In Estonia, FHIR is used for a few specific healthcare data exchange use cases. It is not yet the main standard, but it is gaining ground as part of the national digital health strategy.

Most current FHIR work uses version R5, with some limited use of R4. Adoption is expected to grow strongly in the coming years.

Estonia is actively building out its FHIR foundations while still working with older standards like CDA and HL7 v3 in parallel.

Rules and Support

Estonia has regulation that requires the use of standards in electronic health data exchange. FHIR is not specifically named in the regulation, but standards-based exchange is mandated.

  • Mandate: Standards are required, but FHIR is not specifically mentioned
  • Deadline: Yes, a compliance deadline is included
  • Fines: No fines are imposed for missing the deadline
  • Funding: Government funds are available to support FHIR adoption

Key legal references:

National Setup

Estonia has a national organization responsible for health data standards:

  • Standards body: TEHIK (Health and Welfare Information Systems Centre)
  • Base FHIR guide: A national core implementation guide exists and is used in a limited set of use cases. View it at ig.hl7.fhir.ee/ig-ee-base
  • Terminology server: A national FHIR terminology server is in production
  • FHIR Community Process (FCP): No known FCP activity yet in Estonia

Active Use Cases

Estonia is developing FHIR specifications for several use cases:

  • Prescriptions and pharmacy
  • Referrals and continuity of care
  • Provider directory
  • Terminology
  • Diagnostic orders and reports
  • Consent
  • Document exchange
  • Clinical registries
  • Allergy intolerance
  • Master Patient Index (MPI)
  • Health Declaration
  • Cancer data
  • Advance Healthcare Directive
  • eAmbulance

National specifications build on these international standards:

  • International Patient Summary
  • European Implementation Guides

Who's Using FHIR

The main organizations adopting FHIR in Estonia include:

  • Care providers
  • EHR system vendors
  • Government agencies

The main reasons for adoption are:

  • Regulation and government grants
  • Improving health outcomes
  • Improving care workflows
  • Patient data access
  • Innovation

In terms of how FHIR is applied, the FHIR REST API is widely used. FHIR Shorthand (a way to write FHIR profiles in a simpler format) is also heavily used, along with FHIR Questionnaires and Structured Data Capture (SDC). FHIR Documents and Messaging see little use today.

Estonia uses a healthy mix of open source and proprietary FHIR software.

Success Stories and Challenges

Key success: The Master Patient Index (MPI) project is a standout FHIR use case. See the MPI implementation guide.

The main achievements include:

  • Improved access to information
  • Improved care workflows

Main challenges:

  • High investment cost
  • Lack of FHIR knowledge among stakeholders
  • Changes in political direction
  • Mapping and integrating existing CDA and HL7 v3 data into FHIR

Progress over the last year has been less than expected, and satisfaction with the current adoption rate is neutral.

Future Plans

Last year's major achievements include developing new FHIR standards for specific use cases and expanding FHIR adoption across the healthcare ecosystem.

Looking ahead, Estonia expects to:

  • Develop new FHIR standards for more specific use cases
  • Launch pilot projects with selected healthcare stakeholders
  • Expand FHIR adoption across the healthcare ecosystem

Within the next three years, contributors agree that Estonia will start to see real benefits from FHIR adoption, including better care coordination and a stronger digital health ecosystem.

Contributors

  • Ragne Õitspuu, Data Exchange Team Lead, TEHIK
  • Kerli Linna, Head of Data Management, TEHIK

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

TEHIK
[**Health and Welfare Information System Center (TEHIK)**](https://tehik.ee/) is an ICT competence centre which started operation on the 1st of January, 2017 and consolidates the functions of former ICT department of ministry of Social Affairs and Estonia and Estonian eHealth foundation. TEHIK ensures the operation of ICT services for the Social Insurance Board, Health Board, Labour Inspectorate, Astangu Vocational Rehablitation Centre and Agency of Medicines. Among our clients are also healthcare providers, local goverment, Estonian Health Insurance Fund, Estonian Unemployment Fund, Official Mediators Office and Gender Equality and Equal Treatment Commissioners Agency. For healthcare we develop e-referral, e-lab, e-prescription, Patient Summary, for social system Registry of Social Services and Benefits (STAR) and Registry of Social Protection (SKAIS). **Our mission is to provide human-based and cross-integrated ICT services.**
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