In Germany, FHIR is used for several important healthcare use cases. It is not yet the main standard for all health data exchange, but adoption is growing steadily. FHIR plays a clear role in the national digital health strategy.
The most widely used FHIR version is R4. Some teams also work with STU3, R5, and the pre-release R6. Older versions like DSTU2 are no longer in active use.
We expect strong growth in FHIR adoption over the coming years. New use cases and regulations will likely drive this increase.
Rules and support
Germany has clear rules for electronic health data exchange:
- Regulation is in place that mandates the use of standards.
- FHIR is mandated in some areas and not directly mentioned in others.
- Deadlines for compliance are included in the regulation.
- No fines are imposed when deadlines are missed.
- Some government funding is available to support FHIR adoption.
Key legal and funding sources mentioned:
- Sozialgesetzbuch V (Social Code Book V)
- Gesetz zur Beschleunigung der Digitalisierung des Gesundheitswesens (Law to Accelerate the Digitalization of Healthcare)
- Krankenhauszukunftsgesetz (KHZG), which provides hospital digitalization funding
National setup
Several organizations shape FHIR standards in Germany:
- gematik — the national agency for digital health infrastructure
- HL7 Germany
- BfArM (Federal Institute for Drugs and Medical Devices)
- BIH@Charité
A national base FHIR implementation guide exists. Parts of it are widely used, while other parts are still under development. Guides are published through Simplifier, a platform for sharing FHIR profiles.
A national FHIR terminology server is in development, and some terminology services are already in production.
Active use cases
Germany develops FHIR specifications for many use cases, including:
- Prescriptions and pharmacy
- Referrals and continuity of care
- Provider directory
- Public health reporting
- Terminology
- Diagnostic orders and reports
- Consent
- Clinical decision support
- Imaging
- Genomics
- Immunizations
- Clinical registries
- Scheduling
- Allergy intolerance
- Digital health applications (DiGA)
German FHIR specifications build on several international standards:
- International Patient Summary
- European Implementation Guides
- IHE profiles
Who is using FHIR
The main groups adopting FHIR in Germany include:
- EHR system vendors
- Payers and insurers
- App developers
- Government agencies
- Researchers
The main reasons for adoption are:
- Regulation and grants
- Innovation
Common exchange methods include FHIR Documents and the FHIR REST API. FHIR Messaging and FHIR Questionnaires also see meaningful use. FHIR Shorthand, a simple language for writing FHIR profiles, is widely used by developers.
Both open source and proprietary FHIR software are in use, with a slight lean toward proprietary tools.
Success stories and challenges
Successful FHIR projects in Germany include:
- Electronic prescriptions (e-prescription)
- Electronic sick notes
- Medication service
- Digital health applications (DiGA)
- The Medical Informatics Initiative, which connects university hospitals for research
These projects have improved access to information and care workflows.
The main challenges include:
- High investment costs
- Unclear benefits for some stakeholders
- Limited FHIR knowledge in parts of the ecosystem
- Changes in political direction
- Engagement of software vendors
AI and FHIR
Views on AI's impact are mixed. Some see AI as helping FHIR adoption by increasing interest in structured data as a foundation for AI. Others note that AI may reduce the perceived need to invest in structured data. Overall, respondents disagree that AI removes the need for FHIR.
Future plans
Last year's major achievements include:
- Establishment of a national standards organization
- Development of new FHIR standards for specific use cases
- Expanded adoption of FHIR across the healthcare ecosystem
Progress over the past year was mixed. Some respondents felt progress was less than expected, while others felt it exceeded expectations. Overall satisfaction with adoption is neutral.
Upcoming use cases to watch include:
- EHR system switch API (for moving data between EHR systems)
- Lab and discharge reports
- Extended prescription use cases
- Dental care
For the next year, expected next steps include:
- Continued growth of the national standards organization
- Development of a national FHIR data model
- New regulations for standardized data exchange
- More FHIR standards for specific use cases
- Wider adoption across healthcare
Respondents are cautiously optimistic that Germany will see real benefits from FHIR within three years, including better care coordination and a stronger digital health ecosystem.
Contributors
- Maximilian Reith, Kassenärztliche Bundesvereinigung (KBV)
- Dennis Kipping, mio42 GmbH
- Sylvia Thun, Charité - Universitätsmedizin Berlin
The above summary is based on the answers to the State of FHIR Survey 2026, organized by Firely and HL7 International.
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HL7 Deutschland ist eine von ca. 40 Landesvertretungen und arbeitet an der Förderung und Verbreitung des Standards
in Deutschland. Dabei stehen die Weiterentwicklung des Standards bezogen auf die deutschen Anforderungen durch die
Technischen Komitees im Vordergrund und schließt Ausarbeitung von
Implementierungsleitfäden und anderen Spezifikationen sowie Schulung von Anwendern und Systemherstellern ein.
http://hl7.de/
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Uniklinik Köln
This is the project page for the University Clinic Cologne.
