In Croatia, FHIR is used for a limited set of healthcare data exchange use cases. Adoption is growing, with one respondent describing it as a leading approach and another noting it is still emerging.

The main version in use is FHIR R4. Other versions are not actively reported.

Respondents expect FHIR adoption to increase in the coming years, with growing use across the national health information system.

Rules and Support

Croatia has regulation that supports the use of standards in electronic health data exchange. Here is what you need to know:

  • Regulation is in place for health data exchange standards.
  • FHIR is advised, but not strictly mandated in all situations.
  • A compliance deadline exists, but no fines are imposed for missing it.
  • Government funds help support FHIR adoption. Central services are funded by the state budget and EU funds. Providers fund their own implementations, often with government support.

You can read the regulation here: Croatian Official Gazette regulation.

The central platform, CEZIH (Central Health Information System), is operated under the Ministry of Health and HZZO. It mandates the use of IT standards, including FHIR, for data exchange among Croatian healthcare institutions.

National Setup

Croatia does not have a dedicated national organization for health data standards. However, national resources are available:

  • Base FHIR implementation guide: CEZIH Base Guide on Simplifier
  • National terminology server: Available and in production.
  • Additional FHIR specifications: Several have been developed for specific use cases.

Active Use Cases

FHIR specifications in Croatia are being developed for several areas:

  • Provider directory
  • Terminology
  • Diagnostic orders and reports
  • Clinical decision support
  • Document exchange
  • Imaging
  • Allergy intolerance

Croatian work also builds on international specifications, including:

  • International Patient Summary
  • European Implementation Guides
  • IHE profiles

Who Is Using FHIR

The main groups adopting FHIR in Croatia include:

  • Government agencies
  • EHR system vendors
  • App developers

The main reasons for adoption are:

  • Meeting regulation and using available grants
  • Improving patient data access
  • Improving care workflows

How FHIR is used:

  • FHIR Messaging, Documents, and REST API: Widely used.
  • Subscriptions: Used in several scenarios.
  • CDS Hooks, CQL on FHIR, and Questionnaires (SDC): Used at a moderate level.

The mix of open source and proprietary FHIR software is fairly balanced.

Success Stories and Challenges

Success stories:

  • Clinical data is exchanged via the national Shared Health Records infrastructure.
  • A central EHR portal has been built on top of this shared data.
  • Benefits include improved access to information and better care workflows.

Main challenges:

  • High investment costs
  • Limited FHIR knowledge among stakeholders
  • Unclear benefits for some adopters

Looking ahead: Croatia plans to launch screening programs based on CDS Hooks, Computable Care Guides, and Clinical Practice Guidelines.

Future Plans

Progress so far:

  • Pilot projects launched with selected healthcare stakeholders.
  • Development of new FHIR standards for specific use cases.
  • Expanded adoption of FHIR across the healthcare ecosystem.

Views on progress: Opinions vary. One respondent feels progress has been less than expected, while another says it has matched expectations.

Next steps expected in the coming year:

  • Establishing a national standards organization
  • Developing a national FHIR data model
  • Continuing pilot projects

Looking 2–3 years ahead: Respondents expect one or more Croatian organizations to start exploring participation in the FHIR Community Process (FCP). There is cautious optimism that FHIR adoption will bring meaningful benefits, including better care coordination and a stronger digital health ecosystem.

Contributors

  • Sinisa Koscina, Business Development Director, Healthcare, IN2
  • Kresimir Kers, Product Manager, Ericsson Nikola Tesla

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