In Canada, FHIR is being used in a growing number of healthcare data exchange cases. It is not yet the main standard, but adoption is steady. R4 is the most widely used version. STU3 still appears in some implementations, and R5 is starting to see limited use.

Survey responses suggest a moderate-to-strong increase in FHIR adoption over the coming years. Several provincial health ministries are adopting FHIR profiles for their own implementations, which is helping push adoption forward.

The picture across the country is somewhat fragmented, but momentum is building through national and provincial efforts.

Rules and Support

Canada does not yet have regulation that mandates standards for electronic health data exchange. However, change is expected:

  • No current law requires the use of FHIR.
  • Pending federal legislation (Bill S-5, the Connected Care for Canadians Act) is expected to encourage data sharing.
  • Future regulations stemming from this bill may include requirements around FHIR.
  • Some government funding is available to support FHIR adoption, though details are limited.

The National Setup

Canada has national organizations responsible for health data standards:

A national base FHIR implementation guide is under development:

A national FHIR terminology server is in production. Terminology servers help systems share consistent codes for things like diagnoses and medications.

Active Use Cases

FHIR specifications are being developed in Canada for many areas, including:

  • Prescriptions and pharmacy
  • Referrals and continuity of care
  • Provider directory
  • Public health reporting
  • Terminology
  • Diagnostic orders and reports
  • Document exchange
  • Immunizations
  • Patient access
  • Allergy intolerance

Canadian work also draws on international specifications:

  • International Patient Summary (IPS)
  • IHE profiles

Specific projects mentioned include the Integrated RAI Reporting System (IRRS) and work based on the International Patient Summary. A Canadian common data initiative (CACDI) was also referenced.

Who's Using FHIR

The main groups adopting FHIR in Canada include:

  • EHR (electronic health record) system vendors
  • Government agencies
  • Diagnostic system vendors, such as imaging and lab providers
  • Clinical registries

The main reasons driving FHIR adoption are:

  • Improving health outcomes
  • Patient data access
  • Regulation and grants
  • Innovation

FHIR is being used through several technical approaches. FHIR Messaging and the FHIR REST API (a standard way for systems to request and share data) are the most common. SMART on FHIR (a way to securely launch healthcare apps) and FHIR Shorthand (a simple way to write FHIR profiles) are also seeing meaningful use. CDS Hooks (which provide clinical decision support during care) appears in some implementations.

Success Stories and Challenges

Some clear benefits have been seen:

  • Improved access to information
  • Improved healthcare outcomes

Concrete examples include:

  • The Integrated RAI Reporting System (IRRS)
  • International Patient Summary work

The main challenges include:

  • High investment cost
  • Unclear regulations
  • Lack of FHIR knowledge
  • Unclear benefits in some areas

Open source and proprietary FHIR software are both in use, with a slight lean toward proprietary tools.

Future Plans

Over the past year, Canada has made the progress respondents expected. Key achievements include:

  • Development of a national FHIR data model
  • Development of new FHIR standards for specific use cases
  • Launch of pilot projects with selected healthcare stakeholders

Looking ahead, respondents expect:

  • New regulation prescribing the use of standards (likely linked to Bill S-5)
  • Development of more FHIR standards for specific use cases
  • Wider adoption of FHIR across the healthcare ecosystem
  • More pilot projects
  • Growing involvement in the FHIR Community Process (FCP)

Overall, respondents agree that within the next three years Canada will start to see real benefits from FHIR adoption, including better care coordination and a stronger digital health ecosystem.

Contributors

  • Anil Patel, Canada Health Infoway
  • Elliot Silver, ResMed
  • One respondent 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.

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