Interesting piece by FHIR Commentator Darren Devitt. Do people on here agree with his observations and conclusion?
I certainly do. Over my decade in the digital health side of things, it has been highly painful to watch a clearly superior standard be disregarded by the Digital Health ecosystem - especially in the US.
We are no better here in NZ, where we seem completely blind to the existance of openEHR (I may have pointed this out to more than one national digital leader), let alone considering it an option.
So yes, it needs a āRed Hat momentā - where it becomes suddenly commercially attractive to use, and the clear best choice to build with. And the market isnāt going to deliver this by itself.
Interesting 
Over my head, unfortunately. But if anyone is interested in having a play, has some spare time and hasnāt seen this, I did come across this free tutorial on openEHRā¦
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Not blind Nathan, just ambivalent. To quote from The HISO Interoperability Roadmapā¦
Our position on openEHR openEHR tools and detailed clinical models are welcome in the environment, but they will not be delivered by national programmes nor positioned as HISO standards. Previously, under our now-withdrawn reference architecture for interoperability, openEHR had a level of endorsement, but FHIR is now more prominent and this is where our efforts will go.
Going back nearly a decade, NZ did have a small openEHR Community led by @atalagk, however this gradually became inactive. In the last 2-3 years, interest has increased on the back of the HL7 International and openEHR collaboration and a couple of senior HNZ Digital Services staff visited Better (European openEHR system supplier) in 2024(?) and returned with positive comments.
Yes, I remember speaking with @atalagk about it about a decade ago when at the beginning of my journey - and finding it quite bamboozling!
I didnāt really see how it could work until rubbing shoulders with some prominent open source / standards folk in the UK while over there on my fellowship. It must be said that the UK hasnāt exactly embraced OpenEHR, but there are some notable bits that have.
And yes, it was good to hear that some of our top folk went and checked out Better / Estonia. Iād like to take some credit for nugding them in that direction! Here is a primer for those interested:
The model that Estonia has embraced really is what I believe we should aspire to. Better to be 2nd in line than one of the laggard nations on this front.
I reckon I was a decade and a half early to push openEHR in NZ! Thanks @pkjordan for bringing this up.
If I were to explain what openEHR is and how it compares to FHIR: FHIR is for interoperability and openEHR is for intraoperability. At the core, they are almost identical in terms of defining structured health data in a computable yet human readable/understandable way; FHIR Resources & openEHR Archetypes - extensions, terminology bindings and profiling/templating is almost identical from surface - under the hood different but not divergent.
When we co-aouthored the NZ Interoperability Reference Architecture back in the day, FHIR was not invented so we used openEHR as a reference (not actual deployment of a CDR / record) to build CDA documents as the wire format (and IHE XDSb profiles for discovering & moving data around).
Hereās a recent LinkedIn post which went viral on openEHR & FHIR and more.
Today is very different, we (I identify myself as openEHR & FHIR evangelist - but closer to openEHR) have over 1000 internationally built library of clinical models openly accessible (www.openehr.org/ckm) - works of over 3000 clinicians, health informaticians, engineers, researches, policy makers etc. over 25 years (estimated value over USD 110m!)
So, is openEHR the linux of clinical data standards? Not quite from āfreedomā angle. IMHO - HL7 standards, including FHIR, are also open access (to the fullest extent - under a full public license, more so open than openEHR or others like OMOP). A better analogy would be different distros of Linux - all are open source but targeted for different types of users and at times different use cases. Since the kernel is Linux they support many common things - such as apps, filesystem, CLI etc.
Not sure if youāve been following the convergence initiative between openEHR and HL7 (mostly FHIR) thereās serious work going on to align governance, processes and tooling; led by Grahame and Rachel (former openEHR CEO and now HL7ās) with several working groups comprising openEHR and FHIR experts (Iām co-leading one to embed openEHR modelling into FHIR), others on IPS, tooling (we can now publish openEHR/FHIR or solely openEHR artefacts using FHIR IG Publisher - not 100% done but good enough.) See:
Essentially use FHIR for exchange (interoperability) and openEHR for persistence (intraoperability) supported by terminology is becoming de-facto. Of course the devil is in the implementation but thereās good guidance emerging from this initiative.
I think all these developments call for a fresh look into NZās data and digital standards and initiatives. We must follow international best practices and leverage resources - thereās already a group of people in NZ (including some of my former students) who can drive this. I attempted to establish an openEHR Affiliate a decade ago but then hibernated due to lack off - well pretty much everything, I was a lone cowboy then!
Weāre looking at establishing an Oceania affiliate now as we share a lot of common things - including being in a very difficult timezone. Iād be interested to know your thoughts - especially if you think this will create real value and whoād be keen to contribute. In come countries (like Finland) HL7 and openEHR affiliates run under the same roof, and we looked at it back then and obviously there wasnāt much impetus - but now? Maybe
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