Starting this discussion here, as there are an ongoing thread about collaboration in the Highmed openEHR symposium Highmed openEHR symposium 31.1.25 . Please use this thread instead.
@Lars_Fuhrmann @SevKohler @Paulmiller @ian.mcnicoll @Kanthan_Theivendran @Koray_Atalag @Robert_Ouko
Thank you for the announcement!
Ophthalmologist in training and complete openEHR-Newbie here, I’ll be at the symposium to learn more about it.
side note:
I’m trying to push for better interoperability in ophthalmology - at the moment mostly based on FHIR, but I’m wondering whether we should think about about coherence between information models and terminology between OpenEHR and future ophthalmic FHIR IGs early on, as lots of challenges may overlap.
So if there is anyone out here, who is interested (or already working) in the domain of ophthalmology please feel free to get in touch, at the symposium or whenever!
@ian.mcnicoll maybe know more 
In NHS Scotland we are deploying OpenEyes nationally under the technical leadership of my day job’s organisation, NHS Education for Scotland Technology Service.
We investigated, and Apperta did some modelling, the feasibility of creating openEHR compositions alongside OpenEyes own data but we have not implemented this. At the time our platform maturity was not there. It is better now but there is no priority / use case at the moment for doing this. I think it may come, for example visual acuity and partially sighted status are two OpenEyes data items that could be generally useful in a shared record / patient oriented record.
Right now, however, we have other things being prioritised so when we will hit this requirement is uncertain. Hopefully when it does we will be able to handle it as a fairly routine integration piece. Hopefully…
@David-Jobling probably has more insight, though his work with openEYES.
We have had a few efforts to map openEyes components to openEHR but it is a scarily detailed area.
See an earlier effort in the PDF
Green = match
Yellow = match but needs change
Red = new archetype required
Grey = out of scope
Examination event.pdf (3.0 MB)
@bna -might have some insight from DIPS work in this area.
Dear Ian and Paul,
Thank you both, I have to admit that was not awaye of OpenEyes, what a fascinating project!
From the project’s website I gather it’s mostly implemented in the UK?
I would love to learn more as I see a real need for open ophthalmic EHRs with good data models in Germany.
It’s a shame that implementing it over here would propably be an utterly herculean task, both in terms of language and MDR approval/regulatory aspects…
@ian.mcnicoll “scarily detailed” rings true, but from what I can tell by the UI OpenEyes has not been scared off from modelling in a highly granular fashion, which is great, thank you for sharing!
@Paulmiller National deployment sounds like FHIR-based data exchange might not be as necessary for you as it is in Germany, where the EMR market is highly fractioned.
Are you aware of any efforts to exchange data stored in openEHR or OpenEyes data models using FHIR?
I have this though stuck in my mind that the (relative) immaturity of ophthalmic data modelling in both FHIR IGs and openEHR may turn out be a blessing in disguise, as it may allows for some mutual flexibility and synergies in trying to develop them in tandem…
It may be really difficult to build a team around a common use case for this, but if openEHR architecture for ophthalmic data were aligned with (future) FHIR IGs, then openEHR may be seen as the go-to model to store ophthalmic data in a structure that is easily mappable to FHIR. Or maybe I’m wrong? I would be really interested to hear your thoughts on this!
If you are interested, I’ve done some experimental profiling FHIR ressources for visual acuity data with emphasis flexible recombination of simple SNOMED/LOINC concepts within the resource to reflect many clinically relevant test variants, including complicated things like contact lens overrefraction or binocular tests with monocular correction. which are not supported by most EMRs at the moment. I’m writing about it one the FHIR Zulip Channel for Opththalmology, which sadly isn’t very active.
Sorry for derailing the symposium announcement by the way!
Shall we move our discussion to the “OpenEyes on openEHR” thread or something?
Hi Lars, It may be worth getting in contact with Peter Coates from the The Apperta Foundation who I’m sure you will be interested in talking to as they own the largest Ophthalmology EPR/EMR called openEYES in the UK and they are currently re-platforming to openEHR.: https://openeyes.apperta.org/
Lars - perhaps we can move this topic to a clinical modelling channel, where it might get more visibility?
I have been a member of the openeyes community before it ran out of funds and I’m particularly keen on the use of similar capability in other clinical context outside opthamology. But I wonder if their resources are open. The apperta ckm was shutdown, luckily the github mirror is there, but it’s a little bit difficult implementing or even tinkering with the spec since the documentation is locked. How do we get access to the confluence pages… otherwise i suspect interested persons will have a difficult time utilising/exploring this great spec.
