FHIR and the National Shared Care Record: A Transformative Step in Irish Healthcare
On 20th October 2025, HSE Technology and Transformation hosted a landmark event titled “FHIR and the National Shared Care Record”, bringing together clinical and ICT professionals from across Ireland to explore the evolving landscape of digital health. The session featured two distinguished speakers: Kathryn Kissane, Deputy Delivery Director for Engagement and Delivery, and Grahame Grieve, the creator of HL7 FHIR and its Product Director.
Kathryn Kissane opened the event with a comprehensive overview of the National Shared Care Record (NSCR), a cornerstone of the MyHealth@IE programme. Designed to aggregate key healthcare data from hospitals, GP practices, and community care settings, the NSCR provides a read-only longitudinal view of a patient’s health journey. It is not an Electronic Health Record (EHR), but a support tool to enhance clinical decision-making and empower patients in managing their care.
The NSCR is built on principles of interoperability, security, and patient-centricity, aligning with Ireland’s obligations under the EU Digital Decade and the European Health Data Space (EHDS). It supports cross-border data exchange and is integrated into the HSE Health App, offering patients secure mobile access to their health information. Kathryn emphasised that the NSCR is being delivered incrementally, with data availability tailored to quality and readiness across different patient groups.
Central to the NSCR’s architecture is HL7 FHIR (Fast Healthcare Interoperability Resources), the global standard for exchanging healthcare information electronically. FHIR underpins the secure transmission and storage of clinical data within the NSCR, the HSE App, and across the broader MyHealth@EU ecosystem. Its adoption ensures semantic consistency and real-time access for clinicians and patients alike.
Grahame Grieve’s presentation provided a deep dive into the foundations, global lessons, and future trajectory of FHIR. He began by highlighting the challenges in healthcare IT—fragmented systems, lack of integration standards, and cultural and regulatory barriers. FHIR was developed to address these issues by leveraging web technologies to create an open, community-driven standard for healthcare data exchange.
Grahame described FHIR as “the web for healthcare,” offering a RESTful API, extensibility frameworks, and support for multiple formats including JSON and XML. He stressed that while standards may seem costly upfront, they yield significant long-term savings through improved quality, reduced rework, and better institutional memory.
A key theme in his talk was FHIR’s flexibility and scalability. It supports a wide range of use cases—from clinical documentation and medication management to public health reporting and consumer interactions. Grieve also discussed the importance of extensions and profiles, which allow FHIR to adapt to national and local requirements without compromising interoperability.
The session explored FHIR’s role in governance, conformance, and ecosystem building. Grahame emphasised that successful FHIR adoption requires more than technical implementation—it demands strategic leadership, education, and community engagement. Initiatives like “Connectathons” and sandbox environments provide safe spaces for teams to learn and test FHIR integrations.
Ireland’s use of FHIR in the NSCR and HSE App reflects global trends. In the US, FHIR is mandated for EHRs; in Europe, EHDS is driving adoption; and internationally, specifications like IPS (International Patient Summary) and IPA (International Patient Access) are shaping cross-border data exchange.
Grahame concluded with a candid reminder: FHIR is not a silver bullet. It provides a platform for agreement, but success depends on data quality, stakeholder collaboration, and thoughtful design. The synergy between FHIR and frameworks like openEHR was also discussed, highlighting ongoing collaboration to leverage each other’s strengths.
This event marked a pivotal moment in Ireland’s digital health journey. The insights shared by Kathryn Kissane and Grahame Grieve underscored the transformative potential of FHIR and the NSCR in delivering connected, patient-centered care. As we continue to build and refine these systems, the collaboration between clinical and ICT professionals will be key to unlocking their full value.