In Nepal, FHIR is being used for a small number of use cases. It is not yet the main standard for health data exchange, but adoption is growing. FHIR stands for Fast Healthcare Interoperability Resources, a standard for sharing health data between systems.

Most current FHIR work in Nepal uses version R4 in production systems, with some early use of R5 for new national specifications. Older versions like DSTU2, STU3, and R4B are not in active use.

Respondents expect FHIR adoption to grow in the coming years. The country is in a transition phase, moving toward a more structured and interoperable digital health system.

Rules and Support

Nepal has regulations that mandate standards for electronic health data exchange. Here is a summary:

  • Regulation in place: Yes, standards are required for health data exchange.
  • FHIR status: FHIR is mandated in some areas and advised in others.
  • Compliance deadline: No deadline is set.
  • Fines: No fines apply for missing compliance.
  • Government funding: No specific government funds support FHIR adoption.

Nepal's digital health ecosystem combines national regulations, public insurance programs, and emerging interoperability standards. Key elements include:

  • The Health Insurance Act (2017), which governs national health insurance.
  • The Health Insurance Board (HIB), which runs the national insurance program. Learn more at openIMIS Nepal.
  • The Social Security Fund (SSF), which provides health, accident, pension, and social protection benefits.
  • The openIMIS platform, used for enrollment, claims, and payments. See openIMIS.

Challenges include fragmentation across systems, limited enforcement of standards, and a lack of specific health data privacy rules.

National Setup

Nepal has a national organization responsible for health data standards.

A national core FHIR implementation guide is under development:

  • Name: Nepal HMIS FHIR Implementation Guide
  • Current version: 0.0.1-ballot (draft)
  • Based on: FHIR R5
  • Link: fhir.hmis.gov.np (note: the site is not always accessible)

It defines standardized resources such as Patient, Observation, and Medication.

A national FHIR terminology server is in development. A terminology server provides standard codes for medical concepts.

Active Use Cases

Nepal uses FHIR in several practical ways:

  • Electronic claims processing through openIMIS for HIB and SSF.
  • Patient demographics and master patient index for identifying patients across systems.
  • HMIS data collection and reporting for national health reporting.
  • Pilot use of FHIR Questionnaires for enrollment.
  • Terminology standardization supported by SIL-Nepal.

For international standards, Nepal uses IHE profiles (Integrating the Healthcare Enterprise, a set of profiles for health data exchange) as a basis for its national specifications.

Who Is Using FHIR

The main FHIR adopters in Nepal include:

  • Care providers
  • Payers and insurers
  • EHR (Electronic Health Record) system vendors
  • Diagnostic system vendors (imaging and lab)
  • Clinical registries
  • Government agencies
  • Researchers

The main drivers for adoption are:

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

Most FHIR work uses the REST API mechanism, where systems request and exchange data over the web. FHIR Documents and FHIR Questionnaires are used to a lesser extent. Tools like SMART on FHIR, CDS Hooks, and Bulk Data are in early or limited use.

Success Stories and Challenges

Successful FHIR projects in Nepal have improved healthcare outcomes and access to information. Examples include:

  • Claims processing through openIMIS for the national insurance schemes.
  • Patient identification across systems.
  • Pilot enrollment using FHIR Questionnaires.

Main challenges include:

  • High investment cost
  • Lack of FHIR knowledge among teams
  • Unclear benefits for some stakeholders
  • Unclear regulations
  • Changes in political direction

Open source software dominates FHIR implementation in Nepal, with limited use of proprietary tools.

Future Plans

Last year, Nepal made progress on developing a national FHIR data model. Some respondents felt progress was on track, while others felt it was slower than expected.

Looking ahead, Nepal expects to:

  • Develop a national FHIR data model.
  • Introduce new regulation that prescribes standards for health data exchange.
  • Develop FHIR standards for more specific use cases.
  • Launch pilot projects with selected healthcare stakeholders.
  • Expand FHIR adoption across the healthcare ecosystem.

Specific use cases on the horizon include:

  • Nationwide integration of patient records across hospitals.
  • Real-time electronic claims processing for HIB and SSF.
  • Interoperability with laboratory and diagnostic systems.
  • Expanded use of FHIR Questionnaires for community health programs.
  • Implementation of standardized terminology services (ICD-10, LOINC, SNOMED CT).

For the FHIR Community Process (FCP), an international process for approving FHIR specifications, Nepal currently has no known activity. Within 2–3 years, respondents expect one or more organizations to explore or become FCP participants.

Respondents agree that within the next three years, Nepal will benefit from FHIR adoption through cost savings, better care coordination, and a stronger digital health ecosystem.

Contributors

  • Vicky Pandey, Solution Architect, Mavorion Systems Pvt. Ltd.
  • One contributor 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.