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International Work

This implementation guide builds on HL7 FHIR R4 and aims to be compatible with international patterns and best practice where relevant for Norwegian conditions. At the same time, the guide starts from Norwegian national choices, including use of shared national FHIR base profiles (no-basis), to support good interoperability between municipal health and care services and specialist health services.

HL7 Europe Base/Core

HL7 Europe Base and Core 2.0.0 provides European reference patterns for FHIR R4. It describes flexible Base profiles and more constrained Core profiles that can support reuse across European and national initiatives, including EHDS alignment.

For this municipal IG, the practical interpretation is:

• no-basis remains the direct Norwegian base layer for national exchange.
• HL7 Europe Base/Core is European reference material that should be assessed before future releases and larger profile changes.
• Municipal profiles should stay narrow and domain-specific, so they can coexist with both no-basis and European Base/Core profiles.
• Where future no-basis versions align more explicitly with EU Core profiles, this IG should inherit that alignment rather than duplicate it locally.

This package does not declare hl7.fhir.eu.base as a technical dependency in this version, because the municipal profiles do not derive directly from EU Core parent profiles. HL7 Europe Base/Core is used as a documented reference and inspiration source; see Modelling and profiling for the concrete municipal pattern.

Denmark (KL / FKI)

Denmark has established the Joint Municipal Information Model (Danish: Fælleskommunal Informationsmodel, FKI) through Local Government Denmark (KL) as a shared information model for municipal health, elderly care and social services. The purpose of FKI is to support better data sharing and reuse of documentation between municipal professional systems, thereby reducing double registration and inconsistent terminology.

FKI consists of a conceptual and information model as well as a logical data model, and is used as a basis for KLGateway. The model is anchored in the common municipal reference architecture, and the principle "follow or explain" applies to data sharing within the FKI area.

KL has also published FKI-FHIR implementation guides, including KLCore, which show how FKI concepts are mapped to HL7 FHIR resources and profiles. KLCore describes FKI as a stable core layer independent of concrete use cases, and includes:

• explicit mappings between concepts and FHIR elements
• examples
• clear versioning and change management as part of the implementation guide itself

KLGateway illustrates an important pattern where a rich conceptual foundation (FKI) is combined with tighter profiles for reporting and interoperability. These profiles contain only the minimum data necessary for the relevant purpose, clearly separating documentation from information exchange.

Relevant principles we take from Denmark:

• Model first: establish shared concepts before technical profiling.
• Reuse: build on existing documentation and shared concepts.
• Explicit mapping: document clearly how concepts are represented in FHIR.
• Change as expected state: versioning and change management are part of the standard, not an afterthought.
• Minimum data for interoperability: define purpose-driven minimum content where data is shared.

England (NHS / UK)

In the United Kingdom, UK Core is established as a national FHIR base layer through National Health Service (NHS) England. UK Core consists of cross-sector FHIR R4 profiles, extensions and terminology, and is used across England, Scotland, Wales and Northern Ireland to support consistent information flows between sectors.

UK Core is intentionally designed as a stable base layer. National or sector-specific needs are handled through separate implementation guides and additions. This gives a clear distinction between shared national guidance and more specialized requirements.

For social care, Social Care ADW (Assessment, Discharge, Withdrawal) is a message specification for information exchange between hospitals and social care. The specification describes concrete messages, minimum data and structured exchanges, and is anchored in legislation (Care Act 2014) through a national information standard (SCCI2075). Although the implementation is based on an older FHIR version (DSTU2) and is marked as deprecated, it provides useful inspiration related to:

• clear purpose boundaries
• explicit definition of minimum data
• linkage between information standard and FHIR representation

A broader UK perspective shows that FHIR is chosen as the standard for social care in all four nations, and that systematic work is ongoing on shared data standards and increased maturity in the sector.

Consequences For A Norwegian Municipal FHIR IG (Guidance)

We build on the same main principles:

• Start with shared concepts and a national base layer (no-basis).
• Describe clearly how municipal needs are profiled further from the base.
• Use explicit mapping tables and minimum data where interoperability requires it.
• Maintain clear versioning, change management and publication.

In the Norwegian context, this also means that this IG must be coordinated with existing national and municipal initiatives:

• no-basis is the base layer and should not be duplicated.
• Welfare Technology Hub (Velferdsteknologisk knutepunkt, VKP) and Patient's measurement data (Pasientens måledata, PMD) should own the measurement data model for Observation where those services are used.
• Oslo municipality's Patient Journal API should be used as Norwegian experience for municipal profiling and API behavior.
• HL7 Norway best practice and the method for domain profiles should provide the process frame for further maturation.

References

• KL: Joint Municipal Information Model (FKI)
• KL: KLCore (FKI-FHIR IG)
• KL: KLGateway (reporting and minimum data)
• HL7 Europe: Base and Core FHIR IG 2.0.0
• NHS England: FHIR UK Core
• Social Care Wales: FHIR in social care