In Nepal, FHIR (Fast Healthcare Interoperability Resources) is beginning to be utilized for healthcare data exchange, albeit on a limited scale. Currently, version R4 of FHIR is in use, indicating a nascent but growing adoption of this standard. Expectations for the coming years include a significant increase in the rate of FHIR adoption. This optimism is partly due to the completion of EMR/SHR Guidelines and the drafting of a National Digital Health Blueprint that emphasizes the importance of FHIR and health data standards.

Rules and Support for FHIR Adoption

  • Health Data Exchange Rules:

    • There are regulations mandating the use of standards in electronic health data exchange, though FHIR is not specifically mentioned.
    • No deadlines or fines are imposed for non-compliance, but the absence of government funds for FHIR adoption is noted.

  • FHIR Requirements and Funding:

National Setup

  • Standards Organization:

    • Currently, Nepal does not have a national organization responsible for health data standards. However, there are efforts towards establishing such an entity.

  • Implementation Guides:

    • A base/core FHIR implementation guide exists and is used in limited use cases. It can be found here.

  • Terminology Services:

    • A national FHIR terminology server is in planning stages, indicating future development in this area.

Active Use Cases

  • Local implementations include the use of FHIR in the National Health Insurance Board's claim processing and in supporting the scale of Universal Health Coverage (UHC) with digital health tools.
  • The country is committed to leveraging FHIR for AMR from 26 different sites and exploring its utilization for migrant workers and regional standards to support healthcare ecosystems.

Who's Using FHIR

Organizations actively using FHIR in Nepal range from care providers to EHR system vendors and app developers. The main motivations for adopting FHIR include:

  • Improving health outcomes
  • Enhancing care workflows
  • Driving innovation

These goals are being pursued through FHIR's capabilities for messaging, document handling, and REST APIs.

Success Stories and Challenges

  • Benefits:

    • Improved healthcare outcomes and workflows have been highlighted as clear benefits of FHIR adoption.
    • Specific projects like OpenIMIS showcase the practical application and advantages of FHIR in insurance claim processing.

  • Challenges:

    • High investment costs, unclear benefits and regulations, and a lack of FHIR knowledge are main difficulties.
    • Political changes also pose a risk to the continuity and success of FHIR implementations.

  • Future Plans:

    • Plans include the implementation of a National Health Data Exchange and the development of new FHIR standards for specific use cases.

Future Plans

  • Progress So Far:

    • Nepal has made far more progress than expected in the last year regarding FHIR adoption, with stakeholders expressing high satisfaction.

  • Next Steps:

    • The focus is on expanding the adoption of FHIR across the healthcare ecosystem and launching pilot projects with healthcare stakeholders.

  • Expected Changes:

    • Significant cost savings, enhanced care coordination, and a more robust digital health ecosystem are anticipated benefits in the next three years.

Contributors

  • Vicky Pandey from Mavorion Systems Pvt. Ltd. shared insights as a Solution Architect, highlighting ongoing efforts and future aspirations for FHIR in Nepal.

This document provides a concise overview of the current state and future outlook of FHIR adoption in Nepal, aiming to inform and guide stakeholders across the healthcare spectrum.

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