In France, FHIR adoption is growing steadily. FHIR is used for a few specific use cases today, but momentum is building. Most respondents expect strong growth in the coming years.
The main version in use is R4, which is widely implemented across projects. Some organizations also work with R5 and R4B, while older versions like STU3 see only limited use.
Looking ahead, France expects significant expansion. New regulations, the European Health Data Space (EHDS), and ongoing national projects will likely push FHIR adoption further.
Rules and Support
France has regulations that require standards for electronic health data exchange. Here's what they cover:
- Standards are mandated for health data exchange in France.
- FHIR is mentioned in regulation — sometimes mandated, sometimes advised, depending on the use case.
- Deadlines exist for compliance in many programs.
- Fines may apply if deadlines are missed, although this is not consistent across all rules.
- No dedicated FHIR funding exists today. However, the national Ségur du numérique en santé program funds digital health transformation more broadly.
Useful links:
The current Ségur program mainly uses HL7 v2.5 with French extensions and CDA R2 for document sharing. A FHIR extension based on R4 is under development. EHDS will likely bring more FHIR-based requirements in the future.
National Setup
France has a clear structure for managing health data standards.
Standards organizations:
- Agence du Numérique en Santé (ANS) — the national e-health agency
- Interop'Santé — which hosts HL7 France and IHE France
Implementation guides:
- FR Core implementation guide — the national base FHIR guide, currently in development but already used in limited use cases
- Interop ANS FHIR guides — for specific national use cases
Terminology services:
- A national FHIR terminology server exists. Some respondents say it's in production, others that it's still in development.
Active Use Cases
France is developing FHIR specifications for several areas:
- Prescriptions and pharmacy
- Document exchange
- Terminology
- Diagnostic orders and reports
- Scheduling
- Provider directory
- Clinical registries
- Consent
- Clinical decision support
- Patient access
- Public health reporting
- Allergy intolerance
- Invoice and claim
- Business intelligence and resource management
French specifications often build on international work, including:
- International Patient Summary (IPS)
- International Patient Access
- European (HL7 Europe) implementation guides
- IHE profiles
Who's Using FHIR
The main groups adopting FHIR in France are:
- App developers
- Government agencies
- EHR system vendors
- Care providers
- Researchers
- Diagnostic system vendors (imaging, lab)
- Clinical registries
- Payers and insurers
Main reasons for adoption:
- Innovation
- Patient data access
- Regulation and grants (Ségur)
- Improving health outcomes
- Improving care workflows
- Lowering costs
How FHIR is being used:
- The FHIR REST API is the most common exchange mechanism.
- FHIR Shorthand (a tool for authoring profiles) is widely used.
- FHIR Documents see moderate use.
- FHIR Messaging is used in some contexts.
- More advanced tools like SMART on FHIR, CDS Hooks, CQL on FHIR, Bulk Data, Subscriptions, and FHIRcast are still emerging.
Success Stories and Challenges
Concrete success stories include:
- The national health professional directory (Annuaire Santé)
- The national directory of health services and resources (ROR)
- Mon Espace Santé — the national patient health record
- The CHU de Toulouse FHIR project
- The AP-HP interoperability project
- Scheduling, care service discovery, and vital signs exchange
Main benefits seen so far:
- Improved access to information
- Better care workflows
- Improved healthcare outcomes
Main challenges:
- High investment cost
- Lack of FHIR knowledge
- Unclear regulations
- Unclear benefits
- Changes in political direction
Future Plans
Progress over the past year was mixed. Most respondents say France made "quite the progress expected," while a few report less progress than hoped. Last year's main achievements include:
- Development of a national FHIR data model
- Development of new FHIR standards for specific use cases
- Pilot projects with healthcare stakeholders
- Expanded FHIR adoption across the ecosystem
Coming next:
- New regulations to prescribe standards in health data exchange
- More FHIR standards for specific use cases
- Pilot projects with healthcare stakeholders
- Wider FHIR adoption
Use cases to watch:
- Moving document sharing from XDS to FHIR
- Inter-laboratory workflow exchange
- Clinical Practice Guidelines (CPG) on FHIR
- The EEDS project
- HL7 Europe work supporting the European Health Data Space
Most respondents expect that within three years, France will start to see real benefits from FHIR adoption, including better care coordination and a stronger digital health ecosystem.
Contributors
- Luc Chatty, Fyrstain
- Stéphane Umhang, Dedalus
- Georges-Alexandre Chastin, Enovacom
- Charlotte Latron, Technidata
- Nicolas Riss, French e-health agency (ANS) & HL7 France
- Other contributors chose to remain anonymous
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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The mission of the non-profit association [Interop'Santé](http://www.interopsante.org) is to build and promote standardized semantic interoperability in the field of healthcare in France.
This association embeds HL7 France, the French affiliate of HL7 International, as well as IHE France, the French affiliate of IHE International.
Interop'Santé in its HL7 France component has signed a development license agreement with _SNOMED International_, so as to be able to include SNOMED CT content in its products (specifications, implementation guides, value sets).
Implementation, deployment and usage of any SNOMED CT content is subject to the signature of a [SNOMED CT Affiliate License Agreement](https://www.snomed.org/snomed-ct/get-snomed-ct).
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