In Estonia, the use of the Fast Healthcare Interoperability Resources (FHIR) standard is in its early stages but shows promising growth. The adoption of various FHIR versions varies, with R4 being utilized to a limited extent and significant anticipation for the R5 version. Expectations are high for the increased adoption of FHIR in the coming years, driven by the evolving needs of healthcare data exchange and the global move towards more standardized healthcare information systems.

Rules and Support

• Health Data Exchange Rules and Regulations:

  • The "Health Information System Statute" mandates healthcare service providers to adhere to information system standards set by TEHIK.
  • Specific data exchange standards are not detailed, but future services will be based on FHIR standards.

• FHIR Requirements and Deadlines:

  • No specific mention of FHIR in current regulations.
  • No deadlines or fines for non-compliance mentioned.

• Available Funding:

  • No government funds are currently available to stimulate FHIR adoption.

National Setup

• Standards Organization:

  • Health and Welfare Information Systems Centre (TEHIK) is responsible for health data standards in Estonia. TEHIK

• Implementation Guides:

  • A base/core FHIR implementation guide is available for Estonia, used in a limited set of use cases. Estonian Base Implementation Guide

• Terminology Services:

  • A national FHIR terminology server is in production, supporting the development and use of standard terminologies within FHIR implementations.

Active Use Cases

• Local implementations focusing on:

  • Master Patient Index
  • Health declaration
  • Estonian National Health Information System base services
  • Allergy information

• Key projects under development include:

  • Medication Scheme
  • Health Declaration
  • Medical Certificate

Who's Using FHIR

• Active Organizations:

  • EHR system vendors
  • Health and Welfare Information Systems Centre (TEHIK)

• Main Reasons for Adoption:

  • Improving health outcomes
  • Enhancing care workflows
  • Spearheading innovation in healthcare

• How They're Using FHIR:

  • Data exchange between healthcare providers
  • Mapping data from CDA documents to FHIR standards for modular display of health information

Success Stories and Challenges

• Clear Benefits:

  • The Data Viewer simplifies data review by allowing dynamic data visualization and trend analysis.

• Main Difficulties:

  • High investment cost
  • Lack of FHIR knowledge among stakeholders

• Future Plans:

  • Continued development of new FHIR standards for specific use cases
  • Launch of pilot projects with healthcare stakeholders

Future Plans

• Progress So Far:

  • Less progress than expected in the previous year regarding FHIR adoption.

• Next Steps:

  • Development of new FHIR standards
  • Expanded adoption of FHIR across the healthcare ecosystem

• Expected Changes:

  • Significant cost savings
  • Enhanced care coordination
  • A more robust digital health ecosystem

Contributors

• Permission was granted to use the contributor's names. However, specific names are not listed in the provided survey data excerpt.

This document provides a concise overview of the current state and future expectations of FHIR adoption in Estonia, based on the survey responses provided.

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