In Tonga, FHIR is not yet being used to exchange healthcare data. FHIR is a modern standard for sharing health information between computer systems. At this time, no version of FHIR is active in the country.

Looking ahead, we expect a strong increase in FHIR adoption over the coming years. The Ministry of Health sees real potential in FHIR to support better healthcare delivery.

There is growing interest in moving toward FHIR-based systems, but progress depends on funding, training, and clearer national direction.

Rules and Support

Tonga does not yet have specific rules requiring FHIR or other standards for health data exchange. Here is the current picture:

  • Health data exchange rules: No regulation mandates standards for electronic health data exchange.
  • FHIR requirements: FHIR is not mentioned in any regulation.
  • Existing law: The Personal Health Information Protection Act is in place, but it does not cover FHIR.
  • Deadlines: None set.
  • Government funding: No government funds are currently available to support FHIR adoption.

National Setup

The national infrastructure for FHIR standards is still in early stages:

  • Standards organization: There is no national organization responsible for health data standards.
  • Implementation guides: Tonga does not have a base or core FHIR implementation guide. An implementation guide explains how to use FHIR for specific needs.
  • Terminology server: A national FHIR terminology server is being planned but is not yet built. A terminology server provides standard codes and terms for health data.
  • FHIR Community Process (FCP): There is no known FCP activity in Tonga today. In 2–3 years, we expect one or more organizations to explore becoming FCP participants.

Active Use Cases

FHIR use cases in Tonga are still emerging. One key project stands out:

  • Integrating the National Health Information System (NHIS), the country's electronic medical record, with Senaite, a laboratory information system, using FHIR.
  • Ongoing work to connect the NHIS with the Civil Registration and Vital Statistics (CRVS) system managed by the Ministry of Justice.

These projects show clear intent to use FHIR for real health system needs, even though full implementation has not started.

Who's Using FHIR

The main stakeholders involved in FHIR in Tonga are:

  • EHR system vendors (companies that build electronic health record systems)

The main reasons for wanting to adopt FHIR are:

  • Improving health outcomes
  • Improving care workflows
  • Improving patient access to their data

Successes and Challenges

There are no successful FHIR use cases to report yet. The main challenges include:

  • High investment cost: Vendor fees for FHIR integration are too high for the Ministry's budget.
  • Unclear regulations: No clear national rules guide FHIR adoption.
  • Lack of FHIR knowledge: Many staff do not have the technical skills to set up, run, or maintain FHIR-based systems.

Despite these challenges, there is strong interest in moving forward, especially with the NHIS–Senaite integration project.

Future Plans

Progress in the past year has been less than expected. Looking ahead:

  • We expect expanded adoption of FHIR across the healthcare ecosystem in the coming year.
  • Building local technical skills and securing funding will be key next steps.
  • There is optimism that within three years, FHIR adoption will bring cost savings, better care coordination, and a stronger digital health system in Tonga.

Contributors

  • Tifa Halafihi, Health Information Technology Officer, Ministry of Health

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