In the Netherlands, FHIR (Fast Healthcare Interoperability Resources) is becoming a key standard for exchanging healthcare data. Currently, various versions of FHIR are in use, with R4 being the most utilized according to survey responses. FHIR's adoption is expected to grow, driven by regulatory support and the healthcare sector's ongoing digital transformation.
Rules and Support
- Health Data Exchange Rules:
- Regulations mandate the use of standards in electronic health data exchange.
- FHIR is specifically mentioned and mandated in the regulation.
- FHIR Requirements:
- Compliance with FHIR standards is required by law.
- Deadlines:
- There are set deadlines for compliance, although details on fines for non-compliance are unclear.
- Available Funding:
- Government funds are available to stimulate FHIR adoption.
- Regulations and Funds:
- EHDS (European Health Data Space) and Wegiz (Wet elektronische gegevensuitwisseling in de zorg) are key regulations promoting FHIR.
National Setup
- Standards Organization:
- Zorginstituut Nederland, NEN, and Nictiz are responsible for health data standards in the Netherlands.
- Implementation Guides:
- A widely used base/core FHIR implementation guide: Nictiz R4-zib2020
- For STU3 and R4 versions: FHIR IG STU3 and FHIR IG R4
- Terminology Services:
- A national FHIR terminology server is available and in production.
Active Use Cases
- Local implementations include Prescriptions / Pharmacy, Referrals / Continuity of care, Document Exchange, Imaging, and Immunizations.
- International standards use mentioned is the International Patient Summary.
- Key projects like MedMij Patient Access highlight successful local adoption.
Who's Using FHIR
- Active Organizations: Care providers, EHR system vendors, and diagnostic system vendors like Imaging / Lab are actively implementing FHIR.
- Main Reasons for Adoption: Regulation and grants, improving care workflows, and specific use cases like Birth Care indicate a focused approach to FHIR adoption.
- Usage: FHIR is utilized for various purposes, including messaging, documents exchange, and REST API integration.
Success Stories and Challenges
- Benefits: Improved access to information and care workflows are notable benefits from FHIR adoption.
- Real Examples: The MedMij Patient Access project is a successful use case.
- Main Difficulties: High investment costs and lack of FHIR knowledge are significant challenges.
- Future Plans: Respondents look forward to projects like Birth Care and anticipate significant benefits from FHIR adoption in cost savings and care coordination.
Future Plans
- Progress so far has been described as less than expected, with a neutral satisfaction rate regarding the current adoption rate.
- Next steps include the development of new FHIR standards for more specific use cases and the launch of pilot projects with selected healthcare stakeholders.
- The healthcare ecosystem expects expanded adoption of FHIR, aiming for significant improvements in the digital health landscape.
Contributors
- Alexander Henket (Integration Specialist at Nictiz) shared valuable insights for this survey.
The above summary is based on the answers to the State of FHIR Survey 2025, organized by Firely and HL7 International.
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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