By: Outburn Staff

Updated: August 07, 2024

(This post will be updated regularly as FHIR implementation in Israel progresses. Please check back regularly if you want to stay up to date)

The history of HL7’s Fast Healthcare Interoperability Resources (FHIR) standard implementation in Israel begun around 2018, where Israel’s second largest Health Maintenance Organization (HMO), Maccabi Health Care Services, has announced it would start using FHIR resources as the basis for its new Operational Data Hub (ODH) data model. This can be considered as an implementation of FHIR’s “Persistent Store” exchange mechanism.

The director of Maccabi’s medical division at the time was Professor Nachman Ash (Today the Director General of the Ministry of Health Israel), who believed medical data standardization & interoperability would greatly benefit Maccabi strategically, and the entire Israeli healthcare eco-system in general.

In 2019, Israel’s Ministry of Health founded a FHIR team under the Digital Health division. The team started by scouting the country to see if anyone has started to “play with FHIR”, and set up meetings with different hospitals and HMO’s. At the end of this process, it was clear that the country as a whole was not yet into FHIR, except for Maccabi that has already gained some real-world experience with the standard and was ready to provide useful insights for the ministry on the subject.

In 2020, the non-profit organization “8400 – The Health Network” teamed with the Ministry of Health Israel around the common goal of making FHIR the de-facto standard for interoperability in the Israeli Healthcare and Health-tech ecosystems. After a few meetings with Maccabi, it was announced that a national FHIR community will be established, called “FHIR-IL”.

The same year, the first inter-organizational FHIR interface was deployed. It was a simple interface between health.io and Maccabi that included a wound assessment Observation resource, transferred from a mobile app to Maccabi’s EMR. The transfer mechanism was under the exchange paradigm FHIR defines as “Services”.

Also in 2020, the Ministry of Health announced the first incentive program for the HMO’s, providing partial funding for FHIR projects around specific subjects.

In November 2020, Roy Cohen from the Ministry of Health gave a talk at DevDays titled “Jumpstarting a FHIR Community in Israel”.

In 2021, the FHIR-IL community has published a Request For Proposal (RFP) for Israeli health organizations, requesting inter-organizational FHIR interfaces to be proposed. 7 projects won this RFP, and included 2 HMO’s, 7 hospitals and 4 startups.

Also in 2021, the “Israel Core” (IL-CORE) project was born with the aim of making the required adaptations to the base FHIR standard, while trying to keep the profiles as close to the US Core profiles as possible. Local adaptations included an Israeli “Address” profile (including extensions for city codes, street names, geolocation and more), URI’s for national identifiers and code systems, an extension for the indication of a patient’s HMO, and more. This is an ongoing project, its artifacts are routinely published using the SIMPLIFIER platform and can be viewed here.

The efforts of the Israeli FHIR community were recognized around this time in a World Health Organization report.

Near the end of 2021 the ministry has announced another incentive-based program, this time targeting specifically the 4 HMO’s, offering significant funding for long-term strategic projects that would create an infrastructure for extensive FHIR implementations. The launch event included a kickoff presentation by Prof. Ken Mandel, for all the Israeli Health Care Organizations’ leaders. As part of this program, representatives of the HMO’s were invited to a strategy workshop in Tel-Aviv, where prominent leaders from the industry gave motivational and practical talks, and the participants were given tasks that produced a complete set of FHIR resources to be profiled by the Israel Core team.

The aim of the incentive plan is to enable the HMO’s to arrange their legacy EMR data entities into conformant FHIR Resources ready to be accessed by 3rd parties. That will enhance the practitioners and patients access to data across the healthcare eco system. 

The FHIR-IL community evolved and grew very quickly and includes over 700 registered members. The community consist of 4 main community working groups, led by the Ministry of Health and 8400: architecture work group, security work group, product and use cases work group and more. Members of the community and their IT and clinical leaders shared their wisdom and insights from ongoing FHIR implementation projects in various community gatherings. 

