1. Vietnam Healthcare System — Overview
Vietnam has a 4-level healthcare system with tens of thousands of medical facilities, each using different HIS. FHIR is an opportunity to unify data.
| Granted | Quantity | For example |
|---|---|---|
| Central | ~40 Hospitals | Bach Mai, Cho Ray, Hue Central |
| Province/City | ~400 Hospitals | Provincial General Hospital |
| District/District | ~700 Hospitals | District General Hospital, Medical Center |
| Commune/Ward | ~11,000 | Commune medical station |
2. Relevant legal framework
Circular 54/2017/TT-BYT
Regulation of quality criteria and standards for medical management software.
| Criteria group | Request | FHIR mapping |
|---|---|---|
| BN management | Patient code, demographic information | Patient resources |
| Medical examination | History, diagnosis, medical orders | Encounter, Condition, ServiceRequest |
| Paraclinical | XN, CDHA, GPBL | DiagnosticReport, Observation |
| Inpatient treatment | Developments, drugs, surgery | MedicationRequest, Procedure |
| Hospital fees/health insurance | Expenses, payments | Claim, Coverage |
| Report | Report to the Ministry of Health according to the form | MeasureReport |
Circular 46/2018/TT-BYT
Regulations on electronic medical records (HSBA DT). This is the legal foundation for EMR in Vietnam.
- Article 4: The content of the electronic HSBA must be equivalent to the paper HSBA
- Article 5: Digital signature for doctors and pharmacists
- Article 7: Minimum storage of 10 years (inpatient), 5 years (outpatient)
- Article 8: Data communication between medical facilities
Decree 13/2023/ND-CP
Personal data protection — applies to medical data (sensitive data).
- Must have consent of the patient → FHIR Consent resource
- Notify when it happens data breach within 72 hours
- Bachelor DPO (Data Protection Officer) → AuditEvent tracking
- Rights delete data (right to erasure) — should be considered with medical storage requirements
3. Current interconnected systems
Social insurance portal — Insurance appraisal
┌──────────┐ ┌──────────────┐ ┌──────────┐
│ HIS BV │────▶│ Cổng BHXH │────▶│ BHXH VN │
│ │ XML │ (9210/API) │ │ │
└──────────┘ └──────────────┘ └──────────┘
Hiện: XML 130 mẫu
Tương lai: FHIR?
Currently, the social insurance portal uses its own XML format (130 tables). FHIR can be replaced by map:
| Social insurance XML table | FHIR Resource |
|---|---|
| XML1 — Patient information | Patient + Coverage |
| XML2 — Diagnostics | Condition |
| XML3 — Medicine | MedicationRequest |
| XML4 — Technical Services | Procedure + ChargeItem |
| XML5 — Cost | Claim + ClaimResponse |
VNEID — Citizen identification
{
"resourceType": "Patient",
"identifier": [
{
"system": "http://fhir.vn/sid/cccd",
"value": "001234567890",
"assigner": {
"display": "Cục Cảnh sát QLHC — Bộ Công an"
}
},
{
"system": "http://fhir.vn/sid/vneid",
"value": "VN-001234567890"
}
]
}
National Health Data Portal
┌─────────────────────┐
│ Cổng DL Y tế QG │
│ (HIE Gateway) │
│ ┌───────────────┐ │
│ │ FHIR Server │ │
│ │ (Aggregator) │ │
│ └───────┬───────┘ │
└──────────┼──────────┘
┌────────────────┼────────────────┐
▼ ▼ ▼
┌──────────────┐ ┌──────────────┐ ┌──────────────┐
│ BV Bạch Mai │ │ BV Chợ Rẫy │ │ BV Trung │
│ FHIR Node │ │ FHIR Node │ │ ương Huế │
└──────────────┘ └──────────────┘ └──────────────┘
4. ICD-10 Vietnam
Vietnam uses ICD-10 WHO with additional code VN (ICD-10 VN). Need to create separate CodeSystem.
{
"resourceType": "CodeSystem",
"url": "http://fhir.vn/CodeSystem/icd10-vn",
"name": "ICD10VN",
"title": "ICD-10 Việt Nam",
"status": "active",
"content": "supplement",
"supplements": "http://hl7.org/fhir/sid/icd-10",
"concept": [
{
"code": "A09",
"display": "Tiêu chảy và viêm dạ dày-ruột có nguồn gốc nhiễm trùng"
},
{
"code": "J06.9",
"display": "Nhiễm trùng đường hô hấp trên cấp tính, không đặc hiệu"
},
{
"code": "K29.7",
"display": "Viêm dạ dày, không đặc hiệu"
}
]
}
5. List of drugs covered by health insurance
{
"resourceType": "CodeSystem",
"url": "http://fhir.vn/CodeSystem/thuoc-bhyt",
"name": "ThuocBHYTVN",
"title": "Danh mục thuốc BHYT Việt Nam (TT 30/2018)",
"status": "active",
"concept": [
{
"code": "N05BA01",
"display": "Diazepam",
"designation": [
{
"language": "vi",
"value": "Diazepam 5mg viên nén"
}
],
"property": [
{
"code": "route",
"valueString": "Uống"
},
{
"code": "bhyt-group",
"valueString": "Nhóm 1 — BHYT chi trả 100%"
}
]
}
]
}
6. Roadmap for FHIR implementation in Vietnam
| Phase | Target | Time |
|---|---|---|
| 1. Foundation | VN Core IG (Patient, Organization, Practitioner) | 6-12 months |
| 2. Clinical | Encounter, Condition, Observation, Medication profiles | 12-18 months |
| 3. Integration | Connecting upper and lower level hospitals, social insurance gateway | 18-24 months |
| 4. Scale | National HIE, telemedicine, PHR | 24-36 months |
7. Current Situation and Challenges
| Challenge | Details |
|---|---|
| HIS diversity | 20+ HIS vendors, no common standard |
| IT infrastructure | District/commune level: internet is unstable |
| Human resources | There is a shortage of engineers who understand both IT and healthcare |
| Funding | Public hospitals have limited IT budgets |
| Resistance to change | Medical staff are familiar with the old system |
| Security | Decree 13/2023 is new, there are no detailed instructions for healthcare |
8. Summary
Circular 54/2017 — Healthcare management software standards → map to FHIR resources
Circular 46/2018 — Electronic HSBA, data communication → FHIR Documents + API
Decree 13/2023 — Personal data protection → FHIR Consent + AuditEvent
Social insurance, VNEID — Integration via identifier systems
ICD-10 VN, Health insurance drugs — Need to create CodeSystem/ValueSet for VN
Roadmap — From VN Core IG → Clinical profiles → National HIE