FHIR in the healthcare sector: Basics, use and challenges

The study is based on a systematic analysis of current scientific literature, including several studies on the implementation and use of HL7 FHIR in various contexts. Best practices, challenges and potentials of the standard were recorded and analysed with regard to their relevance for the SHIFT sub-project A.1, the Tech-Foundation.

1. Fragmented IT systems and lack of interoperability: Many hospitals in Switzerland use proprietary systems that make seamless communication difficult. FHIR relies on REST APIs and standardised resources to simplify data exchange and enable the integration of different systems (Nan & Xu, 2023).
2. Different data formats and coding systems: The variety of terminologies such as ICD-10, SNOMED CT or LOINC makes semantic interoperability difficult. The use of the FOXS stack (FHIR, openEHR, XDS, SNOMED CT) could create a consistent, interoperable data structure and facilitate exchange between institutions (Meredith et al., 2023)
3. Legacy systems and technological infrastructure: Many healthcare facilities in Switzerland work with outdated IT systems that are difficult to convert to modern standards. In Germany, FHIR is already integrated into national programmes, which promotes its dissemination(ISiK | Gematik, 2025).
4. Swiss challenges and development potential: The EPR is a central component of Switzerland's digital health strategy, but has so far only been implemented slowly (eHealth Suisse, 2024). The integration of FHIR could help to improve the use of the EPR and make it more interoperable with existing systems.
5. Lack of use of health data for research and AI: The availability and use of health data for research and AI applications falls short of the potential in Switzerland. According to the Digisanté initiative, the potential of structured and interoperable health data is not being sufficiently utilised (FOPH, 2024).

• Define an interoperability strategy: It would be advisable for healthcare organisations to develop a clear strategy for FHIR implementation that takes into account existing systems and gradually builds interoperability (Nan & Xu, 2023).
• Further develop the framework for interoperability: In order to connect siloed IT systems, legal frameworks should be created that include the obligation to use interoperable standards and the homologation of software systems. This could accelerate the integration of FHIR in the healthcare sector and support the digital transformation (eHealth Suisse, 2025)
• Use FHIR for real-time data processing: The use of FHIR for real-time data processing in emergency and monitoring systems can improve patient care, especially in the field of Internet of Medical Things (IoMT) (S. Rubí & L. Gondim, 2019).

• Use FOXS stack as a complementary solution: Combining FHIR with openEHR, IHE XDS and SNOMED CT could strengthen semantic and structural interoperability and enable more flexible data exchange (Meredith et al., 2023).
• Encourage participation in interoperability tests such as the Digital Health Projectathon: Events such as the Digital Health Projectathon 2025 provide a platform for practical testing and further development of FHIR implementations. Participation makes it possible to test systems for interoperability and improve technical integration(Digital Health Projectathon 2025 - Test Event, 2025).
• Optimised use of health data and AI applications: Greater standardisation as well as the targeted use of FHIR could facilitate the exchange and processing of large amounts of data. This could particularly advance research areas such as predictive analyses, personalised medicine and clinical decision support. The combination of FHIR with big data technologies and AI models can help to improve the quality of medical care and promote innovation in the healthcare sector (BAG, 2024).