In Marshall Islands, FHIR is not yet widely used to exchange healthcare data. Adoption is still at a very early stage, with no specific FHIR versions actively in use at this time.

Looking ahead, we expect a strong increase in FHIR adoption in the coming years. While the foundations are still being built, there is clear interest in moving toward standardized health data exchange.

This summary describes the current state of FHIR in the country and the steps being taken to support its future growth.

Rules and support

The Marshall Islands has regulation in place for electronic health data exchange. Here is what we know:

  • Regulation exists that mandates the use of standards for electronic health data exchange.
  • FHIR is advised but not mandated in this regulation.
  • There is no deadline for compliance.
  • There are no fines for non-compliance.
  • Government funds are available to support FHIR adoption.

The Data Modernization Initiative (DMI) is supported by funding from the Public Health Infrastructure Grant (PHIG). This initiative manages and coordinates the connectivity of the country's Health Information System (HIS) infrastructure. Its goals include:

  • Improving network reliability
  • Supporting system integration
  • Ensuring secure and efficient access to health data for public health operations

National setup

The national setup for FHIR standards is still developing:

  • There is no national organization responsible for health data standards.
  • There is no national base or core FHIR implementation guide.
  • There are no plans yet for a national FHIR terminology server (a service that manages standardized medical codes and vocabularies).
  • There is currently no known activity related to the FHIR Community Process (FCP), which is the formal way countries publish and maintain FHIR specifications.

Looking ahead 2–3 years, one or more organizations may begin exploring participation in the FHIR Community Process.

Active use cases

While local FHIR implementation guides are not yet developed, the country draws on several international specifications as a basis for future work:

  • International Patient Summary – a standard summary of essential patient health information
  • International Patient Access – standards for patients accessing their own health data
  • IHE profiles – international integration profiles for health data exchange

Who is using FHIR

The main stakeholders adopting FHIR in the Marshall Islands include:

  • EHR (Electronic Health Record) system vendors
  • Diagnostic system vendors, such as imaging and laboratory providers

The main drivers for adoption are:

  • Improving care workflows
  • Patient access to their data
  • Innovation

In terms of exchange mechanisms, there is very limited use of FHIR messaging, FHIR documents, and the FHIR REST API. Advanced FHIR tools such as SMART on FHIR, CDS Hooks, Bulk Data, and Questionnaires are not yet in use. Software used so far leans toward open source.

Challenges and outlook

There are no widely known successful FHIR use cases in the country yet. The main challenges slowing adoption include:

  • Unclear regulations around FHIR requirements
  • Lack of FHIR knowledge among stakeholders

There is also uncertainty about how AI and machine learning may affect FHIR efforts. However, there is strong disagreement with the idea that AI reduces the need to invest in structured data like FHIR. Structured data is still seen as important.

Future plans

Progress over the past year has been much less than expected, and overall satisfaction with the adoption rate is neutral. The main achievement was new regulation prescribing the use of standards in electronic health data exchange.

In the coming year, we expect progress across many fronts:

  • Establishment of a national standards organization
  • Development of a national FHIR data model
  • New regulation prescribing standards for electronic health data exchange
  • Development of new FHIR standards for specific use cases
  • Launch of pilot projects with selected healthcare stakeholders
  • Expanded adoption of FHIR across the healthcare ecosystem

There is strong agreement that within the next three years, the Marshall Islands will begin to see real benefits from FHIR adoption. These benefits include cost savings, better care coordination, and a stronger digital health ecosystem.

Contributors

This response was provided anonymously.

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