The University Clinic Cologne seeks to improve interoperability within clinical care and research projects.
The projects are united by a shared desire for accurate process and data representation in order to improve patient outcomes through digital health.
Nevertheless, the participants of the published projects are commited to uphold patient and healthcare provider privacy.
The initial focus lies on standarized cancer care through various interconnected projects, yet the scope is not limited to this topic.
All content pusblished by the University Clinic Cologne is subject to the following licence:
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License .
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Die Medizininformatik-Initiative ist ein mehrphasiges Förderprogramm des BMBF, in dem an den deutschen Universitätskliniken und Partnereinrichtungen Datenintegrationszentren aufgebaut und vernetzt werden, um Forschungs- und Versorgungsdaten standortübergreifend verknüpfen zu können. Für konkrete medizinische Anwendungen werden auf dieser Basis innovative IT-Lösungen entwickelt, die die Möglichkeiten moderner digitaler Dienstleistungen und Infrastrukturen im Gesundheitsbereich zeigen sollen.
Weiterführende Links:
- [Website der Medizininformatik-Initiative](https://www.medizininformatik-initiative.de/)
- [Website des BMBF zur Medizininformatik](https://www.bmbf.de/de/medizininformatik-3342.html)
- [Interaktive Karte: Medizininformatik in Deutschland](https://www.medizininformatik-karte.de)
- [Medizininformatik-Initiative im HL7-Wiki](http://wiki.hl7.de/index.php?title=Medizininformatik-Initiative)
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Die Kassenärztliche Bundesvereinigung (KBV) ist der Dachverband der Kassenärztlichen Vereinigungen in Deutschland und damit beauftragt für alle gesetzlich Krankenversicherten die gleiche hochwertige medizinische Betreuung zu garantieren. In diesem Zusammenhang setzt sich die KBV entsprechend der Vorgaben des Bundesministeriums für Gesundheit (BMG) auch für die Digitalisierung des Gesundheitswesens ein. Dazu gehören folgende Projekte:
* Medizinische Informationsobjekte (MIOs)
* KBV-Basis-Profile
* eAU
* eRezept
* Verordnungsschnittstelle
* Archiv-und Wechselschnittstelle
* Schlüsseltabellen
* eTerminservice
**Weiterführende Links:**
* [KBV-Basis-Profile auf simplifier.net](https://simplifier.net/Base1x0)
* [Kommentierungsplattform mio.kbv.de](https://mio.kbv.de/)
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As a national centre of expertise for digital health, gematik supports the efforts of providers and users to make positive network effects possible.
gematik’s core area of expertise is relevant in five areas of action:
1. **A platform for a national telematics infrastructure:**\
gematik establishes the basic functionalities and security measures for a common nationally usable platform so that it can be shared by as many participants as possible.
1. **A centre of expertise and a coordination centre for standardization:**\
gematik coordinates the close communication with the community of standardization experts, the medical profession and industry. It hosts the round table for targeted and internationally implementable standardization on the basis of internationally recognized standards.
1. **A partner for providers and users:**\
gematik advocates user-focused dialogue and provides advice regarding specific technical matters. It focuses on partnerships and these partnerships’ support for solutions. Only in exceptional cases does gematik develop applications of its own.
1. **A forum for future concepts of digital health:**\
gematik has a wide network of contractual partners and supporters, including the central organizations of the healthcare system as shareholders. To promote the mutual dialogue about the future, gematik will develop the forum for sharing ideas and presenting innovative solutions.
1. **A European partner and moderator for national cooperation:**\
In European projects, gematik specifically supports the promotion of uniform data formats for the cross-border sharing of patient data in the EU. It also closely cooperates with other national centres of expertise for digital healthcare and with European authorities.
[www.gematik.de](https://www.gematik.de/)
[github.com/gematik](https://github.com/gematik)
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Das [**Robert Koch-Institut**](https://www.rki.de) (RKI) ist die zentrale Einrichtung der Bundesregierung auf dem Gebiet der Biomedizin. Zu seinen Kernaufgaben zählen das Erkennen, Verhüten und Bekämpfen von Infektionskrankheiten und die Verbesserung der Gesundheit der Bevölkerung in Deutschland. Im Mittelpunkt steht die Forschung. Das RKI berät Fachöffentlichkeit und Politik und ist eine wichtige Schnittstelle zu internationalen Akteuren wie dem ECDC und der WHO.
Im Reiter [Packages](https://simplifier.net/organization/robert-koch-institut/~packages) finden Sie die aktuellen Veröffentlichungen der FHIR-Spezifikationen.
Diese Pakete basieren auf den unter dem Reiter [Projects](https://simplifier.net/organization/robert-koch-institut/~projects) zu findenden Projekten.
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