A national FHIR roadmap: The route to interoperability

By Niek van Galen, Interoperability Expert at Interoplab

The 2023 VWS FHIR decision brought clarity: The Netherlands adopts two fixed combinations of FHIR versions and zib versions as national baselines. FHIR STU3 with zib2017, and FHIR R4 with zib2020. That gave the sector stability. But the question of what comes next remains unanswered.

Two baselines, one open end

The choice for fixed baselines was sound. It gives vendors, healthcare organizations, and standards bodies a common starting point. But reality is stubborn: systems are now being built on R4, while R5 is already available internationally and R6 is in development. How do these relate to national choices?

FHIR R4 is a clear improvement over STU3, with normative components and better support for event-driven message exchange via Subscription resources. But R4 is not the endpoint.

The question facing us now

When comes the next Dutch baseline? Will it be R4 with zib2024 — an evolution within the current generation — or a bigger leap to R5? And how does that align with European EHDS requirements, which use R4 and R5 as the foundation?

These aren’t abstract questions. Vendors must make investment decisions now. Healthcare organizations are signing contracts now. Without clarity on the roadmap, those decisions are hard to justify.

What a FHIR roadmap must address

A good national FHIR roadmap must answer at minimum:

• What is the next baseline, and when is it expected?
• How long will the current baseline be supported?
• How do national choices align with international developments (EHDS, IPS)?
• What transition path applies for organizations implementing now?

This requires coordination between VWS, Nictiz, vendors, and healthcare organizations. The willingness is there — what’s missing is a formal framework to structure that conversation.

Conclusion

The decision to establish baselines was a step in the right direction. The next step is to be equally clear about what comes after. A national FHIR roadmap isn’t a luxury — it’s a prerequisite for scalable, future-proof interoperability in Dutch healthcare.

Questions about FHIR strategy and how to implement today with future-proofing in mind? Get in touch →