This implementation guide specifies the Finnish FHIR base profiles.
{% include cross-version-analysis-inline.xhtml %} There is no plan yet to base this implementation guide on FHIR R5.
This implementation guide depends on the International Patient Access specification, and many profile definitions in this guide derive from IPA profiles.
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There is a separate Finnish Implementation Guide for SMART App Launch that describes how the SMART specification is applied in Finland.
See also all FHIR implementation guides published by HL7 Finland and also HL7 Finland in Simplifier.
The Profiles page lists some Finnish FHIR implementation guides published by other parties.
Better flow of information between systems is one of the key enablers for digitalization and improved efficiency of healthcare systems. Better flow of information is facilitated by interoperability standards. HL7 FHIR® is one of the most important standards for interoperability and exchange of healthcare data.
For many things in healthcare it is hard to achieve a global consensus over what data should be coded and communicated, and how. The base HL7 FHIR standard does an excellent job in defining the global consensus where it exists. At the same time, it specifically allows and encourages smaller communities to come up with more specific profiles and implementation guides.
In many cases, the HL7 FHIR standard allows for several ways to implement a functionality. There are increasing concerns that without a coordinated approach implementers will choose different ways to implement some features, and this will lead to challenges for interoperability. This implementation guide attempts to define a consensus within the Finnish FHIR implementers on which ways we have considered the best fit for use cases in Finland.
In this implementation guide we also describe the code systems and identifiers that are specific to the Finnish healthcare system.
There are dozens of FHIR enabled systems and applications implemented and in use in Finland. This list does not attempt to be a complete list of all implementations. Rather, it is included here for readers not familiar with the Finnish healthcare system, as a quick glance to some of the most notable implementations at the time of writing of the first version of this guide.
Kanta is the Finnish national central registry of health and social welfare information, with many services available for systems, providers, and citizens. Most of both the data and the APIs in Kanta system are based on HL7 V3 standards. However, there is ongoing work to open also FHIR based access to the information.
The part where HL7 FHIR is used the most is the Kanta PHR, a personal health record platform for storing and exchanging health and wellbeing data produced and governed by citizens. This part of Kanta is also the one most open to application developers.
Kanta has also implemented a FHIR APIs for prescription data and for social welfare services.
Omaolo is a collection of services developed by DigiFinland, a publicly funded company. Omaolo has a fully HL7 FHIR based personal health record platform as its core.
Health Village is yet another publicly funded group of services. It has built in HL7 SMART App Launch capability for interacting with third party apps.
Apotti is a sizeable Epic installation in Finland. Epic is one of the biggest electronic health record system vendors globally.
The OMNI360 by CGI Finland is one of the prominent Finnish electronic health record systems and has several native FHIR APIs.
The Esko APTJ by Esko Systems is also one of the prominent Finnish electronic health record systems. It uses several FHIR APIs internally, and offers a SMART App Launch method to interact with third party systems.
The FHIR Demo 2022 showcase presented integrations implemented between a dozen platforms and more than a dozen FHIR apps, all based on HL7 FHIR. The FHIR Demo 2023 concentrated on these base profiles. FHIR Demo 2024 extended the geographical scope of the showcase to cover the Nordic countries. The latest FHIR Demo can always be found on fhir.fi/demo.
Even those showcases do not cover the full extent to which HL7 FHIR is being used in Finland. There's a lot going on!
To learn about the current status, please contact HL7 Finland. We're happy to give you an overview.
The base FHIR specification works on a global scope. It is hard to achieve consensus on many things globally. However, smaller regions and jurisdictions are in a better position to agree on tighter constraints.
For instance, different coding systems and terminologies are used in different parts of the world. In this implementation guide, we document which code systems and terminologies are used in Finland and how they are applied in FHIR.
The FHIR standard also allows implementers to implement many features in several ways. One example is scheduling. Some jurisdictions are working on scheduling API's based on FHIR operations. In Finland, existing solutions have chosen to go with a more fine grained approach with pure FHIR resources and the REST interface.
<style> @counter-style danose { system: cyclic; symbols: 🇩🇰 🇳🇴 🇸🇪; suffix: " "; } @counter-style uscachauee { system: cyclic; symbols: 🇺🇸 🇨🇦 🇨🇭 🇦🇺 🇪🇪; suffix: " "; } </style>Our main intent is still to limit profiling specific to Finland. During the process, we actively monitor other national base profiles. We attempt to harmonize our base profiles with already published base profiles from other Nordic countries:
- the Danish DK Core
- the Norwegian core profiles for R4 HL7 Norway no-basis
- the Swedish Base Profiles
See the presentation slides of the session Nordic harmonization of health data, given in the Vitalis conference in May, 2023. They include an initial comparison of the Danish, Finnish, Norwegian, and Swedish base profile specifications.
