In Portugal, FHIR (Fast Healthcare Interoperability Resources) is becoming an important standard for exchanging healthcare data. Currently, its adoption is moderate, with version R4 being the most actively used, followed by STU3 and R4B. There's an expectation of increased adoption in the coming years. Despite the growing use, there are challenges and developments still underway to fully integrate FHIR into the healthcare system.

Rules and Support

  • Health Data Exchange Rules:

    • There is regulation in place mandating the use of standards in electronic health data exchange.
    • FHIR is not specifically mentioned in the regulation.
    • Details about compliance deadlines are unclear.

  • FHIR Requirements and Funding:

    • No government funds are currently available to stimulate the adoption of FHIR.
    • There are no fines for not meeting regulation deadlines.

National Setup

  • Standards Organization: The national organization responsible for health data standards is SPMS.
  • Implementation Guides: A base/core FHIR implementation guide for Portugal is under development, available on GitHub under the HL7 Portugal repository.
  • Terminology Services: A national FHIR terminology server is in development, aiming to standardize medical terms and codes used across the country.

Active Use Cases

  • Local Implementations: Current successful use cases include access to allergies and obstetrics data.
  • International Standards Use: Portugal is engaging with international patient summaries and European implementation guides to ensure interoperability on a global scale.

Who's Using FHIR

  • The main organizations involved in FHIR's adoption in Portugal are EHR system vendors and app developers.
  • Reasons for Adoption:
    • Innovation in healthcare IT
    • Improved access to healthcare information
  • Usage: The primary focus has been on messaging and REST API applications, with messaging being rated the highest in terms of current implementation levels.

Success Stories and Challenges

  • Benefits: Improved access to important patient information, such as allergies and obstetrics data, has been highlighted.

  • Challenges:

    • Unclear regulations and benefits
    • Lack of FHIR knowledge among healthcare IT professionals
    • Political changes affecting continuity and focus

  • Future Plans: Expectations include the core development of FHIR standards and expanded adoption across the healthcare ecosystem.

Future Plans

  • Progress: So far, the adoption of FHIR has made less progress than expected, leading to dissatisfaction among stakeholders.
  • Next Steps: Development of new FHIR standards for more specific use cases and broader adoption across healthcare providers.
  • Expected Changes: Despite current challenges, there's a cautious optimism regarding FHIR's potential to bring about significant improvements in cost savings, care coordination, and a more robust digital health ecosystem in Portugal. However, expectations are tempered with a realistic perspective on the pace of adoption.

Contributors

  • Joao Almeida, Chair at HL7 Portugal

This document provides a snapshot of the current state and future expectations for FHIR adoption in Portugal, based on input from key stakeholders in the healthcare IT community.

The above summary is based on the answers to the State of FHIR Survey 2025, organized by Firely and HL7 International.