This overview is based on the insights gathered from the DevDays 2024 State of FHIR survey, with a comparison to the 2023 survey to highlight the progress and changes.

Regulation

Germany has established a robust regulatory framework to guide the use of standards in electronic health data exchange. Key regulations include the Sozialgesetzbuch V (SGB V), Digital-Gesetz (DigiG), and various initiatives like ISIK, OEGD, genomDE, KHZG, ePrescription, and Medication. Notably, FHIR is explicitly mandated in some regulations, with compliance deadlines such as January 1, 2025. While some regulations impose fines for non-compliance, others are supported by funding programs to stimulate FHIR adoption. The interoperability coordination council, with multiple subgroups, plays a crucial role in this ecosystem.

Adoption

FHIR adoption in Germany is gradually expanding, primarily driven by regulations and grants. Although currently used in a few specific use cases, the adoption rate is expected to significantly increase in the coming years. The most widely used FHIR version is R4, while other versions like STU3 and R5 are also in use to a lesser extent.

In 2024, the adoption rate expectation is slightly lower compared to 2023, reflecting a more cautious optimism. Current FHIR usage remains consistent, with ongoing efforts to expand its application.

Authoritative Bodies

The key authoritative bodies in Germany include the Kompetenzzentrum für Interoperabilität (KIG), the Interoperability Council, and organizations such as DIN, HL7 Germany, and SITIG. These bodies are instrumental in developing and maintaining standards for electronic health data exchange.

Relevant Institutes

Prominent institutes involved in FHIR implementation include the Kassenärztliche Bundesvereinigung (KBV), gematik, and Charité University Medicine. These organizations contribute significantly to the development and adoption of FHIR standards within the healthcare system.

National Standards Development

Germany has a national FHIR data model that is being utilized in limited use cases. This model is published and accessible through platforms like Simplifier and the Medical Informatics Initiative. Numerous specific FHIR standards have been developed, often deriving from the national FHIR data model. The Gematik National Competence Center is a key player in this domain.

In 2024, there is a noted increase in the specific use cases for the national FHIR data model, reflecting its growing application.

Infrastructure

Germany boasts a comprehensive regional and national infrastructure to support FHIR adoption. Key infrastructure components include the interoperability coordination council and various national initiatives. Software companies are required to integrate seamlessly with this infrastructure, ensuring compliance with established standards and regulations.

FHIR implementation in Germany involves various features and techniques, with FHIR Documents and FHIR Shorthand being widely used. Other features like FHIR Bulk Data, FHIR Rest API, and FHIR Questionnaires and SDC also see considerable use. Patient advocacy groups, such as the GBA and the Patient Representative, actively promote the availability of healthcare data, including attention to FHIR standards.

The 2024 we see more specific FHIR features being used and patient advocacy groups are highlighted more clearly.

Successful FHIR Use Cases

Germany has seen several successful FHIR use cases, including eRezept, eAU, VoS, AWS, Kollegensuche, and eTS. These implementations have led to improved access to information and process improvements, demonstrating the tangible benefits of FHIR adoption.

Compared to 2023, our 2024 survey lists additional use cases, indicating ongoing progress and innovation.

Challenges and Future Use Cases

The biggest challenges for FHIR adoption in Germany remain high investment costs and a lack of FHIR knowledge. However, upcoming use cases such as eMP MIO, eVDGA, KHE MIO, PKA MIO, LAB MIO, and EHR are anticipated to drive further adoption and innovation.

The 2024 survey highlights a broader range of future use cases, reflecting a dynamic and forward-looking approach to FHIR implementation.

Conclusion

Germany is on a promising path toward widespread FHIR adoption, driven by strong regulatory support and collaborative efforts among key stakeholders. With continued investment and focus on interoperability, the future of FHIR in Germany looks bright.

This overview provides a snapshot of the current state of FHIR in Germany, highlighting the key factors influencing its adoption and implementation, with a more detailed and varied perspective compared to the previous year.

This summary presents the current state of Fast Healthcare Interoperability Resources (FHIR) in [COUNTRY] based on the HL7 FHIR DevDays 2024 State of FHIR survey results provided, among others, by Maximilian Reith of the Kassenärztliche Bundesvereinigung (KBV), Dennis Kipping at mio42 GmbH and Sylvia Thun of Charité Universitätsmedizin.

Additional background was added based on the answers to the HL7 FHIR DevDays State of FHIR survey 2023 including from Maximilian Reith, Kassenärztliche Bundesvereinigung (KBV), Simone Heckmann, Gefyra GmbH / HL7 Germany e.V., Sylvia, Charité Universitätsmedizin Berlin.