The Future of FHIR in the UK

Fast Healthcare Interoperability Resources (FHIR) has become central to modernising the UK healthcare ecosystem. As the NHS embraces digital transformation and Integrated Care Systems (ICSs), FHIR is more than a technical standard—it’s a national imperative. This article explores the state of FHIR in UK healthcare, its governance, benefits, challenges, and the strategic roadmap that lies ahead.

1. FHIR and the UK Healthcare Landscape

FHIR, developed by HL7 International, defines a flexible and modern API standard using REST, JSON, XML, and RDF to enable electronic health data exchange. In the context of UK healthcare, FHIR provides a foundation for interoperability between GP systems, hospitals, community care, social care, and digital services like the NHS App.

The UK-specific implementation strategy, known as FHIR UK Core, unifies FHIR profiles across England, Scotland, Wales, and Northern Ireland, establishing national design patterns, extension libraries, and governance processes.

2. Drivers of FHIR Adoption in the UK

Regulatory and Legislative Push

The Data (Use and Access) Act 2025 mandates standardised data and technology frameworks across NHS and social care organisations in England. While it doesn’t explicitly name FHIR, NHS policy documents strongly indicate its use for APIs and data exchange.

The Health and Care Act (2022) and Health and Social Care Act (2012) provide broader legal frameworks promoting standardisation and interoperability.

NHS Digital Leadership & Interoperability Programmes

NHS Digital (now part of NHS England) champions FHIR through its API catalogue and integration strategy. Interoperability initiatives emphasise seamless information sharing—for instance, NHS Pathology Services are transitioning from legacy messaging to FHIR-compliant systems and the Unified Test List.

National Strategy & Frameworks

The UK’s digital vision (GOV.UK) underscores FHIR alongside other standards such as SNOMED CT, dm+d, ICD-11, UCUM, and API authentication tools like OAuth 2.0 and OpenID Connect. This multi-standard framework ensures that FHIR works in harmony with identity, terminology, and clinical coding systems.

3. Benefits of FHIR for UK Healthcare

Interoperability & Care Coordination

FHIR enables real-time, modular access to key clinical data—patients, allergies, medication, diagnostics—facilitating smoother care coordination across GPs, hospitals, and social services.

Efficiency & Reduced Friction

By reducing reliance on patchwork legacy integrations, FHIR simplifies clinical data workflows, improves operational efficiency, and supports ICS-driven initiatives.

Innovation & Scalability

FHIR’s developer-friendly RESTful architecture invites innovation, from mobile apps to AI-powered clinical decision support systems. Cutting-edge implementations like the MCP-FHIR framework showcase its potential in real-time summarisation and personalised EHR insights using LLMs.

Patient Empowerment & Data Access

Through APIs backed by FHIR, patients gain access to their health information via platforms like the NHS App, enabling shared decision-making and self-care.

Research & Public Health

FHIR’s structured, scalable data enables population health monitoring and research—without compromising on data quality or governance.

4. Current Challenges & Constraints in the UK

Legacy Systems & Fragmented Infrastructure

Many UK healthcare providers still operate on decades-old systems lacking standard APIs. Integration requires deep expertise to bridge these legacy systems with modern FHIR-based solutions.

Uneven Implementation of Standards

Despite national FHIR profiles, adoption across regions and vendors remains inconsistent, resulting in varied data quality and interoperability.

Skills Gaps & Cultural Resistance

Shortages in healthcare informatics, and limited FHIR literacy among clinicians and IT teams, slow adoption. Strategic upskilling and workforce transformation are critical.

Governance & Security Concerns

Though FHIR lacks built-in security mandates, integrating robust authentication (OAuth, FIDO) and aligning with Caldicott and privacy guidelines remains challenging.

5. Future Outlook: The Road Ahead for FHIR in the UK

Accelerated National Mandates

The enforcement of FHIR as the standard for APIs will likely increase. Legislative and NHS-level guidance will push both uptake and vendor compliance.

Legacy Infrastructure Transformation

Larger tech modernisation programs will prioritise dismantling siloed systems, advancing FHIR-compatible architectures, and integrating cloud-native services to support scalability.

Education & Community Building

Bodies like HL7 UK and INTEROPen will play a critical role in expanding training, hosting events, and fostering collaboration among NHS, developers, and digital health innovators.

Innovation Ecosystem Growth

Expect broader integration of AI, mobile health apps, and research tools built on FHIR infrastructure—especially MCP-FHIR frameworks and serverless FHIR solutions.

Cross-UK & EU Interoperability

With FHIR UK Core, interoperability will span across devolved nations. The EU’s digital health strategies (e.g., EHDS) further reinforce FHIR’s cross-border potential.

6. Recommendations for Professionals & Organisations

Recommendation	Action
Invest in FHIR Literacy	Encourage training for clinical and IT staff through HL7 UK and NHS clinics.
Embed FHIR in Vendor Contracts	Specify compliance with FHIR UK Core and national API guidelines in procurement.
Engage in Governance & Collaboration	Participate in NHS, ICS, HL7 UK, and INTEROPen forums to shape implementations.
Pilot Smart Integrations	Start with non-critical data flows (e.g., test results) to build momentum.
Monitor & Measure Impact	Track metrics like reduction in duplication, integration time saved, and data quality uplift.

Conclusion

The future of FHIR in UK healthcare is no longer hypothetical—it’s actively shaping the healthcare system’s digital DNA. With governance from NHS England, regional collaboration across devolved systems, and global interoperability potential, FHIR is poised to become the standard foundation for data exchange.

For professionals and NHS leaders, investing in FHIR literacy, participating in governance, and driving adoption in procurement and organisation strategy will ensure that "interoperability" becomes a clinical enabler—not a technical afterthought.

The future is interoperable, patient-centric, and powered by FHIR—and that future is now.