This overview is based on the insights gathered from the DevDays 2024 State of FHIR survey, with a comparison to the 2023 survey to highlight the progress and changes.
Regulation
New Zealand has established robust regulations to foster the use of standards in electronic health data exchange. The cornerstone of these regulations is the HISO 10083:2020 Interoperability Roadmap, which advises the adoption of FHIR (Fast Healthcare Interoperability Resources). While there is no strict deadline for compliance, the regulation is supported by funding initiatives aimed at stimulating FHIR adoption. One notable program is Hira, the National Health Information Exchange Platform, which can be explored in more detail here.
Adoption
FHIR is widely recognized as a pivotal standard in New Zealand's healthcare data exchange landscape. With a strong expectation for increased adoption in the coming years, FHIR is already being used extensively, particularly the R4 version. The use of FHIR is driven by regulatory support, grants, and the clear benefits it offers in terms of improved care and innovation.
The 2024 survey shows a higher score of 4 for current use, indicating broader adoption compared to scores of 2-3 in 2023. Additionally, there is a stronger expectation of increased adoption in 2024.
Authoritative Bodies
The Health Information Standards Organisation (HISO) is the primary national standards organization in New Zealand, playing a crucial role in the development and implementation of health data standards, including FHIR. HISO works closely with HL7 New Zealand to ensure the local FHIR standards are robust and effective.
Relevant Institutes
Several key institutes are involved in the adoption and implementation of FHIR in New Zealand. These include care providers, payers/insurers, EHR vendors, and app developers. The collaborative efforts of these stakeholders are essential to the successful integration of FHIR into the healthcare system.
The 2024 survey includes additional mention of payers/insurers as main adopters, compared to the 2023 survey.
National Standards Development
New Zealand is actively developing its national FHIR data model, with significant progress already made. The NZ Base Implementation Guide (IG) and the NZ Patient Summary IG are accessible here and here, respectively. Additional FHIR standards tailored for specific use cases are also being developed, some of which derive from the national FHIR data model. Health NZ, which oversees the public-facing NZ Health Sector, collaborates with HL7 New Zealand to develop and test these local FHIR standards.
Terminology Usage
The adoption of FHIR in New Zealand includes the use of various FHIR features and techniques. Subscriptions, FHIR Documents, FHIR Rest API, FHIR Questionnaires and Structured Data Capture (SDC), and FHIR Shorthand are among the widely used features. This diverse utilization underscores the flexibility and comprehensive nature of FHIR in meeting different healthcare data exchange needs.
Infrastructure
New Zealand boasts a well-developed regional and national infrastructure to support FHIR implementation. The requirements for software companies to integrate with this infrastructure are clear and supportive, ensuring seamless connectivity and interoperability. The national API standards currently under development will further enhance this infrastructure, providing a solid foundation for future advancements.
FHIR Implementation
The main drivers for FHIR adoption in New Zealand include regulation and grants, improved care, and innovation. Successful use cases have demonstrated achievements such as lowered costs, improved healthcare outcomes, and better access to information. Patient advocacy groups, such as the Consumer Council, are also active, although they do not focus specifically on FHIR.
Challenges
Challenges to FHIR adoption in New Zealand include high investment costs, unclear benefits, unclear regulations, and a lack of FHIR knowledge. Additionally, the 2024 survey notes a lack of experienced implementers as a significant challenge.
Future Use Cases
Future FHIR implementation projects include the FHIR New Zealand Patient Summary and the development of the NZ Base IG v4. These initiatives are expected to further enhance the integration and use of FHIR in the country's healthcare system.
Final Questions
Key stakeholders in the FHIR adoption process include the NZ Digital Health Association, which plays a significant role in the ongoing development and implementation of FHIR standards.
In conclusion, New Zealand is making significant strides in adopting and implementing FHIR standards, driven by supportive regulations, collaborative efforts among key stakeholders, and a well-developed infrastructure. The future of FHIR in New Zealand looks promising, with ongoing developments and a strong commitment to improving healthcare data exchange.
This summary presents the current state of Fast Healthcare Interoperability Resources (FHIR) in New Zealand based on the HL7 FHIR DevDays 2024 State of FHIR survey results provided by Peter Jordan of HL7 New Zealand.
Additional background was added based on the answers to the HL7 FHIR DevDays State of FHIR survey 2023 by Peter Jordan and Alastair Kenworthy of HL7 New Zealand and others.
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The **New Zealand FHIR Registry** is the home for the HL7® FHIR® artefacts that are most important to an interoperable digital health ecosystem in Aotearoa New Zealand. Software developers can freely share and reuse the FHIR profiles and implementation guides posted here.
The registry supports the development of FHIR APIs for national digital services such as the National Health Index (NHI), Health Provider Index (HPI) and National Immunisation Solution (NIS), as well as Hira, the national health information platform.
The FHIR NZ Base implementation guide is also published here.
And all FHIR artefacts endorsed by the [Health Information Standards Organisation (HISO)](https://www.health.govt.nz/our-work/digital-health/digital-health-sector-architecture-standards-and-governance/health-information-standards-0) will be published in the registry.
The registry is hosted on the [Simplifier.net](https://simplifier.net/) platform provided by Netherlands company [Firely](https://fire.ly/). Learn more about the tool in the [Simplifier documentation library](https://docs.fire.ly/projects/Simplifier/index.html). Our registry setup follows the example of the [Canadian FHIR Registry](https://simplifier.net/organization/canadianfhirregistry) and the United Kingdom’s [NHS Digital FHIR Registry](https://simplifier.net/organization/nhsdigital).
Developers can use FHIR Shorthand command line tools to create and upload definitions or use the Forge GUI tool. The registry will be integrated with the NZ Health Terminology Service and HISO standards resource centre.
The registry is co-governed by [Te Whatu Ora](https://www.tewhatuora.govt.nz/) and [HL7 New Zealand](https://hl7.org.nz/). We invite everyone’s participation.
Email [standards@health.govt.nz](mailto:standards@health.govt.nz?subject=NZ%20FHIR%20Registry) to request your account (limited to three per organisation initially).
The [Sandbox project](https://simplifier.net/nz-sandbox) is the place to get started. The [Community Content project](https://simplifier.net/nz-community-content) is then where you can share your work and collaborate with others.
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