In Spain, FHIR is gaining traction as a healthcare data exchange standard. Adoption is growing, with FHIR used in several projects and viewed as central to the national digital health strategy. FHIR is a modern standard for exchanging healthcare information between systems.

The main version in use is R4, with some activity also around R5, R6 (pre-release), and even older DSTU2. Other versions like STU3 and R4B see less use.

Respondents expect a strong increase in FHIR adoption in the coming years.

Rules and Support

Spain has regulation in place that mandates the use of standards in electronic health data exchange.

  • FHIR is specifically mandated by the regulation
  • All new projects are required to support FHIR
  • A compliance deadline is included in the regulation
  • It is unclear whether fines apply when deadlines are missed
  • Government funding to stimulate FHIR adoption is reported as available by some, though views differ

National Setup

Spain has a national organization responsible for health data standards.

  • HL7 Spain is the main standards association
  • The Ministry of Health e-Health page covers the national level
  • A national base/core FHIR implementation guide is under development, published at unicas-fhir.sanidad.gob.es
  • A national FHIR terminology server is in production (a terminology server provides standard codes used across systems)

The status of the FHIR Community Process (FCP) in Spain is not widely known among respondents.

Active Use Cases

Spain bases its national FHIR work on several international specifications:

  • International Patient Summary (a standard summary of a patient's key health data)
  • European Implementation Guides
  • IHE profiles (international integration profiles for healthcare)

A notable national project is UNICAS, highlighted as a successful FHIR use case.

Who is Using FHIR

The main stakeholders adopting FHIR in Spain are:

  • Care providers
  • EHR system vendors
  • Diagnostic system vendors (such as imaging and lab systems)
  • Government agencies

The main drivers for adoption are:

  • Regulation and grants
  • Improving health outcomes
  • Improving care workflows
  • Improving patient data access

In terms of how FHIR is used, the REST API, FHIR Messaging, FHIR Documents, and SMART on FHIR (a way to securely connect apps to health records) all see meaningful use. Open source and proprietary FHIR software are both in play, with a lean toward open source.

Success Stories and Challenges

Reported benefits of FHIR in Spain include:

  • Improved healthcare outcomes
  • Better access to information
  • Improved care workflows

Spain is also noted as having the most FHIR-certified professionals in Europe and the second-most in the world.

The main challenges to wider FHIR adoption are:

  • High investment costs
  • Unclear regulations
  • Lack of FHIR knowledge
  • Changes in political direction

On the impact of AI on FHIR, views are mixed. Some see AI as increasing interest in FHIR as a foundation for AI systems, while others feel AI efforts may slightly slow structured data work. Most respondents disagree that AI removes the need for structured data like FHIR.

Future Plans

Spain has made the progress expected over the past year. Key achievements include new regulation prescribing standards for electronic health data exchange, and the launch of pilot projects with healthcare stakeholders.

Looking ahead, respondents expect:

  • New regulation around standards in health data exchange
  • Development of new FHIR standards for more specific use cases
  • Launch of more pilot projects
  • A key upcoming project is participation in MyHealth@EU services, including:
    • ePrescription and eDispensation
    • Patient Summary
    • Laboratory Results Reports
    • Medical Imaging
    • Discharge Reports
    • EUVac (vaccination records)
  • Regional data interchange is another focus area

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

Contributors

  • Francisco Javier Pérez, Chair, Asociación HL7 Spain
  • One additional 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.