openEHR International Vision

We’re in the process of establishing the Education Program. This requires the adoption of key criteria against which educator and course certification can be evaluated. We all desire an increased uptake of the openEHR IP , the education program plays an important role in assuring that we all deliver the same message. I’d like the openEHR community to participate in the development of a key promotional pitch. This requires us to consider the communities we serve.
The openEHR International Board of Directors are responsible for ensuring that all activities are compliant with its articles of association. These include this organisation’s objectives and philosophical (values) underpinnings. It’s important for this community to consistently interpret these and make use of them as a guide to decision making regarding the use of this knowledge base.
To get us started we need to carefully consider the ‘why’ adopt openEHR, who are the communities we serve and what benefits are they looking for?
Once we are clear about that we can begin to consider how we intend to get there from which we can develop a suitable education program. This exercise should also be beneficial to guide our collective strategic directions to ensure this organisation is financially viable and sustainable.
FYI here is the primary object to guide your thinking.

  1. Objects
    The objects of the Company are to carry on activities which benefit the community and in particular (without limitation) to improve the capability and interoperability of electronic health systems.
    The sub-objects to follow indicate what is valued - ie open knowledge sharing.
    I look forward to reading your insights.



Hi Evelyn,

You’re discussing an important topic. I’d like to give my input. But I’m struggling with the broad scope of your question. It’s hard to answer such a question in a sufficiently nuanced way via a forum post.
I was thinking maybe you could make your question a bit more specific?
Or if you like some people would be open to share their views via video call? I would be open to that:)

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One thing to note in passing: these days we view interoperability as an emergent outcome, not something to be post-hoc engineer onto a black box. openEHR isn’t a black box - it’s a fully specified platform, and its interoperability with the outside world is just a function of transforms in and out of its internal representations and these can easily be limited by the weakness of data representation in external systems.

It is those internal representations that define the semantics of an openEHR system, as well as the computability of its data. Because these are very high quality, we don’t tend to anything further to obtain interoperability - it falls out naturally, to the extent that invariably weaker ‘interop standards’ will support, of course.

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An important question for sure – vision is a sensory process and must continuously adapt to what is seen and represented! Thank you for picking it up and looking to the future. Evelyn prompted me, so here is how I see things. I apologise that it is quite unseasonably long for a forum post. As Jools said, it’s hard to frame and constrain the dialogue that way.

Having been with openEHR since its creation at day one, as well as zero and minus one, I would be happy, if asked, to add my perspective to the sort of joint discussion Jools is suggesting - as I am sure will Sam and Thomas, as co-founders with me and still actively engaged. I have tended to hang back as my time and capacity to act for openEHR are (quite rightly) passing, although it is almost daily still in my thoughts and correspondence. It’s sometimes important for older, well-rehearsed and more or less comfortably established voices like mine, to keep a bit quieter (like children, unless spoken to, of course!), and let newer ones find their voice and be heard. As a corollary of that, it is absolutely important for the newer generation of openEHRers (hopefully committing few openErrors, of which we have all certainly been guilty in the past!) to take the stage with their new vision and capabilities. There are now many appearing from all over the world, which is wonderful to see. In the time that I was in a leadership role, the evolving vision was summarised and is preserved in the About section of the web site.

I’ve had private correspondence with quite a few people who are finding their way into this discussion. There are a few general points that I feel it might be useful to focus on at this stage, here.

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Joost I’m happy to discuss this further. My response to Thomas’s post may assist your understanding of interest in this a bit better? One issue prevalent in any specialty is that the experts ‘just know stuff’. They find it difficult to decompose what they know in terms that is understandable by everyone. In other words novices need to make quantum leaps in thinking when working through their learning process. Education processes need to be designed in a scaffolding manner that enables individuals to work though the learning processes to arrive at the desired outcome.
I’m not a software engineer so I have had to ask lots of questions of the experts to learn what I now know about openEHR . It took me several years to be able to identify the key characteristics that must be met to achieve semantic interoperability and to appreciate its community benefits. I have put together a textbook on the Roadmap to Successful Digital Health Ecosystems which will be available in January. This documents my attempts in decomposing the many complexities associated with this vision. Refer Roadmap to Successful Digital Health Ecosystems - 1st Edition

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Because these are very high quality, we don’t tend to anything further to obtain interoperability - it falls out naturally, to the extent that invariably weaker ‘interop standards’ will support, of course.