Some interesting work going on with AWS and openEYES and openEHR. Peter Coates (peter.coates@Apperta.org) could fill you in. I think a collaborative approach with Ophthalmology clinical modelling could be mutually beneficial.
Yes we have work in opthalmologi in Norway. It’s an initiative lead by the hospital in Tromsø (north in Norway) with support from all the other hospitals.
We have deployed an application for
retinopathy screening/controls. The clinical models are here: GitHub - bjornna/eyecare_retinopaty: openEHR clinical models for screening of diabetes retinopaty
The goal is to support all use-cases related to opthalmologi. Have a look at the archetypes here: GitHub - bjornna/eye_care
There is still lots of modeling work to do. And we should do international review of the archetypes since most of them are for common clinical concepts around the world…
Fully agree, but i don’t know how to do 
Now i see Ian , that you were pointing at another Lars
Too many Lars … 
Our team in Switzerland has recently developed an archetype for the Contrast sensitivity test as part of a specific project. This archetype has been submitted to the international CKM under reference RP-357. Although I lack formal expertise in ophthalmology, this archetype was developed based on extensive research and literature review. I welcome feedback and insights from professionals in the field to ensure its accuracy and applicability.
Hello Bjørn,
I’m very glad to hear about your work and its broad scope, thank you for sharing.
I will try and understand your archetypes, but as I am new here will take me a bit of time to get into the openEHR environment and get used to the tooling. If you have any recommendations which software tools may work well for me please do let me know.
As you mentioned that there is a lot to do and international review makes sense, i feel like getting those who are trying to model ophtalmology in FHIR (like me) to also consider your archetypes in their process may be a good idea.
Maybe we coulde even see how we can get some Archetype/Composition ↔ FHIR mapping going? I am thinking about Visual acuity and intraocular pressure for example?
Terminologically, do you come across a lot of gaps in SNOMED CT/LOINC as well?
If you do maybe it make sense to compare and discuss before we request.
I will get back to you once I have better understanding of your archetypes, thank you for your work!
Eyes on FHIR looks to have stalled. Coincidentally, I recently discovered the FHIR Vision Prescription resource (maturity level 3) which was used in a #nhshackday project in London in October '24.
I’ve been dipping into the Patient Care FHIR WG recently and would be happy to ask the question - is there scope for a collaborative group to bring together the two ophthalmology modelling communities.
Dear Kanthan, sorry for the delay in getting back to you,
I’m interested, and I’ll reach out to you and Peter Coates shortly.
Yes, unfortunately Eyes on FHIR is inactive at the moment, and judging from the Zulip channel there is not much of an active ophthalmic FHIR community right now.
I’m in contact with Ashley Kras, who was the project lead of Eyes on FHIR, we both want to get this ball rolling again because we are sure sure there is plenty of interest for FHIR moddeling in the ophthalmic sector.
This is still in a very early planning phase, and I think there is a big need for community building at the FHIR side.
I would be very interested in see if if there are EHRs or other stakeholders who want to use both an openEHR architecture for storage and FHIR for exchange for ophthalmic data?
At the moment it seems to me that some regions emphasize interoperability by widespread use of openEHR implementations (UK/Scandinavia?) and others by FHIR-based exchange. So I’m not sure who currently has the need to use both, but I figure this is a question of time?
For the moment I’ll try and gain a better understanding of both openEHR and FHIR while Ashley and I explore whether we can get a FHIR-focused working group together to continue the the work of Eyes on FHIR.
But as I am also really interested about the idea of a collaborative FHIR-openEHR Group, maybe it makes sense first try and experimentally start out such a collaboration on a really small, proof-of concept scale?
For example, the Information model of my Visual Acuity Observation Profile in FHIR ist not that dissimilar to the Visual Acuity Test Result Archetype (Eye Examined ↔ Observation.BodySite, components for distance, chart type and correction etc.)
Is there anyone here who would like to collaborate with me to try and make openEHR ↔ FHIR mapping work just for Visual Acuity Data at first?
VA data is as difficult as it is indispensable, so i think it would be great point to start and build experience at collaberative FHIR-openEHR development in this area?
If we succeed this could make it quite a bit easier to estimate the challenges that would be faced when trying to cover other parts of ophthalmology.
My knowledge of ophthalmology is based on anesthetizing eye patients for common operations such as cataract etc, and also the referral process from optometrist to hospital eye service in NHS Scotland. The VA assessment seems like a good starting point - I’m happy to set up a zoom call for interested parties. I’m in the UK but if you want to join, let know time zone and hopefully we can get a convenient time.