In Finland, FHIR is used for a few specific healthcare data exchange use cases. It is not yet the main standard, but adoption is steadily growing. The country has a clear commitment to use FHIR for new national interfaces where it makes sense.

Most Finnish FHIR implementations use R4, which is the most stable mainstream version. A smaller number of projects still use STU3, an older version. Newer versions like R4B, R5, and R6 are not yet in use.

Looking ahead, respondents expect a strong increase in FHIR adoption. The European Health Data Space (EHDS) regulation is one key driver pushing this growth forward.

Rules and support

Finland has clear rules for electronic health data exchange:

• Regulation is in place that mandates the use of standards.
• FHIR is specifically mandated in the regulation, alongside other standards.
• Compliance deadlines are included in the rules.
• Fines may apply if deadlines are not met.
• Government funding is available to support FHIR adoption, including funding for pilot projects.

Regulatory orders point to specifications that include FHIR among other standards. Some funding also supports the national infrastructure that uses FHIR.

The EHDS will further shape national rules and specifications. Finland also takes part in joint Nordic projects aiming for regional harmonisation.

National setup

Finland has a well-organised national structure for health data standards:

• THL (Finnish Institute for Health and Welfare) and Kela (the Social Insurance Institution of Finland) define national data standards and specifications for the national infrastructure.
• HL7 Finland runs the technical committee that develops FHIR specifications.
• A national base FHIR implementation guide exists and is used in a limited set of cases. You can find it here: Finnish Base Profiles.
• A national FHIR terminology server is not yet available, but it is in planning.

A few additional FHIR specifications have been developed for more specific use cases.

Active use cases

Finland is developing FHIR specifications for several use cases:

• Prescriptions and pharmacy
• Consent
• Document exchange
• Immunizations
• Patient access
• Scheduling
• Invoice and claim
• Disclosure notifications for social services data
• Delivery of health certificates to external authorities
• Functional capacity and functional status
• Diagnoses, procedures, encounters
• Audit events and communication workflows

Finnish work also builds on international specifications, including:

• The International Patient Summary
• International Patient Access
• IHE profiles (integration profiles from Integrating the Healthcare Enterprise)

One concrete example is the Esko Systems invoice interface, which uses FHIR as a natural part of its system architecture.

Finland is also exploring the FHIR Community Process (FCP), which lets organisations publish and maintain FHIR specifications outside HL7's traditional process. Some organisations are looking into becoming FCP participants.

Who is using FHIR

The main organisations adopting FHIR in Finland are:

• Care providers
• EHR (electronic health record) system vendors
• App developers
• Government agencies

The main reasons for adoption include:

• Regulations and grants
• Improving health outcomes
• Improving care workflows
• Patient data access

How FHIR is used in practice:

• The FHIR REST API (a way for systems to share data over the web) is the most widely used exchange method.
• SMART on FHIR (a standard for secure app integration with health records) and CDS Hooks (a way to trigger clinical decision support inside workflows) see moderate use.
• FHIR Shorthand (a simple language for writing FHIR profiles) is also in regular use.
• FHIR Questionnaires and SDC (Structured Data Capture, for digital forms) see limited use.
• FHIR Messaging, FHIR Documents, and FHIR Bulk Data are not yet in active use.

Both open source and proprietary FHIR software are used in Finland, with a slight lean towards open source.

Success stories and challenges

Reported benefits of FHIR use include:

• Lower costs in some implementations
• Improved access to information
• FHIR becoming a natural part of system architecture

Finland also faces real challenges:

• High investment costs
• Unclear benefits in some cases
• A lack of FHIR knowledge among some stakeholders
• Other priorities competing with standardisation work
• Limited business case to replace older systems that already work
• Market conditions and limited funding

Existing CDA (Clinical Document Architecture) or older HL7 v2 interfaces often work well, so replacing them may be hard to justify financially. The EHDS may help speed up the transition.

HL7 Finland runs national FHIR training regularly. Several FHIR hackathons take place in Finland, including Nordic collaboration on hackathons and terminology services.

Future plans

Looking back at the last year, respondents say Finland made quite the progress they expected. Key achievements include:

• Development of new FHIR standards for more specific use cases
• Launch of pilot projects with selected healthcare stakeholders

Satisfaction with the current pace is mixed, ranging from neutral to dissatisfied.

In the coming year, expected next steps include:

• Continued development of new FHIR standards for specific use cases
• Expanded adoption of FHIR across the healthcare ecosystem
• Possible new regulations that prescribe the use of standards

Use cases to watch for in the near future:

• Patient data access for wellness applications
• Scheduling
• Medication lists
• Consent (including consent for data sharing between health and social care)
• Disclosure notifications and audit events
• Functional status
• Delivery of data to external authorities
• Communication and CommunicationRequest workflows

There is a clear national commitment to use FHIR for new interfaces in the national infrastructure where this makes sense.

Contributors

• Juha Mykkänen, THL (Finnish Institute for Health and Welfare)
• Mikael Rinnetmäki, Sensotrend
• Mika Tuomainen, Kela
• Kimmo Rissanen, Kela
• Timo Kaskinen, HL7 Finland technical committee

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