Coordinated subnational development of FHIR interoperability standards: a community process proposal for federative health systems

Authors

DOI:

https://doi.org/10.59681/2175-4411.v18.2026.1641

Keywords:

Digital Health, Health Information Interoperability, Health Policy

Abstract

Objective: To propose the subnational FHIR Community Process (FCP) as a governance mechanism for the coordinated development of interoperability profiles by federative units, harmonized with the federal level, in federative health systems. Methods: Propositional study grounded in conceptual analysis, in three stages: mapping of FHIR Core Implementation Guides in 13 countries and the European Union; analysis of subnational fragmentation in the United States, Germany, and India; and proposition of the subnational FCP articulated to a five-level FHIR maturity cycle, derived from the comparative analysis of five reference models. Results: The subnational FCP is proposed as an institutional arrangement that articulates local communities, territorial deliberative committees, formal publication of UF-Core profiles, and competitive incentives for adoption, operating through an optimized sequence of governance structures. The model is accompanied by a five-level FHIR maturity cycle, calibrated through benchmarking with EMRAM, CDMI, SNOMED IMF, GDHM, and BDHI. No subnational FCP was identified in the literature, positioning the proposal as an original contribution. Conclusion: The model preserves federative autonomy, ensures harmonization with the federal level, and offers a planning instrument applicable to Brazil's Unified Health System (SUS) amid recent state-level FHIR implementation policies.

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Author Biographies

Matheus Bresser, Programa de Pesquisa, Desenvolvimento e Inovação de Saúde Digital do Governo do Estado de São Paulo (PDI/SES/HCFMUSP), São Paulo, SP, Brasil

Pesquisador do Programa de Pesquisa, Desenvolvimento e Inovação de Saúde Digital do Governo de São Paulo (PDI/SES/HCFMUSP)

Éder de Carvalho Januário, Instituto Brasileiro de Mercado de Capitais (Ibmec), Rio de Janeiro, RJ, Brasil

Pesquisador em governança, economia institucional e estratégia. Professor de Economia das Organizações do Ibmec Rio de Janeiro; Consultor de Transformação Digital no MAPA.

Lincoln de Assis Moura Júnior, OneHealth Digital, Porto Alegre, RS, Brasil

Consultor internacional em estratégias de saúde digital. Ex-presidente da Sociedade Brasileira de Informática em Saúde (SBIS) e da International Medical Informatics Association (IMIA).

Roberta Rubia de Lima, Coordenadoria de Ciência, Tecnologia e Inovação, Secretaria de Estado da Saúde de São Paulo (SES/SP), São Paulo, SP, Brasil

Responsável pela Coordenadoria de Ciência, Tecnologia e Insumos Estratégicos (CCTIES) da Secretaria de Estado da Saúde de São Paulo.

Maria Cristina Coimbra Lages Balestrin de Andrade, Gabinete, Secretaria de Estado de Saúde do Governo do Estado de São Paulo (SES/SP), São Paulo, SP, Brasil

Assessora do Gabinete da Secretaria do Estado de Saúde de São Paulo (SES-SP).

Carlos Roberto Ribeiro de Carvalho, Universidade de São Paulo (USP), São Paulo, SP, Brasil

Professor Titular de Pneumologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP); Diretor de Saúde Digital HCFMUSP.

Giovanni Guido Cerri, Universidade de São Paulo (USP), São Paulo, SP, Brasil

Professor Titular de Radiologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Presidente do Conselho do InovaHC e do Instituto Coalizão Saúde (ICOS)

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Hospitais de uma cidade, vistos do alto, ligados por linhas de luz a um hospital central sobre uma grade digital

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Published

2026-11-07

How to Cite

Bresser, M., de Carvalho Januário, Éder, de Assis Moura Júnior, L., de Lima, R. R., Coimbra Lages Balestrin de Andrade, M. C., Ribeiro de Carvalho, C. R., & Cerri, G. G. (2026). Coordinated subnational development of FHIR interoperability standards: a community process proposal for federative health systems. Journal of Health Informatics, 18(1), 1641. https://doi.org/10.59681/2175-4411.v18.2026.1641

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Vol. 18 (2026)

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Copyright (c) 2026 Matheus Bresser, Éder de Carvalho Januário, Lincoln de Assis Moura Júnior, Roberta Rubia de Lima, Maria Cristina Coimbra Lages Balestrin de Andrade, Carlos Roberto Ribeiro de Carvalho, Giovanni Guido Cerri

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