Nictiz is the Dutch centre of expertise for digital information in healthcare, published a report to analyse clinical modelling in different countries.
I would like to invite a reflection from people familiar with modelling in those countries, on the results per country.
The Dutch context is currently they model ZIBs (CIMs; see zibs.nl) in UML according to iso13972 and mandate specific FHIR profiles. Very similar to CKM, but without a reference model. There’s big issues with realising value from this approach. So they are considering doing the modelling in openEHR. I’m hopeful this means they will adopt CKM archetypes, but they sometimes seem to think they will keep modelling their own logical models and express those in ADL (which would have limited value).
(Mandating will still be as FHIR profiles, but the CKM archetypes should form the semantic basis, somewhat similar to AUCDI)
Getting some reflections on the above report would help me and @openehr-netherlands push Nictiz further in this direction. And hopefully this would mean contributing modelling resources to the openehr clinical program.
There are several national records in europe on openEHR that seem to be missing:
Slovenia, Malta, Greece, Catalonia, Scotland.
Tieto has around ~70% of the hospitals in finland with lifecare(last time i did the math, you can check their success stories), DIPS around ~80% in Norway.
Imagine a nordic pilot region for an european EHR
Around 10% of all german hospitals have adapted a Vita system openEHR platform, afaik.
AUCDI choses this direction because they already had a strong foundation with FHIR implementations.
If you’re already using openEHR for clinical modeling, it’s worth considering continued support either alongside FHIR or as an alternative. While either standard could be mandated, offering a mapping pipeline (e.g., via FHIRconnect) creates flexibility and promotes interoperability.
Supporting openEHR ensures that systems capturing rich clinical data prospectively can retain their full value. Otherwise, this data and its interoperable potential is unused. A FHIR-only approach, may risk oversimplifying complex clinical information and could limit the development of a truly comprehensive national EHR. It’s worth noting that no European country has yet established a national health record using FHIR in contrast to openEHR.
Using openEHR as a foundation for modeling FHIR resources is a pragmatic compromise but if openEHR is forced into constrained FHIR profiles solely for exchange purposes, some of its strengths may be lost. Since openEHR is also capable of handling data exchange, it could be valuable to treat it not just as a modeling tool but as an equal part of the interoperability strategy.
So the key question remains what do you guys want to achieve? Are we aiming to exchange summaries, or to enable a interoperable, longitudinal health record?
Spain is not in the list, but let me explain which is the situation here.
As most of you know, Spanish is a decentralised State where the 17 regions (+ 2 autonomous cities) are fully in charge on healthcare planning and delivery.
Spain, has historically been working in developing clinical information models that serve the purpose of enabling cross-regional interoperability. The process is orchestrated by the Spanish Ministry of Health and participated by all the Spanish regions. Possibly, the most interesting effort to highlight was the one carried out throughout 2013, focused on developing archetypes related to Royal Decree 1093/2010, which approves the Minimum Data Set for Clinical Reports (CMDIC) in the Spanish NHS, and Royal Decree 1718/2010 on medical prescriptions and dispensing orders. Spain has a repository of semantic resources accessible by all, here. The information models were developed by clinical consensus using UNE-EN ISO 13606.
The modelling approach has continued over the years and new versions or CMDIC are continuously being published and approved by Royal Decrees. The last one is to be found here.
Last but not least, I believe it’s interesting to know that Spain has recently conducted a consensus process on the future of their health information technologies, with a special focus on the evolution on the national EHR. This consensus, followed a Delphi approach and was participated by the Spanish regions, the Spanish MoH and the scientific societies in the country. From there, a set of recommendations were drawn which were also validated by a group of international experts in medical informatics. I am attaching a non-official translation of the deliverable. There is also an ongoing publication under consideration in The Lancet Digital Health. Will share once it’s out if it gets through the peer-review process.
Joost there are historical reasons for Nictiz’ adoption of ISO 13972. The Netherlands had strong opposing camps HL7 vs openEHR. Many years ago William Goossen, Derek Hoy and I had major discussions exploring if it was possible to harmonise RIMs eg HL7v3 RIM and openEHR RIM. We concluded that this was not possible. William had strong views regarding the value of clinical modeling without a reference model. That resulted in ISO13972. I have always been of the view that such models still need a structure for storing and retrieval purposes. That’s essentially the same role as a RIM. We also make use of TAGs or metadata for retrieval purposes. It appears Nictiz is now experiencing the impact of the same conclusion we reached years ago…I’m not a technical expert my views are purely based on logic. CKM archetypes can be used for the development of FHIR profiles refer the Sparked program.
