In Portugal, FHIR is currently used for a few specific use cases rather than as the main standard for health data exchange. Adoption is still in its early stages, but interest is growing.
Several FHIR versions are active in the country, including DSTU2, STU3, R4B, and R5. The mix of versions reflects different projects and experimentation across organizations.
Looking ahead, we expect a notable increase in FHIR adoption over the coming years.
Rules and Support
Portugal has regulation that mandates the use of standards in electronic health data exchange. However, the rules around FHIR specifically are less developed.
- Regulation exists for electronic health data exchange
- FHIR is not specifically mentioned in the regulation
- There is no deadline for compliance
- There are no government funds available to stimulate FHIR adoption
- SPMS (Shared Services of the Ministry of Health) publishes technical specifications, but these are not mandatory. SPMS plays a dual role as both regulator and a player in the digital health space.
National Setup
Portugal has a national organization responsible for health data standards:
A national base FHIR implementation guide is under development. You can find it here:
A national FHIR terminology server is not yet available, but planning is underway.
Active Use Cases
A few FHIR specifications are being developed in Portugal for specific use cases:
- Prescriptions and pharmacy
- Referrals and continuity of care
- Terminology
- Diagnostic orders and reports
- Allergy intolerance
At this stage, Portugal's national FHIR work is not directly based on international specifications like the International Patient Summary or European Implementation Guides.
There is currently no known activity around the FHIR Community Process (FCP), but one or more organizations may start exploring participation in the next 2-3 years.
Who's Using FHIR
The main groups adopting FHIR in Portugal include:
- EHR system vendors (companies that build electronic health record software)
- App developers
- Researchers
The main drivers for adoption are:
- Patient data access
- Innovation
In terms of how FHIR is being used, FHIR Messaging is the most common exchange mechanism. FHIR REST APIs are used to a moderate extent, while FHIR Documents see limited use. Most FHIR tooling (such as SMART on FHIR, CDS Hooks, Bulk Data, and Subscriptions) is barely used yet. The software mix leans more toward proprietary solutions than open source.
Success Stories and Challenges
Success
A notable success is the use of FHIR to improve access to allergies information, helping ensure this important data reaches the right place.
Challenges
Several challenges are slowing down adoption:
- Unclear benefits of moving to FHIR
- Unclear regulations
- Lack of FHIR knowledge
- Changes in political direction
- Many implementers still rely on older standards (like HL7 v2) and lack incentives to migrate without clear guidance from regulators
Future Plans
Over the past year, Portugal has made the progress that was expected. A key achievement was the development of new FHIR standards for more specific use cases.
However, overall satisfaction with the adoption rate is low. There is concern that, without stronger regulatory guidance, Portugal may not fully benefit from FHIR adoption in the next three years.
Expected next steps include:
- Development of a national FHIR data model
- Launch of pilot projects with selected healthcare stakeholders
- Expanded adoption of FHIR across the healthcare ecosystem
Contributors
- João Almeida, Chair, HL7 Portugal
The above summary is based on the answers to the State of FHIR Survey 2026, organized by Firely and HL7 International.