In Sweden, FHIR is used for a few healthcare data exchange use cases today. It is not yet the dominant standard, but adoption is growing steadily. The Swedish E-Health Agency is leading much of this work.

FHIR R4 is the main version in active use. A small amount of R5 use is also reported, while older versions like DSTU2 and STU3 are not in use.

We expect a strong increase in FHIR adoption over the coming years. The trend is positive: all national (state) services will be based on FHIR, rolling out now and over the next few years. The European Health Data Space (EHDS) is also expected to give adoption a further push.

Rules and Support

Sweden has regulation in place for health data exchange:

• Standards are mandated for electronic health data exchange.
• FHIR is specifically mandated in the regulation.
• A compliance deadline is set.
• Government funds are available to support FHIR adoption.
• Work is driven by both EHDS requirements and national needs.

You can find national FHIR guides developed by the Swedish E-Health Agency on Simplifier.

National Setup

Sweden has a clear national structure for health data standards:

• Standards organization: The Swedish E-Health Agency. See HL7 Sweden and the National Group for Standardization.
• National base FHIR implementation guide: Available and used in a limited set of use cases. See the Swedish base IG.
• Terminology server: A national FHIR terminology server is in production. A second one is being planned.
• Other FHIR standards: A few additional national FHIR specifications exist for more specific use cases.

Regarding the FHIR Community Process (FCP), a global framework for managing FHIR specifications, one or more Swedish organizations are exploring becoming participants. In two to three years, Sweden expects to have one or more approved FCP participants.

Active Use Cases

National FHIR specifications are being developed for several areas:

• Prescriptions and pharmacy
• Terminology
• Provider directory
• Consent
• Clinical registries

Sweden builds on international specifications, including:

• The International Patient Summary
• European Implementation Guides

Who's Using FHIR

The main organizations adopting FHIR in Sweden are:

• EHR (Electronic Health Record) system vendors
• Government agencies

The main reasons for adoption are:

• Regulation and grants
• Innovation

In terms of exchange mechanisms, the FHIR REST API (a web-based way to request and share health data) is the most widely used approach. FHIR Messaging and FHIR Documents are not yet in active use.

For FHIR tools, the most adopted are:

• FHIR Shorthand: A simple language for writing FHIR profiles.
• FHIR Questionnaires and SDC (Structured Data Capture): Used for forms and structured data collection.

The software mix leans toward open source, though proprietary tools are also present.

Success Stories and Challenges

A clear success story is the Swedish National Medication List. It has delivered:

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

The main challenges for FHIR adoption in Sweden include:

• High investment costs
• Unclear regulations
• A general lack of FHIR knowledge

On the topic of AI and machine learning, the impact on FHIR work is seen as positive. AI is:

• Accelerating the mapping and transformation of data to FHIR
• Increasing interest in FHIR as a foundation for AI use cases

We strongly disagree with the idea that AI reduces the need to invest in structured data. Good structured data remains essential.

Future Plans

Progress over the past year matched expectations. National services under development are adopting FHIR, and FHIR adoption is expanding across the healthcare ecosystem. Satisfaction with the current pace is mixed, ranging from satisfied to dissatisfied.

Looking ahead, we expect:

• New regulation prescribing standards in electronic health data exchange
• Launch of pilot projects with selected healthcare stakeholders
• Wider adoption of FHIR across the healthcare ecosystem

Use cases to look forward to include the national infrastructure being built by the Swedish E-Health Agency for both national and international interoperability, and progress by the European Medicines Agency (EMA) with FHIR APIs.

We strongly agree that within the next three years, Sweden will see real benefits from FHIR adoption: cost savings, better care coordination, and a stronger digital health ecosystem.

Contributors

• Mattias Colliander, The Swedish E-Health Agency

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