Development of Japan-Specific HL7 FHIR Medication-Related Profiles

Adoption of the HL7 Fast Healthcare Interoperability Resources (FHIR) as the global standard for healthcare information exchange has encouraged many countries to develop localized implementation guides that align with their specific regulatory and clinical needs. In 2018, the NeXEHRS Academic Research Group of the Japan Association of Medical Informatics (JAMI) commenced the creation of JP Core, a collection of FHIR profiles tailored for the Japanese healthcare environment. This study is focused on JP Core v1.2.0 released in December 2024. This includes eight medication-related profiles and 23 extensions that optimize Japanese prescription workflows by incorporating local terminologies such as the HOT and YJ Codes. The transition from Simplifier.net to GitHub, coupled with adoption of the Sushi framework, improved collaboration, version control, and standardization.We also examine the Japanese approach to FHIR governance, highlighting the need for a formal regulatory framework akin to the US Core Implementation Guide and the European governance models. Key challenges include terminology binding, cross-border ePrescription integration, and ongoing profile maintenance. Recommendations include the establishment of a national governance body, alignment of domestic terminologies with international standards (e.g., SNOMED CT), and alignment of JP Core interoperability with global frameworks such as the International Patient Summary (IPS) and the European Union (EU) eHealth guidelines. By analyzing the evolution of JP Core and the integration thereof into the Japanese ePrescription ecosystem, this paper provides insights into future FHIR implementation in Japan and highlights lessons learned from international governance structures.