What is OpenEHR?
When talking about interoperability in healthcare, the key problem lies in how data is written in the first place. Universal interoperability could be achieved if all doctors recorded data in the same structure. This is a very generalized description of what openEHR is: an agreed set of forms for different specialties, defined by surgeons for surgery needs, cardiologists for cardiology needs, and so on. OpenEHR is not a standard for engineers but a standard for medical professionals.
As stated on openehr.org »OpenEHR is a virtual community working on means of turning health data from the physical form into electronic form and ensuring universal interoperability among all forms of electronic data. The primary focus of its endeavour is on electronic health records (EHR) and related systems.«
The idea of a global EHR
In a previous post I shortly touched upon interoperability. Well, in an ideal world, interoperability would not be important at all. Can you imagine a one ubiquitous EHR system all over world that serves all mankind? In this scenario, every one of us would have access to their medical data at any time and any location. But as we all know, the reality is so far from this utopian dream (at least for now).
Lock-in based business models as the unfortunate reality in healthcare!
Medical records management systems have traditionally been developed by software developers that typically designed a database and a user interface on top of it in order to support the work processes of healthcare personnel. And as time passed by, they were doing business as usual and introduced changes to the data model and to the user interfaces. And developers were the ones who knew what the data model actually means. Even more, these data models were not owned by healthcare organizations but by the software companies — in spite the fact that healthcare organizations are typically the owners of the data they produce. So imagine what you can do with raw data without the data model schema that tells you what this raw data really means!
And if you think up a project in which you want to exchange data between different systems, there is a high chance that an integration will not be fully possible because now you have to harmonize two different data models that are under control by two different software companies.
Such data hostage situations are the basis for the lock-in based business models. You find a hook for your customers that makes them dependent on your solution and services and then you are good for years to come because they will not be able to get rid of you. All good for you, if you are the software provider. But everyone else suffer. Not really a sustainable behavior.
Industry standards?
If we take a look at other industries we can quickly find out that there is something we call industry standards. All the service providers implement the standards and then the end customer can choose the service provider based on e.g. how well their customer service is doing, or how user friendly their user interface is etc.
You get a true market where customers can switch between providers without much issues. Telco companies have evolved quickly to support such level of maturity.
So, what is OpenEHR?
This brings us to OpenEHR. It is a standard that enables a one global model of EHR data that can be used by anyone. It is based on the concept of archetypes and templates. Archetypes are very broadly described medical concepts. Each concept is described by as many possible specialists in order to obtain a maximum data set for the concept. And if you have such a database of archetypes that is used globally, you have a common definition for data models that contain not only different data elements and structures but also mappings to the international terminologies like SNOMED. An archetype is modeled by using a common OpenEHR reference model — the core of OpenEHR.
How do software providers use OpenEHR?
When using OpenEHR, software providers design templates with the help of archetypes.These templates as the basis structure that can be represented to the user by means of a user interface. Whatever the end user enters in your system is validated by the OpenEHR engine.If the validation fails, error is triggered. If not, data is stored.
Each system that conforms to OpenEHR will be able to receive and understand all the data. Ergo, technical and semantic interoperability in action!
OpenEHR — the open industry standard?
So by using OpenEHR, the data models are not locked by software companies, but are publicly available to any provider that wants to design a software based on OpenEHR. The company that will provide a better use interface or provide better algorithmic services etc. on top of OpenEHR will win more customers.
Where is OpenEHR used?
OpenEHR is not a new invention. Work on its development has started in 1994 in England. Unfortunately, England chose to try a very costly approach instead of OpenEHR but lastly found its way back to the original idea. OpenEHR is used in countries like Australia, Brasil, Norway, Sweden, Netherlands, Russia, India, and Slovenia. Even more countries participate in different projects both in academia and industry.
OpenEHR in Slovenia
Slovenia has started using OpenEHR almost 10 years ago. The Ministry of health has co-funded a research project focused on building an OpenEHR based platform. It has then provisioned the development of a brand new hospital information system that was based on OpenEHR. OpenEHR has been used as the basis for the national eHealth where OpenEHR is used for defining national documents that need to be exchanged between the healthcare providers. One example of such of a document is the Patient Summary. The data set is a European Commision recommendation for cross-border exchange. Slovenia used OpenEHR to model all the data. Now, every provider of EMR systems in hospitals and other healthcare providers is sending different parts of the Patient summary to the national EHR. This data is then accessible to all healthcare providers and patients on an online portal.
Practical example
One of the sections of the Patient Summary is the Vaccination data set. Patient Summary thus holds information about your vaccinations. Based on this, Slovenia was able to create a national vaccination registry by tapping into the Vaccination section of the Patient Summary.
The beauty of OpenEHR lies in the fact that it is not a standard for engineers but a standard for medical professionals. The OpenEHR community provides great tooling support and also a vast network of medical professionals who are working all over the world on a common knowledge database that holds the OpenEHR archetypes.
Since OpenEHR is organically growing since 1994 it is not a hype but a strong hold in healthcare that supports the idea of a ubiquitous EHR.
