In Spain, FHIR (Fast Healthcare Interoperability Resources) is increasingly being utilized to facilitate the exchange of healthcare data. This standard helps different healthcare systems to communicate with each other efficiently. Currently, Spain is exploring various versions of FHIR, including R4 and its updates, although specific version adoption details remain under discussion. The country anticipates significant growth in FHIR adoption in the coming years, driven by regulatory mandates and the healthcare community's commitment to improving interoperability.

Rules and Support

• Health Data Exchange Rules
  • The use of standards in electronic health data exchange is mandated by regulation.
  • FHIR is specifically mentioned and mandated in the regulation.
• FHIR Requirements
  • No deadline for compliance is specified in the regulation.
  • There are no fines for failing to meet a compliance deadline, as one does not exist.
• Available Funding
  • No government funds are currently available to stimulate the adoption of FHIR.
• Regulation Details
  • Public tenders require the use of FHIR & HL7 standards and certification in these standards.
  • Spain follows EU indications regarding health data regulation.

National Setup

• Standards Organization
  • There is no specified national organization responsible for health data standards in Spain.
• Implementation Guides
  • A base/core FHIR implementation guide for Spain is under development.
  • Some guides are managed by the Ministry of Health on a project-by-project basis, but no URLs were provided.
• Terminology Services
  • A national FHIR terminology server is available and in production.

Active Use Cases

• Local Implementations
  • The UNICASS Project is noted as a successful FHIR use case in Spain.
• International Standards Use
  • Spain utilizes the International Patient Summary and European Implementation Guides, focusing on enhancing healthcare interoperability across borders.

Who's Using FHIR

• Active organizations include care providers, EHR system vendors, diagnostic system vendors (like Imaging/Lab), and app developers. They adopt FHIR for various reasons:
  • Improving healthcare outcomes
  • Enhancing access to information
  • Streamlining care workflows

Success Stories and Challenges

• Benefits
  • Improved healthcare outcomes
  • Enhanced access to information
  • Streamlined care workflows
• Real Examples
  • The UNICASS Project stands out as a significant success story.
• Main Difficulties
  • A notable challenge is the variation in policy across different regions.
• Future Plans
  • There is enthusiasm for upcoming FHIR implementation use cases.

Future Plans

• Progress So Far
  • Spain has made far more progress in FHIR adoption than expected in the last year.
  • Stakeholders are very satisfied with the current adoption rate.
• Next Steps
  • Continued development of a national FHIR data model.
  • Launch of pilot projects with selected healthcare stakeholders.
  • Expanded adoption of FHIR across the healthcare ecosystem is anticipated.
• Expected Changes
  • In the next three years, significant benefits from FHIR adoption are expected, including cost savings, enhanced care coordination, and a more robust digital health ecosystem.

Contributors

• Francisco Javier Perez Fernandez, President at HL7 Spain, provided valuable insights for this survey.

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