In Slovenia, the deployment of a FHIR-based national demographic and operational data repository marks a significant advancement in healthcare data management. Built on the FHIR R4 specification, it harmonises data from diverse sources, offering healthcare providers, EMR systems, and other stakeholders a reliable, up-to-date primary source of information.
The FHIR advantage: standards and customisation
Adopting FHIR R4 standards provided a structured and interoperable approach to managing demographic and status data. Our implementation supports a comprehensive range of FHIR resources, including:
- Patient, RelatedPerson, Practitioner, and PractitionerRole for representing individuals and their roles.
- Organisation, Location, and HealthcareService for mapping healthcare providers and facilities.
- CareTeam, EpisodeOfCare, Coverage, and Consent for operational and contextual data.
To address local requirements, we developed dedicated FHIR profiles for each resource, extending them where necessary to include Slovenia-specific attributes like extended parental rights or custom organisation types. This customisation balances global interoperability with national relevance.
Harmonising data from diverse sources
Slovenia’s FHIR-based repository acts as the Reference data synchronisation platform (RDSP), consolidating data from various national sources to ensure a unified and up-to-date dataset. By integrating information from the Population registry, Healthcare insurance company, National registry of healthcare organisations and workers, Ministry of education, and the Surveying & Mapping Authority of the Republic of Slovenia, the repository harmonises demographic and operational data into a single, reliable source for healthcare providers and systems. In total covering more that 10 million resources referenced and linked to eachother and updated on a daily basis.
Beyond harmonisation, the FHIR repository allows data to be consumed, amended, and enriched through a range of applications within Slovenia’s eHealth ecosystem. These applications empower stakeholders to update and enhance data directly within their operational workflows, making the repository a dynamic and evolving resource. By allowing multiple stakeholders to consume and enrich data through various applications, the FHIR repository becomes more than a static database—it evolves into a living, interconnected system that reflects the needs of Slovenia’s healthcare ecosystem.
Optimised resource references
One of the key benefits and successes of Slovenia’s FHIR-based repository is its ability to fully leverage FHIR’s design for creating a dynamic web of interconnected resources. This capability enables sophisticated data queries that span multiple resource types, transforming how healthcare data is accessed and utilised. By adhering to FHIR’s standards, particularly the use of _include, _revInclude, and _include:iterate parameters, the repository supports multi-level queries, unlocking advanced search capabilities that are critical for modern healthcare systems.
For instance, identifying a patient’s general practitioner and their affiliated organisation can be accomplished with a single query. This retrieves the patient’s demographic data, the practitioner’s details, and the organisation’s information, streamlining workflows such as care team assignments, referral validation, and detailed reporting on patient-practitioner relationships. These interconnected queries reduce operational complexity and ensure timely and accurate data retrieval.
This adherence to FHIR’s core capabilities delivers numerous benefits. It provides holistic views of patient relationships, combines multiple resources in a single query to reduce latency, and enables real-time, evidence-based decision-making in clinical and administrative contexts. For example, hospitals can quickly validate practitioner assignments or ensure organisational data accuracy during referrals, improving efficiency and coordination.
Addressing challenges in FHIR implementation
Implementing a national FHIR-based repository comes with its set of challenges, as highlighted by several experts. Our experience in Slovenia has provided valuable insights into overcoming these obstacles:
- Performance and scalability: We optimised our FHIR server to efficiently manage millions of records, ensuring quick response times even under heavy load.
- Data quality and consistency: We implemented rigorous data validation and harmonisation processes to maintain high data quality across the repository.
- Interoperability: By adhering strictly to FHIR standards and implementing robust profiling, our system achieves high interoperability, facilitating smooth data exchange across different healthcare platforms.
- Security and access control: We employed Attribute-Based Access Control (ABAC) policies to define who can access and amend specific data points, ensuring data integrity and compliance with privacy regulations.
Securing data with granular access control
The Slovenian FHIR-based repository ensures data integrity and security through Attribute-Based Access Control (ABAC), implemented via the Better Platform’s CRPD component. This approach enforces detailed, role-based policies for accessing and modifying data, ensuring that only authorised users can interact with specific resources.
Granular permissions limit operations like updating patient telecom information or managing care team details to designated roles safeguarding data accuracy. Search restrictions further protect privacy by allowing users to query patient data only through targeted parameters like identifiers, names, or birthdates, in line with strict policies. Consent management is tightly controlled, with policies ensuring that access to consent-related data is granted only to authorised entities, such as eHealth agents or primary care physicians. This guarantees compliance with GDPR and national regulations, while maintaining patient trust.
By embedding these policies across all workflows—from managing organisations and care teams to supporting preventive programs like school health screenings—the repository achieves a balance between robust security and operational flexibility. This ensures that sensitive data is protected without compromising the usability for healthcare providers.
How FHIR data powers healthcare applications
The FHIR-based repository underpins healthcare workflows in Slovenia, enabling efficient and secure access to patient, practitioner, and organisation data. It supports critical processes like referrals, notifications, and administrative updates by providing comprehensive, interconnected information. The repository enhances care coordination by enabling seamless collaboration via CareTeam resources and enforcing patient preferences through Consent resources, ensuring GDPR compliance. Preventive programmes also benefit, with pediatricians assigned to school classes for efficient health screenings. Additionally, real-time updates keep general practitioners informed about new patients and changes to demographics or insurance coverage, improving care delivery and administrative efficiency. By linking diverse resources, the repository transforms healthcare data management in Slovenia.
Transforming operational health data management
Slovenia’s FHIR-based demographic and operational data repository represents a major milestone in national healthcare digitalisation. By combining interoperability, scalability, and security, the repository sets a new benchmark for national healthcare data management, paving the way for more efficient, collaborative, and person-centric care. This implementation serves as a model for other countries seeking to modernise their healthcare infrastructure and unlock the full potential of their data.
The Slovenian Ministry of Health (MoH) has transitioned to a platform-based architecture reflected by the Central Registry of Patient Data (CRPD). This national system presents a patient-centered approach, separating standardised clinical data from demographic and operational data. This is an essential step in achieving privacy-by-design, as championed by openEHR. By decoupling data from applications, Slovenia has unlocked the potential of a multi-vendor ecosystem, providing interoperability through robust standards like IHE, openEHR, and FHIR. This paradigm ensures that critical health information is accessible to all who treat patients, enabling scalable, future-proof solutions, but still safeguarding privacy. The CRPD stands as a model for national shared care record systems worldwide, demonstrating that data-driven platforms are the foundation for modern, integrated, and secure healthcare delivery.