On January 2022 the Israeli Chamber of Information Technology and Outburn Ltd conducted the first Israeli FHIR conference, which contributed even more to the fusion of the Israeli FHIR community and especially contributed to a rising interest by health-tech startups in adopting FHIR as part of their product’s data models and architecture.  

At the beginning of 2022 The Israel Innovation Authority, 8400 and the Ministry of Health announced two more incentive programs, this time focused on data infrastructures for clinical research and SMART on FHIR applications

In July 2024 a new health data mobility law was ratified. The law regulates a whole host of subjects that will allow patients better control over their data and facilitate the easy transmission of a patient’s data between providers. The law will make provisions for standard quality of information, information buckets, who gets to share information and what obligations they will have, as well as the purposes for doing so; licensing, accessibility and enforcement of the law. Read more about it here.

A partial list of known FHIR projects in Israel:

• • Pre-authorization (“Tofes 17”)
    • • Organization: Maccabi, Health.io
      • Exchange mechanism: Services + Persistent Store

• • Distributed ML Research
    • • Organizations: The Hebrew University, Jerusalem Center for Computational & Personalized Medicine, Hadassah Hospital, Sheray Tzedek Hospital, Meuhedet Health Services
      • Exchange mechanism: RESTful + Bulk FHIR

• • Home Hospitalization
    • • Organizations: Assuta Medical Center, DATOS
      • Exchange mechanism: RESTful

• • Digital Prescriptions
    • • Organizations: Tel Aviv Medical Center, Maccabi, Assuta, MaccabiDent
      • Exchange mechanism: RESTful

• • Israel Core Profiles
    • • Organizations: 8400, Ministry of Health Israel
      • Contributors: Outburn Ltd., Israeli HMO’s

• • Patient-Caregiver Communication – Patient Reports
    • • Organizations: Rambam Hospital, IMNA
      • Exchange mechanism: Services

• • Digitization of Clinical Studies
    • • Organization: Soroka hospital, YonaLink
      • Exchange Mechanism: Services

• Community Genetics
  • • Organizations: Ministry of Health Israel, Igentify
      
      
• Lab Report Cycle (LRC) 
  • • Objective: Creating a system that allows community clinics to send bloodwork of oncology patients to the hospital, prior to treatment, enabling hospitals to predetermine treatment feasibility.
      
    • Organizations:  Sheba Medical Center, Meuhedet, Clalit Health Services
• Exchange Mechanism: Services
• IG (Hebrew): Click Here
  
  
• Characterization of the interface for checking liabilities (Form 17) 
  • • Objective: Allowing automatic transfer of Coverage eligibility requests and responses between the HMOs and hospitals, lowering rates of “Patient as courier” incidence and improving service.
    • Organizations:  Division of Government Hospitals, Meuhedet, Clalit Health Services, Leumit Health Services,  Maccabi Healthcare Services
• Exchange Mechanism: Services
• IG (Hebrew): Click Here
  
  
• Mandatory reporting of infectious diseases in Israel
• • Objective: To streamline a system for epidemiological research, allowing Organizations to transfer data (lab results, observations, diagnostic reports) in cases where one of a subset of diseases is detected, to prevent the spread of highly contagious dangerous diseases.
  • Organizations:  Israeli Ministry of Health
• Exchange Mechanism: Messages
  
  
• Providing Supplemental health insurance data as part of a decision support tool
• • Objective: To allow Israeli citizens to easily view their Supplemental health insurance in their HMO 
  • Organizations:  Israeli Ministry of Health, Leumit Health Services, Clalit Health Services 
• Exchange Mechanism: RESTful
  
  
• Hospital-community Lab Referral Cycle 
• • Objective: Data flow automation of lab referral cycle – hospitals can request lab tests from community clinics, which transfer the results back, all done automatically. 
  • Organizations:  Sheba Medical Center, Meuhedet Health Services,  Clalit Health Services
• • Exchange Mechanism: Services