Wafae Abbaoui, Soumia Ziti, Sara Retal
FHIR has successfully catalyzed widespread technical innovation and serves as the foundation for advanced clinical applications. However, a significant translational gap persists. Future efforts should expand beyond technical development. To bridge the divide between prototype and widespread clinical impact, rigorous studies are needed in three areas: implementation science, user-centered design, and sustainable value demonstration.
BACKGROUND: The Fast Healthcare Interoperability Resources (FHIR) standard is heralded as a key solution to healthcare's pervasive interoperability challenges, promising to enable a new ecosystem of connected clinical applications. However, a comprehensive synthesis of its real-world implementation landscape is lacking.
OBJECTIVE: This narrative review aims to map the current domains of FHIR-based clinical applications, assess their implementation maturity, and identify critical trends and translational gaps.
METHODS: A systematic search was conducted in Scopus and PubMed for English-language articles published between January 2019 and January 2026. Studies describing concrete FHIR-based tools with empirical findings in clinical or research settings were included. A thematic synthesis was performed, structuring the findings into a functional taxonomy and an implementation maturity framework.
RESULTS: The analysis of 20 studies reveals that FHIR enables six core functional paradigms: (1) Artificial Intelligence and Decision Support, (2) Large-Scale Surveillance and Research, (3) Patient Safety and Care Coordination, (4) Patient Empowerment and Telehealth, (5) Semantic Interoperability and Advanced Modeling, and (6) Data Harmonization. The maturity assessment indicates a vibrant innovation pipeline, with the majority (12/20) of studies at the Proof-of-Concept stage, focused on technical validation. A smaller subset has progressed to clinical Pilots (4/20) or Institutional Integration (4/20), where challenges shift from technical feasibility to organizational adoption, workflow integration, and demonstrating clinical utility.
CONCLUSION: FHIR has successfully catalyzed widespread technical innovation and serves as the foundation for advanced clinical applications. However, a significant translational gap persists. Future efforts should expand beyond technical development. To bridge the divide between prototype and widespread clinical impact, rigorous studies are needed in three areas: implementation science, user-centered design, and sustainable value demonstration.