New on Simplifier.net: Comprehensive Country Summaries from the 2025 State of FHIR Survey.
As the Product Lead for Simplifier.net, I am thrilled to announce a significant enhancement to our platform: the availability of detailed country summaries based on the insights from the 2025 State of FHIR Survey. This new feature, accessible in Simplifier.net's 'Jurisdictions' section underscores our commitment at Firely and HL7 International to fostering global health data interoperability.
The 2025 State of FHIR Survey is an annual global initiative, collaboratively organized by HL7 International and Firely. Its primary goal is to provide deep insights into the current state and progression of HL7 FHIR adoption worldwide. Conducted in April 2025, this year's survey focused on identifying shifts in adoption rates, understanding diverse applications, tracking FHIR version usage, and uncovering both the key drivers and persistent challenges influencing global adoption.
This year's response was truly remarkable, collecting 90 unique submissions from 57 distinct countries, a significant increase from previous years. The survey aimed to obtain input from at least one informed respondent per country, distributing an online survey to HL7 affiliates and national standards organizations.
While the 82 responses received from 52 distinct countries were included in the official report, all 90 country submissions have been summarized for Simplifier.net. These results should be interpreted primarily as qualitative rather than quantitative due to the open-ended nature of many questions and occasional contradictions among respondents from the same country.
Let me share some key Insights from the 2025 State of FHIR Survey.
A striking 71% of respondents reported FHIR is already being used for at least a few use cases in their country, a notable increase from 66% in 2024. Looking forward, nearly half of respondents (54%) anticipate a strong increase in the rate of FHIR adoption in the coming years, a substantial jump from 39% in 2024. This optimistic trajectory is seen in regions like Argentina, Brazil, Australia, the United States, and numerous European and Asian countries.
Regarding FHIR version adoption: R4 remains the most widely adopted main standard, cited by 40% (31 of 78) of respondents. Only the Netherlands reported STU3 as their main standard. R5 shows better uptake than R4B overall whilst the majority (38 of 57) are not yet using R6 (pre-release).
Regulation plays a critical role. 78% of the countries have regulations mandating standards in electronic health data exchange. More importantly, 73% of those regulations specifically mention FHIR as mandated or advised, indicating a significant increase in its formal recognition. Although roughly half of regulated countries (29 of 63) have compliance deadlines, the majority (41 of 64) report no fines for non-compliance.
A vast majority (67 of 80) of countries have a national organization responsible for health data standards and 65 of 82 respondents confirmed the existence of a base/core FHIR implementation guide for their country.
71% of respondents reported developing other FHIR standards for specific use cases. The most common are prescriptions/pharmacy (39), terminology (34), and diagnostic orders/reports (29).
The International Patient Summary (IPS) serves as the basis for national FHIR specifications for 42 respondents, followed by European Implementation Guides (26) and International Patient Access (IPA) (7).
Roughly half of respondents (39 of 79) have a national FHIR terminology server in production or development, with 27 others planning one.
EHR vendors continue to lead FHIR adoption, with care providers now the second most cited group, ahead of app developers. The FHIR REST API is widely applied, underscoring FHIR’s API-first approach and tools like SMART on FHIR are widely applied, along with CDS Hooks, CQL on FHIR, SQL on FHIR, FHIR Bulk Data, Subscriptions, FHIRcast, FHIR Questionnaires and SDC, and FHIR Shorthand.
The lack of FHIR knowledge (59) remains the biggest hurdle. Other challenges include unclear benefits (35), changes in political direction (34), high investment cost (33), and unclear regulations (33).
It is safe to say that the future of FHIR is viewed with strong optimism by many respondents. Over 60% agreed or strongly agreed that they anticipate reaping the benefits of FHIR adoption within the next three years, leading to significant cost savings, enhanced care coordination, and a more robust digital health ecosystem.
I hope these comprehensive country summaries offer invaluable insights for you as an implementer, policymaker or innovator. By making this rich data from the 2025 State of FHIR Survey readily available on Simplifier.net, we aim to empower the community to navigate challenges and drive further progress in their respective regions, paving the way for a truly connected and innovative future in healthcare.
You may download your copy of the full report here. And check out my blog for my in-dept analysis and interpretation of the outcomes.