8 Key Insights from the 2024 State of FHIR Survey

Wondered how FHIR is progressing lately? Well, the State of FHIR Survey, organized by HL7 International and Firely, is back for its second year. In this landmark survey, we provide an in-depth look at the adoption, regulation, and implementation of the FHIR (Fast Healthcare Interoperability Resources) standard across countries from around the world. 

This year’s results—from 29 different countries—offer a valuable comparison to last year’s insights, highlighting progress, persistent challenges, and emerging trends in FHIR adoption. So, what’s changed? Let’s dive into the results. 

1. FHIR Adoption Rate Change

The 2024 survey reveals that 84% of respondents (32) anticipate an increase in FHIR adoption, reflecting a consistent trend from the previous year. More exciting is that 40% (15 respondents) are expecting a strong increase, with only 1 of the 38 respondents expecting the rate of FHIR adoption to decrease. This optimistic outlook highlights FHIR’s continued and growing importance in the healthcare landscape. 

Interestingly, from a couple of the countries with multiple responses (e.g. Germany, Thailand), we see different expectations for the change in FHIR adoption.

2. Current Use of FHIR

FHIR’s usage varies significantly across countries. The report shows that countries like Lithuania and Switzerland* now report FHIR as the main standard for healthcare data exchange. In the report, the * denotes a contradiction from countries with multiple responses. Across the 3 responses from Switzerland, we have scores of 2, 3 (a few use cases) and 5 (the main standard), so it’s interesting to see the wide differences in opinion within countries.  

Notably, we saw a jump from only one response in the top two brackets (red and yellow on the graph below) in 2023 to six responses in the 4+ bracket (Belgium, New Zealand Thailand*, United Kingdom, Lithuania, Switzerland*). This indicates significant progress in FHIR implementation in these regions, moving beyond isolated use cases to broader adoption.  

Meanwhile, many other countries report using FHIR for a few specific use cases. This variation highlights the different stages of FHIR implementation globally, with some regions leading in adoption while others are still exploring its potential. However, there are some positive signs with multiple countries reporting greater usage than last year (Cyprus).

3. FHIR Version Use 

Most respondents are not using DSTU2 and STU3 anymore (only the Netherlands reported using it as the main standard) and are yet to upgrade to the later R5 (only Estonia using this as their main standard) and R6 Pre-release versions (only Germany reported using it at all). 

Most respondents (22 of 38) said they are using R4 as their main standard. As reported in a poll of attendees at FHIR DevDays 2024, most are looking to jump from R4 to R6, skipping R5 due to the timeframes and its lower adoption.

4. Regulation Involving FHIR 

It’s no secret that regulation plays a crucial role in the adoption of FHIR, so this is an important factor to monitor. The survey reveals that many countries that responded (over 80%) have regulations in place prescribing the use of standards for electronic health data exchange. 

In many cases (65%), these regulations specifically mandate or advise the use of FHIR in their country’s most important regulation that prescribes the use of standards in electronic health data exchange—which is a 10% jump from last year. 

Interesting to note, among those respondents who said there is regulation in place, almost half said there is no compliance deadline. For the 35% of respondents who said there is a deadline, the deadlines ranged from 2010 to 2026, but only Germany and Slovenia report having fines imposed in case the regulation is not met before the deadline

5. National Standards Development

A substantial number of countries (nearly three-quarters) reported having national standards organizations that oversee the implementation and use of FHIR, as well as a national FHIR data model. This is slightly down from 2023—although it’s important to note that the report does include submissions from 11 new countries.

Ultimately, the result of standardization at a national level is more clarity for everyone in the healthcare ecosystem and greater access to understandable data that wasn’t available before—leading to better outcomes and more efficient healthcare.

6. Successful FHIR Use Cases

Almost 70% of respondents report successful FHIR use cases that have led to improved access to information, while a smaller group have reported reduced costs and better healthcare outcomes. Some of the examples provided for better healthcare outcomes include national health directories, patient and provider access, electronic referrals, and e-prescribing systems.

7. Who is Adopting FHIR

We saw a strong uptick in FHIR adoption rates among EHR vendors and app developers. In 2023, 63% of respondents cited EHR vendors as adopters, with this jumping to 79% in 2024. App developers saw a more modest increase from 60% in 2023 to 65% in 2024. 

Additionally, the “Other” section, which comprises mostly governmental organizations, has also embraced FHIR at a higher rate. Adoption in this sector nearly doubled, rising from 16% in 2023 to 29% in 2024. This could indicate a broader acknowledgment of FHIR’s potential to improve public health data systems and governmental healthcare operations. 

Overall, these trends highlight the expanding influence of FHIR across diverse segments of the healthcare industry, which is great to see. 

8. Primary Drivers and Challenges of FHIR Adoption

The survey identifies innovation, regulation, and grants as the primary drivers for FHIR adoption which is in line with responses from 2023. However, regulation & grants have seen an increase—likely due to increasing regulation globally. Improved care, though less cited in 2024 compared to last year, remains a significant motivator. 

Despite its benefits, FHIR adoption faces challenges. Lack of FHIR knowledge was cited as the biggest barrier to adoption for the second year running with over three-quarters of respondents selecting this option, significantly ahead of any other challenge. 

This was followed by unclear regulations, high investment costs, and unclear benefits, reflecting much of the same sentiment as last year. However, we did see a small decrease in responses for “Unclear regulations”, which hopefully points to greater regulatory transparency.

Embracing FHIR

The 2024 State of FHIR Survey highlights the growing global adoption of FHIR and the critical role of regulation in driving this trend. As one of the initiators of FHIR, Firely believes the survey results are a valuable guide to its current and future progress. Sharing global insights helps confirm FHIR’s benefits, highlight potential barriers, and encourage further adoption through shared learning. 

The full report is available for download on the HL7 website. We have also introduced FHIR jurisdiction overview pages which allow you to explore the FHIR regulations, content, and primary publishing standards organizations from different regions. Go to Simplifier.net and click on any country on the map to explore. 

If you’d like to check out the results from last year, take a look at our blog on the State of FHIR Report 2023. We welcome your feedback on everything we do, so please send your comments and questions to info@fire.ly, or get in touch via our contact page.