medication, Clinical, national infrastructure connectivity, Lab, to security.
You can find the Belgian FHIR packages here on Simplifier.
Terminology Usage
In Belgium, multiple base terminologies are accepted, using both SNOMED and Loinc and ICD-10 and a few national base terminologies. And because Belgium is multi-lingual, they have a bilingual thesaurus called 3BT, and is now maintained as an extension on Snomed.
Infrastructure
Belgium boasts a well-established regional and national infrastructure that supports FHIR integration. Software companies aiming to plug into this infrastructure must meet certain technical requirements ensuring seamless interoperability and data exchange. The FHIR Rest API and FHIR Shorthand are notably widely used, indicating robust and sophisticated infrastructure capabilities.
The regional governements maintain their own infrastructure for data exchange, which they call 'Vaults': These systems are
- Vitalink (Flanders)
- RSW (Wallonia)
- Brusafe+ (Brussels region)
Health companies and organizations are encouraged to addopt FHIR and connect with national infrastructure. Their principles are focused on openness, transparency, and collaboration.
In conclusion, the state of FHIR in Belgium is progressive and promising. With strong regulatory backing, substantial adoption, and proactive development and infrastructure support, Belgium is well-positioned to not only standardize health data exchange but also innovate and improve healthcare outcomes significantly.
This summary presents the current state of Fast Healthcare Interoperability Resources (FHIR) in Belgium based on the HL7 FHIR DevDays 2024 State of FHIR survey results provided by José Costa Teixeira of Hl7 Belgium.
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Within the domain of health and healthcare, there are a large number of data flows with various objectives operational in Belgium: administrative data flows, data flows that guarantee the continuity of care (patient-related follow-up), or the traceability of a condition, medicine or healthcare product. There are also many data collections in the context of epidemiology and quality of care, for example.
This last group of scientific data collections, the so-called registries, is characterised by a heterogeneous methodological approach, not only in terms of technology (paper, fax, email, web applications, batch upload, web services), but also with regard to content (different data structures). Furthermore, the same data is often requested multiple times from the same data provider.
The consequences of this diversity for the providers and collectors of this data include reduced efficiency in the registration and processing of the information (a lot of manual data cleaning, retyping and mapping), real privacy risks and the scattered deployment of IT resources and people for the same tasks. Moreover, this context is not motivating for the (highly skilled) employees involved in these data collections (both among the data providers and the researchers). Finally, this situation leads to a high (direct and indirect) financial commitment on the part of data providers, the researchers and their clients.
The healthdata.be team opted to align the standardization of these so-called "real world data" projects with the clinical context (in stead of starting from the research context) and to look for an information architecture that can be technically implemented in the various applications used in the Belgian healthcare landscape.
One of the initiatives studied by the healthdata.be team is the “Registration at the source” project of the Dutch University Medical Centers (UMCs), united in the Dutch Federation of University Medical Centers (NFU). Within this initiative, which is supported by the National ICT Institute in Healthcare (NICTIZ), it was decided to work together in the field of standardization of healthcare data. The result of this collaboration is a set of so-called “Zorginformatiebouwstenen” (or Clinical Building Blocks).
These Dutch Zorginformatiebouwstenen are reviewed and adapted to national landscape by the healthdata.be team and their stakeholders. The result are "Clinical Building Blocks" which are published on Simplifier as logical models.
In a next step, the clinical building blocks will be translated into HL7 FHIR R4 compliant profiles and related conformance materials for data collections supported by healthdata.be (Sciensano). All assets will become available on Simplifier.
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