In Greece, FHIR is being used for several healthcare data exchange use cases. It is not yet the main standard, but adoption is growing steadily.

The most common FHIR versions in use are R4 and R5. Older versions like DSTU2 and STU3 are not in use. R4B and R6 (the pre-release version) have unclear adoption levels.

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

Rules and Support

Here's how Greece regulates health data exchange:

  • Regulation exists: Yes, regulations require the use of standards for electronic health data exchange.
  • FHIR status: FHIR is advised, but not strictly mandated.
  • Compliance deadlines: Unclear.
  • Penalties for non-compliance: Unclear.
  • Government funding: No specific government funds are available to support FHIR adoption.

National Setup

Greece has a clear structure for managing health data standards:

  • Standards organization: HL7 Hellas leads health data standards work in the country.
  • National base FHIR implementation guide: Under development. You can follow progress on the HL7 Hellas GitHub page.
  • Terminology server: A national FHIR terminology server is currently in development.
  • FHIR Community Process (FCP): The status in Greece is currently unclear.

Active Use Cases

Greece bases its national FHIR work on several international specifications:

  • International Patient Summary
  • European Implementation Guides
  • IHE profiles

A national base FHIR implementation guide is being developed, but no other use case-specific FHIR standards have been created yet.

Who's Using FHIR

The main organizations adopting FHIR in Greece include:

  • Payers and insurers
  • EHR (electronic health record) system vendors
  • Diagnostic system vendors, such as imaging and lab providers
  • App developers
  • Government agencies
  • Researchers

The main reasons driving FHIR adoption are:

  • Regulation and grants
  • Improving care workflows
  • Supporting innovation

How FHIR is being used

The most widely adopted FHIR exchange mechanisms in Greece are:

  • FHIR REST API: The most heavily used approach for exchanging data.
  • FHIR Documents: Strong adoption.
  • FHIR Messaging: Not currently used.

Common FHIR tools in Greece include:

  • FHIR Shorthand: A shorthand language for writing FHIR specifications — widely used.
  • FHIR Bulk Data: Used for large-scale data exchange.
  • FHIR Questionnaires and SDC (Structured Data Capture): Moderately used.

Open source software dominates over proprietary FHIR tools in Greece.

Success Stories and Challenges

Key success

The National EHR API stands out as a successful FHIR use case in Greece. It has delivered:

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

Main challenges

Greece faces several obstacles to broader FHIR adoption:

  • High investment costs
  • Unclear benefits for some stakeholders
  • Unclear regulations
  • Changes in political direction

AI and FHIR

There's a notable view in Greece that, given AI advances, heavy investment in FHIR and structured data may be less critical, since AI can interpret unstructured data directly. So far, AI and machine learning have had no noticeable impact on FHIR efforts in the country.

Future Plans

Progress over the past year

Last year, Greece made more progress than expected, including:

  • Development of a national FHIR data model
  • Creation of new FHIR standards for specific use cases
  • Launch of pilot projects with healthcare stakeholders
  • Expanded adoption of FHIR across the healthcare ecosystem

Overall satisfaction with the adoption rate is neutral.

What's coming next

In the coming year, we expect to see:

  • Further development of the national FHIR data model
  • More FHIR standards for specific use cases
  • Additional pilot projects with healthcare stakeholders

The outlook for the next three years on whether FHIR will deliver significant cost savings, better care coordination, and a stronger digital health ecosystem remains neutral.

Contributors

  • Nikos Kyriakoulakos, Secretary General, HL7 Hellas

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