Global survey finds growing FHIR adoption, expanding regulatory momentum, and an emerging ‘AI paradox’ as organizations invest in both AI and interoperability.
AMSTERDAM & ANN ARBOR, MI, June 17, 2026 — Firely, a global leader in FHIR-based software and services, and Health Level Seven International (HL7®), the global authority on healthcare data interoperability, today released the 2026 State of FHIR Report, offering a global view of how healthcare organizations, governments, and technology leaders are advancing interoperability using HL7® FHIR®.
“As healthcare organizations move from AI experimentation to implementation, the importance of interoperable, standards-based data has only increased,” said Professor Rachel Dunscombe, CEO of HL7 International. “These findings reinforce that AI and interoperability are not competing priorities. In fact, the success of AI increasingly depends on trusted, well-structured, and exchangeable health data.”
Now in its fourth year, the survey gathered responses from 101 interoperability experts across 63 countries and found continued growth in FHIR adoption, increasing regulatory support, and broad agreement that AI and interoperability are becoming increasingly intertwined.
One of the report’s most notable findings is what respondents described as the industry’s emerging ‘AI paradox’. While AI continues to dominate healthcare conversations, 72% of respondents disagreed that AI reduces the need to invest in FHIR and structured health data, compared with only 10% who agreed, suggesting that organizations increasingly see interoperability as a prerequisite for successful AI deployment.
The findings come as governments, regulators, and healthcare organizations continue to accelerate investments in standards-based interoperability. In the US, recent initiatives such as the CMS Health Technology Ecosystem and expanded use of FHIR-based implementation guides are increasing demand for trusted, exchangeable health data to support patient access, care coordination, and AI-enabled innovation.
Additional survey highlights
- FHIR adoption continues to mature globally, with 62% of respondents now reporting active FHIR use cases in their country and 20% identifying FHIR as their primary interoperability standard.
- Regulatory momentum continues to build, with 80% of respondents whose countries have regulation in place reporting that FHIR is mandated or recommended through national policy or guidance.
- Lack of FHIR knowledge remains the industry’s biggest challenge, cited by 75% of respondents and well ahead of investment cost and unclear regulation. Capacity building, not technology, remains the limiting factor.
- FHIR work centers on practical, high-volume use cases, with prescriptions and pharmacy leading, followed by terminology, diagnostic orders and reports, immunizations, and document exchange.
The survey also highlights the continued growth of FHIR adoption worldwide and the ongoing need for implementation expertise, governance, and investment.
“This year’s survey reaches 63 countries across five continents, including parts of Africa and the Pacific that weren’t part of this conversation a year ago,” said Ward Weistra, Product Lead at Firely. “And the message is consistent wherever you look: FHIR is becoming genuinely global infrastructure, and what people need to make it work (education, governance, investment) is the same everywhere.”
This year’s State of FHIR report dives deeper into regional and country-level findings, version adoption, tooling maturity, and the emerging role of AI across national FHIR programs. Access the full report here.
Media Contacts
Firely — Els van Bergeijk
els@fire.ly
+1-857-263-3112
HL7 — Andrea Ribick
andrea@HL7.org
+1-734-677-7777
About Firely
Firely is a global digital healthcare company providing FHIR software, training, and consultancy. As one of the initiators of the FHIR standard, Firely has been at the center of its development since the beginning. Trusted by governments, providers, payers, and health IT vendors worldwide, its solutions span FHIR server infrastructure, FHIR profiling, and the official open-source .NET SDK for HL7 FHIR. Learn more: www.fire.ly
About Health Level Seven International (HL7)
Health Level Seven® International (HL7) is an ANSI accredited, not for profit standards developing organization with the mission of empowering global health interoperability. With affiliates in over 30 countries, HL7’s global membership envisions a world in which everyone can securely access and use the right data when and where they need it. Widely implemented by vendors and healthcare systems—and required by governing bodies around the world—HL7 standards deliver solutions for health information technology, including HL7® Fast Healthcare Interoperability Resources (FHIR®), Version 2 (V2), and Clinical Document Architecture (CDA®). For more information, visit www.HL7.org.