# openEHR International Vision **Category:** [Community](https://discourse.openehr.org/c/community/10) **Created:** 2021-11-25 07:25 UTC **Views:** 1913 **Replies:** 34 **URL:** https://discourse.openehr.org/t/openehr-international-vision/2107 --- ## Post #1 by @Evelyn_Hovenga 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. Evelyn ` --- ## Post #2 by @joostholslag 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:) --- ## Post #3 by @thomas.beale [quote="Evelyn_Hovenga, post:1, topic:2107"] 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 [/quote] 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. --- ## Post #4 by @DavidIngram 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. --- ## Post #5 by @Evelyn_Hovenga 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 https://www.elsevier.com/books/roadmap-to-successful-digital-health-ecosystems/hovenga/978-0-12-823413-6 --- ## Post #6 by @Evelyn_Hovenga 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. --- ## Post #7 by @pablo [quote="thomas.beale, post:3, topic:2107"] we view interoperability as an emergent outcome, not something to be post-hoc engineer onto a black box [/quote] 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. --- ## Post #8 by @DavidIngram 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. --- ## Post #9 by @DavidIngram 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 ](https://www.dropbox.com/s/d7z1934ujwn1446/Note%20re.%20CIC%20standing%20of%20openEHR%20CIC.%20docx.docx?dl=0) 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. 3. 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. 4. 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… --- ## Post #10 by @thomas.beale [quote="pablo, post:7, topic:2107"] 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. [/quote] Me too. A blog post I did on [Desiderata for Successful e-health Standards](https://wolandscat.net/health-informatics/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. --- ## Post #11 by @thomas.beale [quote="DavidIngram, post:9, topic:2107"] Disagreement is a constructive sign of life as well as a potentially destructive one. [/quote] 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). --- ## Post #12 by @Evelyn_Hovenga [quote="DavidIngram, post:9, topic:2107"] The openEHR community must continually find words to express its shared mission [/quote] 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|attachment](upload://jbYaOqrkY0yQ4tlOG1rLhvSfwiP.docx) (31.9 KB) --- ## Post #13 by @thomas.beale [quote="Evelyn_Hovenga, post:12, topic:2107"] 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’. [/quote] One thing to be aware of (should have posted this earlier) is that the [definitive Vision and Mission statements are here on the website](https://www.openehr.org/about/vision_and_mission), not in the Articles of Association. There is also quite a lot about motivations (WHY) on the [What is openEHR page](https://www.openehr.org/about/what_is_openehr) - see Motivations, and also Value of using openEHR. --- ## Post #14 by @birger.haarbrandt 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. Best, Birger --- ## Post #15 by @joostholslag Hi Evelyn, [quote="Evelyn_Hovenga, post:12, topic:2107"] …first we need to understand the community served and their motivations, (the WHY)… [/quote] 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: https://discourse.openehr.org/t/i-finally-don-t-feel-new-to-openehr-anymore/1275?u=joostholslag --- ## Post #16 by @Evelyn_Hovenga 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. --- ## Post #17 by @bna [quote="Evelyn_Hovenga, post:1, topic:2107"] 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? [/quote] 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: ![image|690x388](upload://eb4713vlxFTPTJbKZlk9vm8vHHY.png) --- ## Post #18 by @Evelyn_Hovenga @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. --- ## Post #19 by @Evelyn_Hovenga @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. --- ## Post #20 by @thomas.beale [quote="Evelyn_Hovenga, post:19, topic:2107"] 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 [/quote] 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. --- ## Post #21 by @Evelyn_Hovenga Thomas you've described an issue I've dealt with ever since I began teaching Health Informatics! It is continuing to be an issue. The HI knowledge domain is huge in depth and breadth. That's why micro-credentials are most useful. openEHR is applicable to all aspects. Your short list is helpful. We need a comprehensive program showing how these micro-credentials scaffold knowledge and skills, from one module to another. This also enables people to pick and choose what they need most now (just in time learning, gap training) enabling them to build on what they already know. One way to deal with the current disorganisation and confusion is to de-compose required knowledge and skills relative to roles (not positions or disciplines) and identify pre-requisite foundational knowledge and skills the course design builds on. Where possible we focus on generic content that can be applied to a variety of instances. Pre-requisite knowledge and skills may be from foundational software engineering or computer science or programming or clinical or management or genetics or information management or statistics or any other foundational disciplinary knowledge. We need to identify not only the key foundational knowledge and skills each course but also provide resources for further reading/study to enable people to get up to