In France, FHIR (Fast Healthcare Interoperability Resources) is becoming a fundamental part of healthcare data exchange. Presently, the R4 version is the most actively used, with emerging interest in R5. The country shows a moderate level of FHIR usage with a positive outlook toward significantly increasing its adoption in the coming years. Stakeholders expect this growth due to both domestic health policy evolution and the broader global shift towards standardized health data protocols.

Rules and Support

France is aligning its healthcare data exchange with FHIR standards, supported by regulations and incentives:

  • Health Data Exchange Rules: Regulations mandate the use of standards in electronic health data exchange, specifically advising FHIR.
  • FHIR Requirements: FHIR is not only advised but also mandated in some contexts, indicating a strong governmental endorsement.
  • Deadlines and Fines: While some respondents are unsure about the deadlines and fines for non-compliance, others indicate the absence of such measures.
  • Funding: Government funds are available to stimulate FHIR adoption, although specifics may vary. Notable initiatives include Segur and Annuaire Santé.

National Setup

France's approach to FHIR and health data standards involves several key organizations and resources:

  • Standards Organization: The French e-Health Agency plays a pivotal role.
  • Implementation Guides: France utilizes both a general FHIR core guide and specific guides under development, such as the FHIR-FR-Core guide.
  • Terminology Services: A national FHIR terminology server is in production, facilitating consistent data interpretation.

Active Use Cases

FHIR is applied across various healthcare domains in France, including:

  • Local Implementations: CHU de Toulouse FHIR platform and Mon Espace Santé
  • International Standards Use: Engagement with IHE profiles like MHD
  • Key Projects: Projects like Annuaire Santé and ViaTrajectoire showcase FHIR's utility in enhancing healthcare interoperability.

Who's Using FHIR

FHIR adoption spans multiple sectors:

  • Organizations: Care providers, EHR system vendors, and government agencies are key users.
  • Reasons for Adoption: The main drivers include regulatory compliance, improved healthcare outcomes, and enhanced access to information.
  • Usage: FHIR facilitates diverse applications, from patient care coordination to backend system integration.

Success Stories and Challenges

The journey of FHIR adoption in France reveals both achievements and hurdles:

  • Benefits: Improved access to information and interoperability between systems stand out as clear advantages.
  • Real Examples: Platforms like Mon Espace Santé and initiatives like the terminology server illustrate FHIR's impact.
  • Difficulties: High investment costs and a lack of FHIR expertise are notable challenges.
  • Future Plans: Ongoing projects aim to further integrate FHIR into national healthcare systems, with expectations of significant benefits in the coming years.

Future Plans

France anticipates a robust expansion of FHIR's role in healthcare:

  • Progress: The country has made considerable strides in adopting FHIR, aligning with international standards and developing national implementation guides.
  • Next Steps: Future plans include the development of new FHIR standards for specific use cases and the launch of pilot projects.
  • Expected Changes: Stakeholders are optimistic about achieving substantial improvements in healthcare efficiency, coordination, and innovation through broader FHIR adoption.

Contributors

  • Marie Brulliard, Kereval
  • Luc Chatty, Fyrstain
  • Mael Priour, French e-health agency

This document reflects the collective insights of these contributors, emphasizing France's strategic commitment to leveraging FHIR for advancing healthcare interoperability and innovation.

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

HL7 France and IHE France (part of Interop'Santé)
The mission of the non-profit association [Interop'Santé](http://www.interopsante.org) is to build and promote standardized semantic interoperability in the field of healthcare in France. This association embeds HL7 France, the French affiliate of HL7 International, as well as IHE France, the French affiliate of IHE International. Interop'Santé in its HL7 France component has signed a development license agreement with _SNOMED International_, so as to be able to include SNOMED CT content in its products (specifications, implementation guides, value sets). Implementation, deployment and usage of any SNOMED CT content is subject to the signature of a [SNOMED CT Affiliate License Agreement](https://www.snomed.org/snomed-ct/get-snomed-ct).
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