Thank you Thomas. From an educational perspective we need to de-compose this sentence and document those ‘internal representations’ in terms of what are their characteristics that make it ‘high quality’. What I’ve learned over the years is that the architectural design, the RIM, the universal and maximal use cases considered when developing archetypes and the terminology bindings are key criteria. An additional consideration is a definition of the ‘communities’ who need to benefit.

  • Community characteristics, needs and desires need to be matched by what is being delivered.
  • Not only does our education program need to focus on those key aspects but the entire openEHR community needs to be on the same page to ensure consistency in interpretation and use of the IP of this freely available knowledge domain.

The decomposition of these key aspects need to be expressed concisely as a pitch to suit each benefactor, or as high level graduate outcomes. Educators are then able to decompose this further to identify knowledge and skills required and to develop educational delivery strategies to suit complete novices, advanced beginners, etc and those with a variety of foundational skills from multiple disciplines.
Those concise pitches are also useful for marketing purposes.


Adding my 2 cents, openEHR enables interoperability (instead of “improving”).

In my view, the main goal is “openEHR improves governability”. That is: openEHR provides the specifications of a platform that allows to manage data from semantic definition to generation, consumption, effective use, analysis, processing, and sharing/exchange.

I prefer “platform” instead of “EHR”, and “data governability” instead of “interoperability” as key words associated with the current status and focus of the openEHR specs.

The term “capability” is too generic, and we have specific terms to name each capability characteristic, which IMO is better for communicating and understanding when talking about openEHR.


I concur. This is why GEHR/openEHR started from exhaustive rehearsal and formal statement of user requirements which then closely informed its architectural design. These were taken into the CEN and ISO standards documents of that era. Dipak would have detailed knowledge of these GEHR/CEN/ISO documents as he increasingly focussed his UCL/CHIME and personal mission in that domain.


My further thoughts re vision for openEHR moving forward.

  1. openEHR is both carefully and legally protected IP (the Foundation’s oversight role, still) and open mission (the CIC’s role to represent and pursue vision and action). These two are legal entities. The Foundation no longer trades and is there as a backstop while the CIC finds its feet. The CIC is where the action is and must be. It is, however, no more than the sum total of the efforts of its actors and what they bring. If it is now to consolidate and grow, first and foremost it will need wider membership and resource. It is a radical mission and history shows that pioneers tend to be on their own until successful, whereafter many more canny folk, usually positioned a bit more distant from the front line of the innovation, have always been their friends! Healthcare IT is inevitably a hugely consequential and contested domain and any radically new idea is tested to survival or destruction in such reality. New ideas have their time, and that can cut both ways. How vision is pursued and enacted is every bit as important as what it claims to be. Actions speak louder than words and that’s why rigour, engagement and trust, combined with practical implementation in real world context, are the crucial lynchpins and testing ground for what openEHR does and achieves in the world.
  2. CIC law lies between charity law and commercial law. It was created by a lawyer I knew well, acting in this on behalf of government and recognizing that diverse sectoral interests, operating in different contexts and with different needs, perspectives, opportunities and constraints, are all important in combining efforts to make a difference for the communities they all serve. Key to this legal structure is a statement of the community interest served by a CIC.

Here, from my personal archive of openEHR from day zero, is the statement of openEHR Community Interest that we submitted and was accepted by the CIC Regulator in establishing the openEHR CIC.

The openEHR Community Interest Statement

It is a very broad statement and in drawing together the groups who align their efforts under the umbrella of the CIC, it is unrealistic to expect, and certainly not achievable in real life, that actions of all participants can always be coherent and harmonised. What matters is that all find trusted common ground and motivation to work within the wider articulated and shared community interest. The hallmark of success is that each sector of interested parties thus brought together within its umbrella of governance, should be enabled and supported in the different contributions they make towards the overall shared community interest. There should be no imposed hierarchies of participant interest in this endeavour – all are necessary. The company is constrained in law to act in this way, notably through its asset lock.