speed. We are making use of the SFIA framework and any other framework where relevant. This education program is all about design....just like you do for architectures. --- ## Post #22 by @borut.jures I cannot help but add an observation about two extremes: - Thomas is fully aware of the complexity of HI and openEHR. - Evelyn is fully aware of the knowledge and skills of the stakeholders. It is a (sad) reality that the attention span, knowledge and skills of (some) HI stakeholders are often comparable to children learning new things. Maybe what is needed are "children books" for HI/openEHR. Short, with many pictures, limited in scope. Intendent to be read in less than 30 minutes. Each such "book" would build on the previous ones in a series (there would be different series/paths focused on different stakeholders). Some prefer reading, others prefer watching. Accordingly there should be books and videos to cover both approaches to learning. Some examples of such "learning paths": - [Microsoft Learn](https://docs.microsoft.com/en-us/learn/browse/) - [Salesforce Learning Paths](https://trailhead.salesforce.com/en) --- ## Post #23 by @thomas.beale [quote="Evelyn_Hovenga, post:21, topic:2107"] We need to identify not only the key foundational knowledge and skills each course but also provide resources for further reading/study to enable people to get up to speed. We are making use of the SFIA framework and any other framework where relevant. This education program is all about design…just like you do for architectures [/quote] I do think we should distinguish what can be properly openEHR material and what can be more general health-informatics-as-it-should-be material. For example, the concepts of knowledge driven platform are not openEHR specific; openEHR is just an instance of realising such an idea. However, much of what we want to promulgate that the openEHR community has arguably created in terms of general paradigms isn't in health informatics courses or textbooks - platform, clinical modelling, multi-level methodology, how to use terminology and so on. So there is a gap here: a large block of knowledge (typically the kinds of things you see on our blogs) that isn't taught in any standard health informatics course, but also isn't an openEHR specific. On the other hand, openEHR industry trainers tend to train based on openEHR specifics, and they provide these concepts in passing. It is a strategic question in my mind as to whether the openEHR Education Program should be trying to develop syllabus for and teach the missing conceptual pieces. I don't think it should be - the missing piece is wider than openEHR, and it would also be hamstrung by being labelled as 'openEHR'. If there is appetite (probably yes) and resources (questionable) to build this corpus of material, then I think it should be done in a separate organisation, which could be a fellow-traveller open source education project - call it 'Domain-centred Health Informatics Education' or similar. We could set this up today. If we did this, then it provides a clear(ish) separation of paradigmatic and conceptual material, and openEHR-specific material and practices. The result would be to make the openEHR Education Program more limited and focused, closer to what is already being taught in the industry context, rather than trying to be a university level course. I think the governance and certification needs for both areas of education would the crystallise out more easily than they are now. --- ## Post #25 by @joostholslag The highmed symposium featured a lot of speakers that said something about their why from different perspectives: (My very rough summaries) @patrikgh : MD “openEHR solves my problems” @TomazG : ceo “data for life platform (is a good business model, JH)” @johnmeredith : national it architect “key part of national infra” erik: consultant, “openEHR is part of smart system for complex care” @jpieraj : “openEHR as a regional infra” @bna : product vendor:” with openEHR I know I can handle all clinical requirements” @ukpenguin, Proffessor: “Convergence on open standards is essential“ Edit: videos here https://www.highmed.org/en/events --- ## Post #26 by @Evelyn_Hovenga @thomas.beale I'm in total agreement with your observations. When I refer to the need to identify foundation knowledge and skills (pre-requisites) I simply use that as a method to provide context. The openEHR program itself and especially certification processes must be based exclusively on openEHR content which has built on those fundamentals. In other words they are embedded. Other education providers need to provide courses that teach those contextual fundamentals. We need to alert our target audience to the most relevant foundational knowledge required with some references to enable those with identified foundational knowledge gaps to get up to speed in any way they can. Of course many openEHR educators provide courses that include aspects of anyone or many of those associated knowledge domains. That's what differentiates openEHR education providers and courses offered. For example we (GeHCo) focus on data and data supply chains as that is our area of strength. --- ## Post #27 by @Evelyn_Hovenga Thank you Joost, all very useful from each of their perspectives. The why I'm looking for are benefits realised by the users/recipients of care openEHR applications serve. Many of those are listed on the openEHR vision page. --- ## Post #28 by @d.tarenskeen I also agree with your observations, the gap in HI really exists and