Other national base profiles we have drawn inspiration from include
- the US Core
- the Canadian baseline
- the Swiss CH Core
- the Australian AU Base
- the Estonian Base Implementation Guide
Many of the Finnish FHIR base profiles derive from the International Patient Access (IPA) specification, and we will do our best to keep the specifications conformant where possible. Should we find any constraints in IPA that we can't adhere to, the main resolution should be to affect the IPA specification and search for wider consensus and shared understanding.
Regarding international cooperation, please see also the National IG Implementations page in HL7 International's Confluence.
The FHIR community is currently figuring out how different implementation guides interact and can be layered. See, for instance, the layering approach in the Norwegian base profiles and the explanation on the Canadian Baseline specification.
According to those terms, this version of this implementation guide is closest to the national baseline profile. Its main purpose is to inform implementers of approaches already chosen, and thereby avoid re-implementing the wheel in a different form for new implementations.
There are other, more use case specific FHIR implementation guides in Finland. For instance, both the Finnish Appointment IG and the Finnish Scheduling IG focus on scheduling.
Especially the Kanta specific implementation guides for Finnish PHR, Kanta FHIR Prescription, and Kanta sosiaalihuolto are closer to national Core profile specifications.
This implementation guide may also in the future be extended to cover core profiles, in addition to the base profiles of this version.
This version of this implementation guide does not define any Must Support rules.
As explained in the FHIR specification (see link above), the meaning of the Must Support rules defined in the IPA specification apply as specified there for all profiles in this implementation guide that depend on an IPA profile.
We publish profile resources that help implementers validate their implementations.
We also publish examples, as we think they are another good way to interoperability.
Also, where we cannot find consensus and agree on one single approach, we attempt to document all different approaches used.
The main aim of this implementation guide is to inform vendors on how to implement the FHIR specification in Finnish context. Requirements and constraints are limited, in order to allow for maximum reusability across a variety of use cases.
In the first versions of the implementation guide, a lot of profiling is done on resource type level. For instance, the patient identifier is profiled for the Patient profile. Another approach would be to concentrate on data types. We may evolve the profiling towards that direction in the future.
The profiling work is performed in a project driven by HL7 Finland. See the announcement (in Finnish), the running memo, and some more details. We warmly welcome new participants to the project. You may even be compensated for your efforts.
The team involved in creating the first version of the specification includes
- Arto Huusko, CGI Oyj
- Janne Heikkinen, BCB Medical Oy
- Jari Kariniemi, Kymenlaakson hyvinvointialue
- Jari Vuonos, Apotti Oy
- Joni Hirviniemi, Fujitsu
- Jyrki Soikkeli, Apotti Oy
- Kalle Moilanen, Esko Systems Oy
- Marko Kaukonen, BCB Medical Oy
- Markus Lind, Buddy Healthcare Oy
- Markus Suonpää, CGI Finland Oyj
- Miika Langille, Esko Systems Oy
- Mika Jylhä, Esko Systems Oy
- Mika Lentovaara, HUS
- Mika Tuomainen, Kela
- Mikael Rinnetmäki, Sensotrend Oy
- Tero Pekkola, Esko Systems Oy
Each published major version of this implementation guide goes through the ballot and voting processes of HL7 Finland, and then represents the consensus view of the Finnish FHIR community.
We want this implementation guide to be useful for you.
If you are implementing FHIR in a system or application that is meant to be used in Finland and are thinking of some implementation details, you are probably in the right place and this implementation guide should help you with those questions. If this implementation guide in any way fails to give you the answers you are looking for, we'd love to hear about it so we can make it better. Please do be in touch in one of the ways listed below.
The source code of this implementation guide is maintained in a publicly accessible repository in GitHub. Issues opened in that GitHub repo are very welcome. They help the team pick up any proposed changes or additions and to discuss them publicly.
Pull requests are even better. If you are in a position to suggest how exactly your proposal should be implemented in the specification, do it! It helps the team maintaining the implementation guide a great deal.
Please also consider joining the development effort. This is the best way to affect the outcome of the profiling work. You may even be compensated for your efforts. Please be in touch with HL7 Finland to discuss options, if this even remotely interesting for you.
The best implementation guide is the one that reflects the views and the consensus of the whole FHIR community!
This implementation guide defines data elements, resources, formats, and methods for exchanging healthcare data between different participants in the healthcare process. As such, clinical safety is a key concern. Additional guidance regarding safety for the specification’s many and various implementations is available at https://www.hl7.org/FHIR/safety.html.
Although the present specification does give users the opportunity to observe data protection and data security regulations, its use does not guarantee compliance with these regulations. Effective compliance must be ensured by appropriate measures during implementation projects and in daily operations. The corresponding implementation measures are explained in the standard. In addition, the present specification can only influence compliance with the security regulations in the technical area of standardisation. It cannot influence organisational and contractual matters.
This document is licensed under Creative Commons CC0 1.0 Universal Public Domain Dedication.
This implementation guide contains and references intellectual property owned by third parties ("Third Party IP"). Acceptance of these License Terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise.
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See also http://hl7.org/fhir/license.html.
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