In Bosnia and Herzegovina, the Fast Healthcare Interoperability Resources (FHIR) standard is currently being used at a basic level for healthcare data exchange. Active versions include R4, R4B, and R5, with moderate utilization, while R6 (pre-release) sees limited use. The country expects to see a significant increase in the adoption rate of FHIR in the upcoming years, indicating a growing recognition of its benefits for healthcare data interoperability.

Rules and Support

  • Health Data Exchange Rules:
    • There are regulations in place mandating the use of standards for electronic health data exchange.
    • FHIR is specifically advised in these regulations.
  • FHIR Requirements:
    • No specific deadline for compliance is included in the regulation.
    • No fines are imposed for non-compliance before any deadline.
  • Available Funding:
    • Currently, there are no government funds available to stimulate the adoption of FHIR.

National Setup

  • Standards Organization: No national organization is currently responsible for health data standards in Bosnia and Herzegovina.
  • Implementation Guides: There are no base/core FHIR implementation guides available for the country.
  • Terminology Services: While a national FHIR terminology server is not available, it is in planning stages.

Active Use Cases

  • Local Implementations: Specific use cases developed in Bosnia and Herzegovina include Referrals/Continuity of Care, Diagnostic Orders/Reports, Document Exchange, Imaging, and Patient Access.
  • International Standards Use: European Implementation Guides are being utilized.
  • Key Projects: Notable projects include patient portals and integration of diagnostic imaging and laboratory systems.

Who's Using FHIR

  • Active organizations integrating FHIR into their operations include Electronic Health Record (EHR) system vendors, diagnostic system vendors (such as Imaging/Lab), and app developers.
  • Main Reasons for Adoption:
    • Regulation and grants
    • Innovation
  • How They're Using FHIR: Utilization focuses on FHIR Messaging, Documents, Rest API, and Bulk Data capabilities.

Success Stories and Challenges

  • Clear Benefits:
    • Improved healthcare outcomes
    • Enhanced access to information
    • Streamlined care workflows
  • Real Examples: Patient portals and seamless diagnostic imaging and laboratory integration stand out as successful FHIR use cases.
  • Main Difficulties:
    • Unclear regulations
    • Lack of FHIR knowledge among stakeholders
  • Future Plans: There is anticipation for national-level integration and data exchange to expand.

Future Plans

  • Progress So Far: The country has made more progress than expected in the last year regarding FHIR adoption.
  • Next Steps: Plans include the development of a national FHIR data model and the launch of pilot projects with selected healthcare stakeholders.
  • Expected Changes: Within the next three years, significant benefits from FHIR adoption are anticipated, including cost savings, improved care coordination, and a more robust digital health ecosystem.

Contributors

  • Tarik Demirovic, CTO at Berg

This document reflects the current state and future expectations for FHIR implementation in Bosnia and Herzegovina, providing insights into the challenges, successes, and plans surrounding healthcare data interoperability in the country.

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