In Sweden, the use of FHIR (Fast Healthcare Interoperability Resources) for exchanging healthcare data is in its early stages but is gaining momentum. The current adoption level is moderate, with the R4 version of FHIR being the most actively used. There's a clear expectation among healthcare professionals that the rate of FHIR adoption will significantly increase in the coming years. This optimism is driven by the demand for better data interoperability and the anticipated regulations mandating the use of FHIR.

Rules and Support

• Health Data Exchange Rules: Currently, there is no specific regulation mandating the use of standards in electronic health data exchange in Sweden. However, future mandates such as EHDS (European Health Data Space) and regulations by the European Medicines Agency (EMA) are expected to significantly promote the use of FHIR.
• FHIR Requirements: While specific FHIR requirements are not mentioned in current regulations, the development of a base/core FHIR implementation guide indicates a structured approach towards standardization.
• Deadlines and Fines: No deadlines or fines are currently in place for the adoption of FHIR standards.
• Funding: There are no government funds available specifically to stimulate the adoption of FHIR.

National Setup

• Standards Organization: Sweden has national organizations responsible for health data standards, including HL7 Sweden and eHälsomyndigheten.
• Implementation Guides: A base/core FHIR implementation guide is under development, accessible here.
• Terminology Services: A national FHIR terminology server is currently in development, indicating efforts to standardize healthcare terminology.

Active Use Cases

• Local Implementations: Sweden is seeing FHIR implementation in various areas, though specific use cases within the survey were not detailed.
• International Standards Use: International Patient Access and European Implementation Guides are noted areas of focus.
• Key Projects: One highlighted project is the Swedish National Medication List, showcasing a practical application of FHIR.

Who's Using FHIR

• Organizations involved in healthcare data exchange in Sweden are gradually adopting FHIR. This includes state agencies, healthcare providers, and possibly EHR system vendors.
• FHIR is primarily adopted for improving access to information, with the development of national standards and models being a key driver.

Success Stories and Challenges

• Benefits: Improved access to information is a clear benefit of FHIR adoption, as demonstrated by the Swedish National Medication List project.
• Difficulties: Major challenges include a high investment cost, unclear benefits, and a lack of FHIR knowledge among stakeholders.
• Future Plans: EHDS-related implementations are eagerly anticipated, suggesting a focus on aligning with European standards.

Future Plans

• Progress: Sweden is making the progress it expected in FHIR adoption, despite current dissatisfaction with the adoption rate.
• Next Steps: Development of new FHIR standards for specific use cases and expanded adoption across the healthcare ecosystem are planned.
• Expected Changes: In the next three years, significant benefits such as cost savings, enhanced care coordination, and a robust digital health ecosystem are strongly anticipated from FHIR adoption.

Sweden's journey with FHIR is evolving, with a strong foundation being laid for widespread adoption and standardization across the healthcare sector. The focus on developing national implementation guides and terminology services, alongside anticipated regulations, positions Sweden to significantly advance its healthcare interoperability and innovation.

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