FHIR as an interoperability enabler for clinical applications: a narrative review of implementations, impacts, and...

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.

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.

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.

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.

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.