  1. Disagreement is a constructive sign of life as well as a potentially destructive one. How disagreement is handled in the special characteristics and legal framework of a CIC is crucial to its culture – that’s fundamentally about disagreeing in a good way, as others have written elsewhere. Disagreeing in bad ways can be very destructive to the stated community interest, which will thus not be served. It is something of a new style and context of institutional politics for the information age, and currently pretty anarchic and evolutionary, for sure.
  2. The costly and burdensome disjoint histories of many well-motivated efforts in our field - of governments, standards organisations, academic, professional and service organisations, industries, and so many others - indicate in spades that new vision and community of interest are needed. Now is clearly a propitious time to push ahead for progress on shaping this. Things can change quickly in anarchic times!

I hope this adds a bit by way of useful reflection on the very important discussion Evelyn has initiated. The openEHR community must continually find words to express its shared mission and it feels great that this topic is being opened up widely for discussion in this way. We did much the same over a two year period before setting up the CIC. I have my own personal sense of how health plus care plus IT missions need to combine moving forward, having grown up in a social care setting. This perspective goes quite a long way beyond openEHR, but builds from my experience and eyewitness account of its story and that of OpenEyes, as examples. It has taken me 18 months to draw all this together in a book that I hope to get published, open access, next year. That will be after review by a number of long-standing colleagues and much needed further tidying, editing and condensing of the manuscript, so we will see! But I do have a very suitable and successful publisher interested…


Me too. A blog post I did on Desiderata for Successful e-health Standards a while ago might be of interest to some. It summarises the top-level priorities as:

  • Platform Friendly
  • Semantic Scalability
  • Implementability
  • Utility
  • Responsive Governance
  • Commercial acceptability

NB these are characteristics of standards, not systems. I see (true, automatic) Interoperability as a consequence of getting the first three right.

I think that the kind of disagreement found in a science-based culture is the right one. It is always that the case the today’s theories may need to be adjusted or even jettisoned when contradicting evidence comes into view. More fundamentally, even paradigms may be overturned by better ways of seeing things.

We thus progress by the creation of ‘pretty good’ theories by some (synthesis), while others try to take them apart (analysis). The latter either strengthens them (proves they work in a greater scope than previously recognised) or demonstrates their weaknesses.

The key is never to be religiously attached to one’s theories, only the process of investigation. This is why I believe the culture of openEHR is essentially industrial R&D, rather than ‘standards development’; its good quality results find use as standards anyway (what works is what gets used).

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This community’s shared mission is to ‘carry on activities which benefit the community’ , these benefits are expressed as ‘improve capability and interoperability of electronic health systems’.
In my original post I suggested that first we need to understand the community served and their motivations, (the WHY) in order to identify what the openEHR community’s activities should encompass (the HOW). Discussion so far has focused on the WHAT - interoperability. We first and foremost need to focus on why anyone wants to take up openEHR. As is relevant to any negotiation we need to understand our opposition and what motivates them in order to work out how to be able to engage with them and move forward, ie who do we need to convince and teach? Our education strategy is dependent upon understanding the motivators to change or change restrictive behaviours.
In the absence of this void Heather and I did some brainstorming that resulted in a list of stakeholders together with their motivators for you all consider. We need to put ourselves in the shoes of these stakeholders and think about the benefits they are able to attain if and when the openEHR knowledge domain is optimally adopted. Our big picture list includes:

  • Healthcare Clinicians,
  • Software related stakeholders
  • Payors and Planners
  • Academics

Once we have clarified that we’ll be in a strong position to develop our educational strategic directions. We’ll also be able to identify who is dependent on others to do the right thing in order to attain the desired benefits, as there are many interdependencies. Please add any we may have missed.
Stakeholders and Motivators.docx (31.9 KB)

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One thing to be aware of (should have posted this earlier) is that the definitive Vision and Mission statements are here on the website, not in the Articles of Association.

