In Israel, FHIR is used for several important healthcare data exchange cases. It's not yet the main standard for all data exchange, but adoption is growing steadily. Many organizations now use FHIR to share patient information across the healthcare system.

The version most widely used is FHIR R4. This is the current stable version of the standard.

We expect a strong increase in FHIR adoption over the coming years. New rules and active national projects are driving this growth.

Rules and Support

Israel has clear rules in place to support health data exchange:

  • The Health Data Portability Law was enacted in July 2024 and is now being implemented.
  • The law and its regulations require building FHIR infrastructure for mandatory data portability across the health system and other government bodies (such as Welfare).
  • FHIR is mandated by the regulation.
  • A compliance deadline is set for July 2029 for full implementation.
  • Government funding is available through the Ministry of Health to support adoption.

Privacy and confidentiality of health data are mainly governed by the Patient's Rights Law, with additional rules from the Privacy Protection Law.

Helpful links:

National Setup

Israel has built a strong national foundation for FHIR:

  • The Ministry of Health and the FHIR community founded ILCORE, a team responsible for adapting FHIR to Israel's health ecosystem.
  • A separate national terminology team decides which health terminologies to use nationally and helps implement them.
  • A national base FHIR implementation guide is widely used. You can find it at Simplifier ILCore.
  • A national FHIR terminology server is in production.

Israel also has one or more approved specifications under the FHIR Community Process (FCP), and expects to maintain this position over the next 2–3 years.

Active Use Cases

FHIR specifications in Israel cover many use cases, including:

  • Prescriptions and pharmacy
  • Referrals and continuity of care
  • Public health reporting
  • Terminology
  • Diagnostic orders and reports
  • Consent
  • Clinical decision support
  • Imaging
  • Genomics
  • Immunizations
  • Provider directory
  • Clinical registries
  • Patient access
  • Allergy intolerance
  • Lab results and pathology

The national specifications build on HL7 FHIR and US Core implementation guides.

Who's Using FHIR

The main groups adopting FHIR in Israel are:

  • Care providers
  • EHR system vendors
  • Government agencies
  • HMOs (Health Maintenance Organizations)

The main drivers for adoption are:

  • Regulation and 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, along with SMART on FHIR and FHIR Shorthand. FHIR messaging and questionnaires are used to a moderate extent. Tools like CDS Hooks, CQL on FHIR, SQL on FHIR, Bulk Data, and Subscriptions are still in early stages.

The mix of software used leans more toward proprietary than open source.

AI and FHIR

AI and machine learning are somewhat helping FHIR efforts in Israel. The main effect is increasing interest in FHIR and structured data as a foundation for AI. The view that AI reduces the need for structured data is strongly rejected.

Successes and Challenges

Successful use cases include:

  • Better data sharing between HMOs and hospitals
  • Support for insurance coverage decisions
  • Home hospitalization
  • Cancer treatment coordination
  • Research

The main benefits seen so far:

  • Improved access to information
  • Improved care workflows

The biggest challenges are:

  • High investment cost
  • Lack of FHIR knowledge

Future Plans

Last year brought solid progress in line with expectations. Key achievements included:

  • Development of a national FHIR data model
  • New FHIR standards for specific use cases
  • Pilot projects with selected healthcare stakeholders
  • Expanded adoption across the healthcare ecosystem
  • Publication of the first national terminology catalogues

Looking ahead, exciting projects include:

  • A National Patient Consent Management System
  • Implementation of the first 8 data domains required by the data portability law

In the coming year, we expect more FHIR standards for specific use cases, more pilot projects, and broader adoption across the healthcare ecosystem. Overall satisfaction with FHIR adoption in Israel is positive, and there's optimism that the next three years will bring real benefits in cost savings, care coordination, and digital health innovation.

Contributors

  • Milka Wissman, Ministry of Health (Medical Data Portability Implementation Officer)
  • Eyal Shaltieli, Ministry of Health (Digital Health Regulation Manager)

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