In The Netherlands, FHIR is widely used to exchange healthcare data. It is considered one of the main standards for several important use cases, though adoption is still uneven across the country.

The most active versions are STU3 and R4. STU3 remains common in established projects, while R4 is increasingly used for newer implementations. Some early use of R4B is also reported.

Respondents expect a strong increase in FHIR adoption over the coming years, driven by new regulations and European initiatives.

Rules and Support

The Netherlands has regulations that require standards for electronic health data exchange. FHIR is specifically mandated in these rules.

  • Regulation in place: Yes, with FHIR mandated
  • Compliance deadline: Yes, deadlines are set
  • Fines for non-compliance: Yes, fines may apply
  • Government funding: Yes, funds are available to support FHIR adoption

Relevant references shared by respondents:

One respondent noted that the Netherlands traditionally leaves much of this to the market, with Nictiz acting as an independent coordinating party.

National Setup

The Netherlands has clear national organizations responsible for health data standards.

Active Use Cases

FHIR specifications are being developed for many specific use cases in the Netherlands, including:

  • Prescriptions and pharmacy
  • Referrals and continuity of care
  • Provider directory
  • Public health reporting
  • Terminology
  • Diagnostic orders and reports
  • Consent
  • Document exchange
  • Imaging
  • Immunizations
  • Clinical registries
  • Patient access
  • Allergy intolerance
  • Endpoint registry
  • Longitudinal health record

National FHIR work also builds on international specifications, particularly European Implementation Guides and IHE profiles. Some projects also draw on mCode, US Core, and Patient Corrections.

Regarding the FHIR Community Process (FCP), there is little activity yet. Some organizations are exploring participation, and most respondents expect this will grow modestly over the next 2–3 years.

Who's Using FHIR

The main FHIR adopters in the Netherlands are:

  • Care providers
  • EHR system vendors
  • Diagnostic system vendors (imaging, lab)
  • App developers
  • Government agencies
  • Vendors in general

Main drivers for adoption include:

  • Regulation and grants
  • Improving health outcomes
  • Improving care workflows
  • Patient data access
  • Innovation

The most commonly used FHIR exchange mechanisms are the FHIR REST API, FHIR Documents, and FHIR Messaging. Tools such as FHIR Shorthand, SMART on FHIR, and FHIR Questionnaires (SDC) are also seen, but more selectively. Both open source and proprietary FHIR software are used, with a fairly balanced mix.

Success Stories and Challenges

Respondents pointed to several successful FHIR projects:

  • MedMij – patient access to personal health data
  • Zorgviewer (RIVO-Noord) – a regional viewer for sharing patient data
  • ePrescription – electronic prescription exchange
  • BgZ MSZ – the basic dataset for hospital care

Key benefits reported include:

  • Improved access to information
  • Improved healthcare outcomes
  • Improved care workflows

Main challenges include:

  • High investment cost
  • Unclear benefits
  • Unclear regulations
  • Lack of FHIR knowledge
  • Changes in political direction
  • Deep legacy systems
  • Disperse, uncoordinated projects

One respondent put it directly: "We all want to harmonize, but we are not taking the time to do it." Another noted that uptake has been slow without legislation and a clear business case, and that confusion from misaligned messaging by key influencers has held things back.

Looking ahead, respondents are excited about:

  • The European Patient Summary
  • EHDS implementation
  • Sharing of lab reports
  • Using terminology ontologies to build smart overviews tied to care processes

Future Plans

Last year brought new regulations, new FHIR standards for more specific use cases, pilot projects, and broader adoption across the healthcare ecosystem. Still, most respondents feel the country made less progress than expected and are dissatisfied with the current adoption rate.

Expected next steps in the coming year include:

  • Developing new FHIR standards for more specific use cases
  • Launching new pilot projects with healthcare stakeholders
  • Expanding FHIR adoption across the broader ecosystem
  • Possible work on a national FHIR data model and new regulations

Views on whether the Netherlands will reap the full benefits of FHIR within three years are mixed, ranging from neutral to disagreement. AI is seen as either neutral or somewhat helpful for structured data efforts. Respondents strongly disagree with the idea that AI removes the need to invest in FHIR.

Contributors

  • Michael van der Zel, UMCG
  • Alexander Henket, Nictiz
  • Two additional respondents 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.

Nictiz
Nictiz is the compentence centre for digital information management in healthcare. Nictiz is committed to developing a vision for the healthcare information system and the architecture supporting that system. We develop and maintain standards for digital information management, ensuring that healthcare information can be recorded and exchanged in an unambiguous manner. In addition, we have an advisory function and share knowledge about digital information management in healthcare, focussing not only on the Netherlands, but on international developments as well.
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