There is also quite a lot about motivations (WHY) on the What is openEHR page - see Motivations, and also Value of using openEHR.

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Dear Evelyn and all,

some time back there was an analysis done by members of the board, defining personas as you listed. I’m sure the results are a good starting point and I will try to find out where to obtain the info.




Hi Evelyn,

I really like this approach. I would love to share my why, but as stated it’s a pretty broad question, hard to share via discourse.
Maybe this post of mine is a helpful start: I finally don’t feel ‘new to openEHR’ anymore

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Joost I liked reading about your journey, but what made you take this journey in the first place? That’s the WHY I’m looking for.

As @joostholslag and others have stated - this is a pretty broad topic. I will give a short answer.

I want to be part of an international community with competent people who try to improve the way we develop clinical applications. Since the health and care is big and growing we need global cooperation. Both to share technical artifacts like archetypes, software and even more important; knowledge and skills.

I base much of may daily investment on this simple vision:


@bna Thank you for sharing your personal ‘WHY’, I share your why and I’m in total agreement with that vision. That vision expresses the ‘WHAT’ in terms of what will be delivered by a software vendor who uses openEHR IP. I’ll continue to be provocative and behave like a 3 or 4yr old who keeps asking why! Who within the health sector, in addition to software vendors, benefits from adopting ‘light-footed and sustainable innovation’ ? Why is that important, who are the beneficiaries , what are those benefits and why should the openEHR knowledge domain be adopted to achieve this? The answer to my last question is inferred in the vision.

@thomas.beale these pages provide very useful high level information. Developing a comprehensive education program requires us to de-compose many of the concepts referred to. This then enables us to develop specific curricula to suit the many different stakeholders and the variety of roles they are expected to occupy. Some stakeholders just need a general understanding to make the right decisions and direct others to make it happen, others need to have in depth knowledge and practical skills that enables them to work with specific aspects. The target group comes from a variety of different academic and experiential backgrounds we need to be able to build on, others need to learn about foundational principles to enable them to begin to understand various aspects of the openEHR knowledge domain.
To enable us to determine desired educational outcomes requires us to clearly identify those stakeholders, determine their prior knowledge and skills then develop content that enables them to build on those foundations to enable them to achieve their desired outcomes. That’s why we need to be far more specific.
We want to focus on developing micro-credentials based on ‘just in time role based learning ’ to best suit everyone. That is, we need a course that explains how openEHR use, enables each desired benefit mentioned to become a reality.
As expressed on the’ What is openEHR page’ the education program needs to bring the technical outputs of the other programs to the real world , to enable the efficient use and uptake of the outputs of openEHR and ensure its usability in local languages, within diverse healthcare cultures and funding environments.

Theoretically I agree of course, but this is only partly realisable I think, because the sector is highly disorganised and confused. Few institutions even know on what basis to hire what kind of people, and the result is that people with one set of skills are trying to do entirely different jobs, generally with no clear paradigm-level overview and often with no exposure to health informatics as a discipline (such as it is).

As a consequence, the situation I think we are really in is ‘gap training’, i.e. helping people who are doing tasks for which they had no prior training to fill in the gaps. This would point to a) modules with over-arching principles type material (= health informatics) and b) separated goal-oriented modules for e.g. giving HCPs interested in modelling some background in e.g. principles of ontology, terminology, UI/UX, work efficiency and so on.

This is likely to be a big program.

Anyway, in terms of drivers, my short list is from the What is openEHR page:

  • complexity and rate of change of information and processes - reflecting the innate complexity both of human biology and society;
  • the growth of specialisation and team-based care, such as for acute stroke and sepsis, requires an over-arching model of care process, plans and real-time notification across facilities and to the patient;
  • patients routinely move across enterprise and jurisdictional boundaries while expecting seamless care;
  • the rapid march of technology versus the longevity of care processes: healthcare process state must be constantly transferrable across changing OSs, DBs, programming languages and user devices.
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