In India, FHIR (Fast Healthcare Interoperability Resources) is increasingly being recognized as a critical standard for the exchange of healthcare data. Currently, its adoption is in the early stages but is expected to grow significantly in the coming years. The most active version of FHIR in use is R4, indicating a focus on utilizing up-to-date standards for health data interoperability.

Rules and Support

  • Health data exchange rules: Currently, there are no regulations mandating the use of FHIR specifically, but guidelines and recommendations have been published.
  • FHIR requirements: The National Digital Health Blueprint of 2019 recommends the use of HL7 FHIR R4.
  • Available funding: Government funds are available to stimulate the adoption of FHIR.

National Setup

  • Standards organization: The National Resource Centre for EHR Standards (NRCeS) is responsible for health data standards in India. NRCeS
  • Implementation guides: A base/core FHIR implementation guide for India is available, currently used in a limited set of use cases. FHIR R4 Implementation Guide
  • Terminology services: A national FHIR terminology server is in planning. Meanwhile, Wolters Kluwer offers a FHIR Terminology Server. Wolters Kluwer FHIR Terminology Server

Active Use Cases

  • Local implementations: The Ayushman Bharat Digital Mission (ABDM) and the National Health Claims Exchange (NHCX) are key projects using FHIR for claims data.
  • International standards use: India is utilizing the International Patient Summary standard.
  • Key projects: Personal Health Records (PHR) for citizens is a notable use case, providing a digital means to access health records.

Who's Using FHIR

  • Active organizations: EHR system vendors, app developers, and payers/insurers are among the main users.
  • Main reasons for adoption: The drive towards digital health transformation and improving interoperability among healthcare systems.
  • How they're using FHIR: For health claims, patient access to data, and document exchange among other uses.

Success Stories and Challenges

  • Clear benefits: Improved access to information is a significant benefit, as seen with the ABDM and PHR use cases.
  • Real examples: ABDM's use of FHIR for streamlining health claims exchange is a practical demonstration of its potential.
  • Main difficulties: High investment costs, unclear benefits, and regulations, along with a lack of FHIR knowledge, pose challenges.
  • Future plans: There's an anticipation of broader FHIR adoption, contingent on increased EHR adoption and legal mandates.

Future Plans

  • Progress so far: Adoption has been less than expected, with dissatisfaction among stakeholders.
  • Next steps: Efforts include launching pilot projects and expanding FHIR's adoption across the healthcare ecosystem.
  • Expected changes: In the next three years, significant cost savings, enhanced care coordination, and a robust digital health ecosystem are anticipated through FHIR adoption.

Contributors

  • SUPTENDRA NATH SARBADHIKARI, Independent Consultant
  • Kumar Satyam, HL7 India Volunteer - Chair Technical Committee

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