In Belgium, FHIR (Fast Healthcare Interoperability Resources) is actively used to exchange healthcare data. The country currently uses the R4 version of FHIR, indicating a modern approach to health data interoperability. There's a noticeable momentum towards increasing the adoption rate of FHIR in the coming years, with expectations of significant progress. This move is supported by regulations and incentives aiming to enhance healthcare data exchange and integration.

Rules and Support

  • Health Data Exchange Regulations:
    • There's a mandate for the use of standards in electronic health data exchange.
    • FHIR is explicitly mentioned and mandated in regulations.
    • Compliance deadlines are in place, though specific details about fines for non-compliance are unclear.
  • Support and Funding:

National Setup

  • Standards Organization:
    • Belgium has a national organization responsible for health data standards, accessible at eHealth Fgov.
  • Implementation Guides:
  • Terminology Services: Information on a national FHIR terminology server is under development or not clearly mentioned.

Active Use Cases

  • Local implementations include vaccination registries and allergy information across Belgium.
  • International standards, such as European Implementation Guides, are also in use.
  • Key projects involve mapping hospital data to FHIR for both primary and secondary uses, enhancing interoperability between hospitals and software companies.

Who's Using FHIR

  • Organizations:
    • Care providers, payers/insurers, EHR system vendors, and diagnostic system vendors are actively involved.
  • Reasons for Adoption:
    • Improving healthcare outcomes and care workflows are primary motivators.
  • Usage:
    • FHIR is utilized through a range of applications including REST APIs, messaging, and documentation.

Success Stories and Challenges

  • Benefits:
    • Improved access to information and potential efficiency gains are notable benefits.
  • Real Examples:
    • The vaccination registry is a highlighted success story.
  • Difficulties:
    • High investment costs and lack of FHIR knowledge are main challenges.
  • Future Plans:
    • Looking forward to person-centric health data vaults and OPAT (Outpatient Parenteral Antimicrobial Therapy) trajectory implementations.

Future Plans

  • Belgium has made considerable progress with FHIR adoption, aiming for expanded use across the healthcare ecosystem.
  • Next steps include the development of new FHIR standards for specific use cases and launching pilot projects with healthcare stakeholders.
  • Significant changes expected in the next three years include cost savings, enhanced care coordination, and a robust digital health ecosystem.

Contributors to this survey were not listed for privacy reasons.

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

healthdata.be (Sciensano)
Within the domain of health and healthcare, there are a large number of data flows with various objectives operational in Belgium: administrative data flows, data flows that guarantee the continuity of care (patient-related follow-up), or the traceability of a condition, medicine or healthcare product. There are also many data collections in the context of epidemiology and quality of care, for example. This last group of scientific data collections, the so-called registries, is characterised by a heterogeneous methodological approach, not only in terms of technology (paper, fax, email, web applications, batch upload, web services), but also with regard to content (different data structures). Furthermore, the same data is often requested multiple times from the same data provider. The consequences of this diversity for the providers and collectors of this data include reduced efficiency in the registration and processing of the information (a lot of manual data cleaning, retyping and mapping), real privacy risks and the scattered deployment of IT resources and people for the same tasks. Moreover, this context is not motivating for the (highly skilled) employees involved in these data collections (both among the data providers and the researchers). Finally, this situation leads to a high (direct and indirect) financial commitment on the part of data providers, the researchers and their clients. The healthdata.be team opted to align the standardization of these so-called "real world data" projects with the clinical context (in stead of starting from the research context) and to look for an information architecture that can be technically implemented in the various applications used in the Belgian healthcare landscape. One of the initiatives studied by the healthdata.be team is the “Registration at the source” project of the Dutch University Medical Centers (UMCs), united in the Dutch Federation of University Medical Centers (NFU). Within this initiative, which is supported by the National ICT Institute in Healthcare (NICTIZ), it was decided to work together in the field of standardization of healthcare data. The result of this collaboration is a set of so-called “Zorginformatiebouwstenen” (or Clinical Building Blocks). These Dutch Zorginformatiebouwstenen are reviewed and adapted to national landscape by the healthdata.be team and their stakeholders. The result are "Clinical Building Blocks" which are published on Simplifier as logical models. In a next step, the clinical building blocks will be translated into HL7 FHIR R4 compliant profiles and related conformance materials for data collections supported by healthdata.be (Sciensano). All assets will become available on Simplifier.
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