In Belgium, FHIR is being used for a few specific healthcare data exchange cases. It is not yet the main standard, but adoption is growing.

The main version in use is FHIR R4. Some R5 activity may also be happening, but this is less clear.

Looking ahead, we expect a strong increase in FHIR adoption in Belgium over the coming years.

Rules and Support

Belgium does not yet have regulation that mandates the use of standards for electronic health data exchange. However, government funding is available to support FHIR adoption.

  • Mandatory standards: No regulation in place
  • FHIR-specific rules: None mentioned
  • Funding: Available through Data Capabilities projects
  • Related initiatives: eHealth and BMUC

National Setup

Belgium has a national organization responsible for health data standards. A national base FHIR implementation guide is also widely used.

A "base" or "core" implementation guide is a foundational set of rules that defines how FHIR should be applied in the country.

Active Use Cases

Belgian FHIR work builds on European Implementation Guides as the international foundation. The country has at least one successful FHIR use case in production.

  • Known project: SHIFT
  • International basis: European Implementation Guides
  • Upcoming use case to watch: Problem list integration in HiX (Chipsoft EHR)

Who's Using FHIR

The main groups adopting FHIR in Belgium include:

  • Diagnostic system vendors (such as imaging and lab providers)
  • App developers
  • Clinical registries
  • Government agencies

The main driver for adoption is regulation and grants. Belgium also leans strongly toward open source FHIR software rather than proprietary tools.

Success Stories and Challenges

The SHIFT project stands out as a successful example. A key benefit reported is uniform integration possibilities, meaning systems can connect in a more consistent way.

Main challenge: Large EHR (Electronic Health Record) vendors are not yet implementing FHIR standards. This slows down wider adoption.

Use case to look forward to: The problem list feature in HiX (Chipsoft).

Future Plans

Progress over the past year matched expectations, with pilot projects launched and broader FHIR adoption across the healthcare ecosystem. However, satisfaction with the current pace remains low.

  • Last year's progress: As expected
  • Current satisfaction level: Dissatisfied
  • Next year's focus: Expanded FHIR adoption across the healthcare ecosystem
  • Three-year outlook: Strong confidence that FHIR will deliver cost savings, better care coordination, and a stronger digital health ecosystem

Concerns remain about how AI and machine learning may reduce the perceived need to invest in structured FHIR data, since AI can interpret unstructured information directly.

Contributors

The contributor to this survey chose to remain anonymous.

The above summary is based on the answers to the State of FHIR Survey 2026, organized by Firely and HL7 International.

healthdata.be (Sciensano)
Within the domain of health and healthcare, there are a large number of data flows with various objectives operational in Belgium: administrative data flows, data flows that guarantee the continuity of care (patient-related follow-up), or the traceability of a condition, medicine or healthcare product. There are also many data collections in the context of epidemiology and quality of care, for example. This last group of scientific data collections, the so-called registries, is characterised by a heterogeneous methodological approach, not only in terms of technology (paper, fax, email, web applications, batch upload, web services), but also with regard to content (different data structures). Furthermore, the same data is often requested multiple times from the same data provider. The consequences of this diversity for the providers and collectors of this data include reduced efficiency in the registration and processing of the information (a lot of manual data cleaning, retyping and mapping), real privacy risks and the scattered deployment of IT resources and people for the same tasks. Moreover, this context is not motivating for the (highly skilled) employees involved in these data collections (both among the data providers and the researchers). Finally, this situation leads to a high (direct and indirect) financial commitment on the part of data providers, the researchers and their clients. The healthdata.be team opted to align the standardization of these so-called "real world data" projects with the clinical context (in stead of starting from the research context) and to look for an information architecture that can be technically implemented in the various applications used in the Belgian healthcare landscape. One of the initiatives studied by the healthdata.be team is the “Registration at the source” project of the Dutch University Medical Centers (UMCs), united in the Dutch Federation of University Medical Centers (NFU). Within this initiative, which is supported by the National ICT Institute in Healthcare (NICTIZ), it was decided to work together in the field of standardization of healthcare data. The result of this collaboration is a set of so-called “Zorginformatiebouwstenen” (or Clinical Building Blocks). These Dutch Zorginformatiebouwstenen are reviewed and adapted to national landscape by the healthdata.be team and their stakeholders. The result are "Clinical Building Blocks" which are published on Simplifier as logical models. In a next step, the clinical building blocks will be translated into HL7 FHIR R4 compliant profiles and related conformance materials for data collections supported by healthdata.be (Sciensano). All assets will become available on Simplifier.
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