Global FHIR Adoption Gains Momentum, But Policy and Implementation Gaps Persist: 2025 Survey Results

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Firely and HL7 International announced the release of the 2025 State of FHIR survey report, based on input from 82 experts across 52 countries. This report provides a comprehensive look at real-world adoption, implementation, and regulation of HL7 FHIR®. The findings show a clear global surge in momentum: over 70% of surveyed countries report active FHIR use for national use cases, and 54% anticipate strong growth in the next three years. However, significant hurdles persist despite this progress. Key challenges identified include: 1. Limited Primary Standard Adoption: While used widely, only a minority have adopted FHIR as their primary national exchange standard (exceptions noted like Israel and India). 2. Underutilized Implementation Guides: 79% of respondents report having a national FHIR IG, but only 20% say it is widely utilized. 3. Enforcement Lag: Although mandated or recommended in 73% of countries, fewer than half have defined compliance deadlines, and only 16% impose penalties for non-compliance. 4. Version Fragmentation: Multiple versions (R4, R4B, R5) coexist nationally, complicating interoperability even in high-adoption regions. The report emphasizes that while FHIR is the most scalable path for data exchange, realizing its full benefit requires sustained investment, education, and coordinated global governance to prevent fragmentation.