In United Kingdom, FHIR (Fast Healthcare Interoperability Resources, a standard for exchanging healthcare data) is used for several important use cases. It is not yet the main standard for all health data exchange, but adoption is growing.

The most widely used version is FHIR R4. Some teams still work with older versions like STU3 and DSTU2. Newer versions (R4B, R5, and R6) are not yet in active use.

Looking ahead, we expect a strong increase in FHIR adoption across the country in the coming years.

Rules and support

Healthcare in the UK is a devolved matter. England, Scotland, Wales, and Northern Ireland each set their own rules for health data and IT standards.

Key points about regulation and funding:

  • Yes, there are rules that mandate the use of standards for electronic health data exchange.
  • These rules specifically mandate FHIR.
  • There is a deadline for compliance, but no fines are imposed if it is missed.
  • Government funding is available to support FHIR adoption.

Key regulations:

  • In England, the Data (Use and Access) Act 2025 was passed in June 2025. It extends existing powers to mandate IT standards and, for the first time, brings IT suppliers directly within scope alongside care providers. While specific technical standards are still to be defined, it includes enforcement powers like public censure for non-compliant vendors. NHS policy points strongly to FHIR R4 (UK Core) as the basis for interoperability.
  • More information is available at NHS Digital Information Standards.
  • In Scotland, the Care Reform (Scotland) Act 2025 was passed in July 2025. It provides powers to mandate information standards for health and social care, with civil sanctions for non-compliance.

National setup

Each UK nation has its own organisation responsible for health data standards:

Core FHIR implementation guides (the technical rulebooks that explain how to apply FHIR locally) are widely used:

A national FHIR terminology server (a service that provides standard codes for medical concepts) is in production.

Additional resources from HL7 UK:

Active use cases

Many FHIR standards have been developed for specific use cases, including:

  • Prescriptions and pharmacy
  • Referrals and continuity of care
  • Provider directory
  • Terminology
  • Diagnostic orders and reports
  • Consent
  • Document exchange
  • Imaging
  • Genomics
  • Immunizations
  • Patient access
  • Scheduling
  • Allergy intolerance

Regarding the FHIR Community Process (FCP, a way for groups to publish FHIR specifications), one or more UK organisations are exploring becoming participants.

Who's using FHIR

The main groups adopting FHIR in the UK are:

  • Care providers
  • EHR (electronic health record) system vendors
  • Diagnostic system vendors, like imaging and laboratory systems
  • App developers
  • Government agencies

The main reasons for adopting FHIR include:

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

How FHIR is being used:

  • FHIR REST API (a way for systems to talk to each other over the web) is the most widely applied exchange method.
  • FHIR Messaging and FHIR Shorthand (a simple language for writing FHIR profiles) are used to a moderate extent.
  • SMART on FHIR (a way to add apps to electronic health records) is also being used.
  • FHIR Documents, CDS Hooks (a way to give clinical advice during workflows), and FHIR Questionnaires are used in a limited way.

Open source and proprietary FHIR software are used in roughly equal measure.

AI and machine learning are seen as somewhat helping FHIR efforts. Interest in FHIR as a foundation for AI is growing. The view that AI removes the need for structured data is strongly disagreed with.

Success stories and challenges

Successful FHIR projects in the UK include:

  • NHS England — Electronic Prescription Service
  • NHS England — GP Connect Access Record: Structured
  • Digital Health and Care Wales — National Data Resource (NDR)
  • Yorkshire & Humber Care Record (YHCR/Interweave)

The main benefits seen so far:

  • Improved access to information
  • Improved care workflows

The biggest challenges include:

  • High investment cost
  • Lack of FHIR knowledge
  • Legacy system complexity

Upcoming projects to look forward to:

  • NHS England Genomic Order Management Service
  • NHS England National Imaging Registry
  • UK Patient Summary
  • England Single Patient Record
  • England Single National Formulary
  • Maternity
  • Research

Future plans

Progress over the past year has been less than expected, and the current adoption rate is viewed with some dissatisfaction. Still, there were clear achievements:

  • New regulation mandating the use of standards in electronic health data exchange
  • Development of new FHIR standards for more specific use cases
  • Expanded adoption of FHIR across the healthcare ecosystem

Expected next steps in the coming year:

  • Further regulation on standards-based health data exchange
  • More FHIR standards for specific use cases
  • Wider adoption across the healthcare ecosystem

Looking three years ahead, there is agreement that the UK will start to see the benefits of FHIR adoption, including better care coordination and a stronger digital health ecosystem.

Contributors

  • Ben McAlister, Chair, HL7 UK

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

NHS England
We're the national information and technology partner to the health and social care system using digital technology to transform the NHS and social care
Everything Projects Packages Guides
HL7 UK
HL7 UK looks after HL7 activities in the UK. By joining, you gain access to our standards community and help us to create the best and most widely used standards in healthcare. For further information on HL7 UK please visit: https://www.hl7.org.uk/
Everything Projects Packages Guides
NHS Wales
Simplifier project for the NHS Wales FHIR Implementation Guide
Everything Projects Packages Guides