In the United Kingdom, FHIR (Fast Healthcare Interoperability Resources) is currently being utilized to exchange healthcare data, but its use is at an early stage. The active versions of FHIR in use include DSTU2, STU3, R4, with R5 and the pre-release R6 seeing limited use. There's a strong expectation that the adoption of FHIR will significantly increase in the coming years, driven by the need for improved healthcare data exchange and interoperability.

Rules and Support for FHIR

• Health Data Exchange Rules: Currently, there are no specific regulations mandating the use of FHIR standards for electronic health data exchange in the UK.
• FHIR Requirements: While regulations encourage open APIs, FHIR is not specifically mandated.
• Funding: There is no major governmental funding or grants available specifically for FHIR adoption. However, healthcare being publicly funded includes IT spending that sometimes covers FHIR projects.

National Setup

• Standards Organization: The UK has different organizations responsible for health data standards in England, Scotland, Northern Ireland, and Wales. NHS England, Digital Health and Care Wales, Digital Health & Care Scotland, and Health and Care NI.
• Implementation Guides: A base/core FHIR implementation guide for the UK is available, which is being used in a limited set of use cases. You can find it here.
• Terminology Services: The UK has a national FHIR terminology server in production, supporting the use and implementation of FHIR standards.

Active Use Cases

• Local Implementations: Various FHIR standards are developed for specific use cases such as Prescriptions/Pharmacy, Referrals/Continuity of care, Provider Directory, Diagnostic Orders/Reports, Consent, Clinical Decision Support, Genomics, Immunizations, and Patient Access.
• Key Projects: One standout project is the YHCR (Yorkshire & Humber Care Record), which can be explored here. There are also many small successful FHIR projects throughout the UK.

Who's Using FHIR

• Active Organizations: FHIR is being used by care providers and EHR system vendors across the UK.
• Main Reasons for Adoption:
  • Improving health outcomes
  • Enhancing care workflows
  • Driving innovation
• How They're Using FHIR: Through FHIR Messaging, FHIR Documents, and FHIR Rest API, organizations are aiming to improve healthcare interoperability.

Success Stories and Challenges

• Benefits: Improved access to information through projects like YHCR showcases the potential benefits of FHIR adoption.
• Challenges: High investment costs, unclear regulations, lack of FHIR knowledge, and changes in political direction are main difficulties faced.
• Future Plans: There is hope that governmental changes will further help FHIR adoption in the UK.

Future Plans

• Progress So Far: The adoption of FHIR has made quite the progress as expected last year.
• Next Steps: Development of new FHIR standards for more specific use cases and expanded adoption of FHIR across the healthcare ecosystem.
• Expected Changes: In the next three years, significant cost savings, enhanced care coordination, and a more robust digital health ecosystem are anticipated, thanks to FHIR adoption.

Contributors

• Rik Smithies, Technical Chair at HL7 UK

This summary offers a snapshot of FHIR's current state, its application, and future direction in the UK's healthcare data interoperability landscape.

The above summary is based on the answers to the State of FHIR Survey 2025, organized by Firely and HL7 International.