In Ecuador, FHIR is starting to take root. Right now, the country uses FHIR for only a few specific use cases. The main version in use is R4, with limited adoption across the healthcare system.

The outlook is positive. We expect a strong increase in FHIR adoption over the coming years. National efforts are moving from planning to active implementation, supported by new regulations and a clear digital health strategy.

FHIR is becoming the foundation for Ecuador's single electronic health record and cross-border health data exchange.

Rules and Support

Ecuador has rules in place for health data exchange:

  • Regulation mandates the use of standards in electronic health data exchange
  • FHIR is advised (not yet mandated) in current regulation
  • A compliance deadline exists
  • No fines are imposed for missing the deadline
  • No direct government funds support FHIR adoption, but financing comes through international partners

Key regulations and frameworks include:

Two recent regulatory updates stand out:

  • Resolution SPDP-SPD-2026-0005-R (February 2026): Health data processing is now officially classified as "Large-Scale Treatment". This makes appointing a Data Protection Officer mandatory for health institutions.
  • Privacy by Design: New digital health projects must document privacy protections from the start. When implementing FHIR resources, you must justify why each data element is needed.

Funding comes from:

  • The Inter-American Development Bank through the Health Services Quality Improvement Program
  • The Ministry of Public Health's flagship investment project for digital health infrastructure
  • The Pan-American Highway for Digital Health (PH4H), supported by PAHO/WHO

National Setup

Ecuador has national organizations responsible for health data standards:

Current state of national infrastructure:

  • No national base FHIR implementation guide exists yet
  • No other FHIR standards have been developed for specific use cases at the national level
  • No national FHIR terminology server is available, and there are no current plans for one

On the FHIR Community Process (the formal route for publishing FHIR specifications), one or more organizations in Ecuador are exploring becoming participants. Within 2–3 years, we expect Ecuador to have one or more approved participants.

Active Use Cases and Standards

Ecuador draws on international standards as the basis for national work:

  • International Patient Summary
  • IHE profiles

The country is expanding its use of clinical terminologies:

  • SNOMED CT is being extended with local terms, including traditional medicine and regional epidemiology
  • LOINC is being adopted nationwide to standardize lab results

Who's Using FHIR

The main groups adopting FHIR in Ecuador are:

  • Care providers
  • Payers and insurers
  • Clinical registries

The main drivers for adoption are:

  • Regulation and grants
  • Improving health outcomes
  • Patient data access
  • Innovation

How FHIR is being applied:

  • FHIR REST API has the most traction (a way for systems to request and share data over the web)
  • FHIR Messaging and FHIR Documents see moderate use
  • Most other FHIR tools (like SMART on FHIR, CDS Hooks, Bulk Data, Questionnaires) are not yet widely used

Software use leans slightly toward open source.

Success Stories and Challenges

Ecuador has seen real benefits from FHIR adoption:

  • Improved healthcare outcomes
  • Improved access to information
  • Improved care workflows

Concrete examples include:

The main challenges include:

  • High investment cost
  • Unclear benefits
  • Unclear regulations
  • Lack of FHIR knowledge
  • Changes in political direction

AI and machine learning are strongly helping FHIR efforts in Ecuador. There is growing interest in structured FHIR data as a foundation for AI applications.

Upcoming projects to watch:

  • October 2026 National Connectathon: The Ministry of Public Health, social security (IESS), and private providers will exchange a Digital Care Summary using FHIR R4
  • Cross-border Health Passports: Ecuador is a pilot country for the Pan-American Highway for Digital Health, working toward International Patient Summary exchange
  • Real-time epidemiological surveillance: FHIR-based reporting is being planned for HIV monitoring and chronic diseases

Future Plans

Last year brought major achievements:

  • Establishment of a national standards organization
  • Launch of pilot projects with healthcare stakeholders
  • Expanded adoption of FHIR across the healthcare ecosystem

The First National Health Interoperability Summit (March 2026) was a turning point. It formalized HL7 FHIR R4, SNOMED CT, and LOINC as the mandatory standards for the National Health System. It also catalyzed the National Interoperability Model, finalized in April 2026.

The country has made far more progress than expected, and respondents are satisfied with the current adoption rate.

Expected next steps in the coming year:

  • Development of a national FHIR data model
  • New regulation prescribing standards in electronic health data exchange
  • Launch of more pilot projects
  • Expanded adoption across the healthcare ecosystem

Within three years, Ecuador expects to see real benefits from FHIR adoption, including cost savings, better care coordination, and a stronger digital health ecosystem.

Contributors

  • Fabricio Salas, Chair, HL7 Ecuador

The above summary is based on the answers to the State of FHIR Survey 2026, organized by Firely and HL7 International.