In an HL7 global survey of FHIR development uncovers the key drivers and persistent challenges influencing global adoption, as well as the most prominent use cases.
In 2025, HL7 International and Firely partnered for the third year in a row to conduct a global online survey aimed at gaining deeper insights into the current state and progression of FHIR adoption. Ultimately, 82 responses were collected from 52 distinct countries.
In an Oct. 16 webinar, Diego Kaminker, HL7’s deputy chief standards implementation officer, reviewed the findings. He noted that the use cases mentioned by the most respondents include prescriptions/pharmacy (39), terminology (34), diagnostic orders/reports (29), document exchange (28), referrals/continuity of care (28) and immunizations (26).
“The surprise here is that diagnostic orders and reports appears before document exchange and referrals and patient access,” Kaminker said. “One can think that most of the countries are giving patients access to their own data, and we think that most of the projects around the world exchange diagnostic orders and reports using v2 or something like that. But this is changing finally. I thought it would be changing 10 years ago or five years ago, but finally we are seeing diagnostic orders and reports as the third use case that is moving forward.”
Among the 63 respondents who said they were aware of successful FHIR use cases in their country, 56 cited the main achievement being improved access to information.
Other single mentions were as follows:
1. Improved quality of data, use of terminology
2. Get Quality Data for Analysis and Secondary use
3. Research
4. Faster integration with care provider systems
5. Collaboration
6. Improved timeliness of care
7. Improved public health reporting
Among the 82 respondents, the three groups most often cited as adopting FHIR were EHR vendors (60), care providers (42) and app developers (37). Consistent with 2024 and 2023, EHR vendors remain the most often cited group.
In a multiple-choice question, the survey asked respondents to name the main drivers for FHIR adoption in their country. Respondents most often mentioned Innovation (52) and Regulation and grants (52). Among the respondents who said there is regulation in place in their country, the majority (47 of 64, or 73%) said FHIR is either mandated or is being advised in their country’s most important regulation that prescribes the use of standards in electronic health data exchange.
In 2025, 39 of 82 respondents said there are no government funds available in their respective countries to stimulate the adoption of FHIR, a slightly higher proportion than in 2024 (15 of 38). HL7 said this suggests the prevalence of government funds available for FHIR adoption may be decreasing, or the respondents are not aware of the funds.
Asked to name the biggest challenges for FHIR adoption in their country, lack of FHIR knowledge was cited by the majority of respondents (59 of 82) as the biggest challenge for FHIR adoption, which is consistent with previous findings. Other challenges were mentioned by almost an equal number of respondents: Unclear benefits (35), Changes in political direction (34), High investment cost (33) and unclear regulations (33).
Focusing on developments in the U.S. market, Kaminker said that HL7 is working on another FHIR accelerator called Gizmo that involves medical device interoperability. “We will focus on creating exchange for any device. It is a broad definition. It could be something in the hospital, something in the lab — any device will be covered by this accelerator,” he said. “We also are starting to think about a new accelerator on quality measures for next year.”
The FHIR accelerator program seeks to speed the development and availability of FHIR to deliver better data that leads to better health outcomes. Other accelerators include the Argonaut Project, Carin Alliance, Codex, Da Vinci, the Gravity Project, Helios and Vulcan.
Kaminker also brought up the vision of the CMS interoperability pledge to accelerate open standard-based data exchange and create what they call CMS-aligned networks to put patients and providers first. The goal is to give patients access to all electronic and medical information through applications of your choice. He noted that several health data networks have agreed to do this, as have 11 health systems and providers covering millions of patients, seven EHR vendors, and 30 patient-facing app companies. A core requirement is that all networks must commit to support and implement FHIR APIs, and the compliance deadline is July 4, 2026. “Interesting times if they do all of it,” he said. “It’s a pledge.”
In September, HL7 announced that CEO Charles Jaffe, M.D., Ph.D., would step down at the end of year, after nearly 20 years of leading the organization, and the board said a search for a successor was beginning.