explaining openEHR without proper preparation of concepts is difficult. You mention: "If there is appetite (probably yes) and resources (questionable) to build this corpus of material, then I think it should be done in a separate organisation, which could be a fellow-traveller open source education project - call it ‘Domain-centred Health Informatics Education’ or similar. We could set this up today." I agree with this too. Probably another target group (modelers) can be approached with these knowledge. For developers, I think more examples of openEHR prototypes, with coherent implementation of an Archetype and one or more Templates could help them thinking in openEHR terms. Simple prototypes without security and complex SoS enterprise systems. In my view developers can learn directly from code examples, and even extract conceptual thinking from coding. --- ## Post #29 by @d.tarenskeen Then there is another issue that is not mentioned here and adds extra complexity to openEHR. It is "open". The openness points to extendability in the sense of adding new functionality in already existing systems, but also points to openness for other clinical professionals to add to the models and extend domain knowledge. For as far as I know this openness has not been offered in other systems in production in healthcare. New posts here mention "open platforms". I have some questions about the term open platform: Which party or which company has control over the platform? There is a suggestion of openness of control, but there are no agreements about this or mandatory monitoring open to users and organizations, we know that when the platform conforms to the openEHR specification it operates in a specific predictable way, but users of the platform have no control over the operations. I do not say that this is a lack, maybe I have missed specifications about the openness of platforms, but I would like a more transparent description of open platforms in relation to openEHR. --- ## Post #30 by @birger.haarbrandt Hi Deborah, this is a very good question and I like to give my 2 cents from a user and vendor perspective : > Which party or which company has control over the platform This depends on the use-case. I'm quite sure the EMR vendors in the Nordics will have some say in what extensions are allowed (for patient safety reasons). In the case of our national COVID-19 platform, control is in the hands of the operating non-profit organization. It can be hospitals in other cases. > we know that when the platform conforms to the openEHR specification it operates in a specific predictable way, but users of the platform have no control over the operations They can, if they like to. Just pick one of the open source solutions and start building and operating the open platform. > maybe I have missed specifications about the openness of platforms, but I would like a more transparent description of open platforms in relation to openEHR From my point of view, "open platform" describes a design principle/philosophy and not such much a concrete specification. From a technical perspective, an open platform can be understood, roughly speaking, as vendor-neutral and with 100% open APIs. We are building such platforms in HiGHmed and within vitagroup but we still see some variations of the ingredients and architectures: 1) Do we use IHE XDS for being able to access documents from multiple repositories at runtime or do we load them into a dedicated multimedia storage? 2) Does the platform follow an event-driven architecture? 3) What is the authentication mechanism? 4) What is used for access control: ABAC, RBAC based on IHE APPC/BPCC or something else? It would surely be the next step to standardize the "open platform" as one distinct specification (then maybe with a different name). However, I would choose an evolutionary approach driven by markets and vendors and see if a reference architectures emerges which finally could be the foundation for a standard (likely in the sense of IHE profiles or similar). --- ## Post #31 by @thomas.beale [quote="birger.haarbrandt, post:30, topic:2107"] > maybe I have missed specifications about the openness of platforms, but I would like a more transparent description of open platforms in relation to openEHR From my point of view, “open platform” describes a design principle/philosophy and not such much a concrete specification. From a technical perspective, an open platform can be understood, roughly speaking, as vendor-neutral and with 100% open APIs. [/quote] Blog posts that may be of interest here: * [What is an open Platform](https://wolandscat.net/health-informatics/what-is-an-open-platform/) * [The Health IT platform - a definition](https://wolandscat.net/2021/05/14/the-health-it-platform-a-definition/) --- ## Post #32 by @ian.mcnicoll Further reading... "Defining an Open Platform" ... https://apperta.org/openplatforms/ > In October 2017, we published “Defining an Open Platform” to make the case for open platforms and lay out a blueprint for an open platform architecture at a level of detail that would allow any willing party to build a first generation implementation of an open platform that would be interoperable with any other. > > Our proposal is based on HL7 FHIR, SNOMED-CT, IHE-XDS and openEHR and draws on pioneering work globally and in the UK that have proven how these standards can be used to build an open platform. For me the most significant aspect is that control of the data AND the data definitions passes from the tech vendor to the 'customer' -usually a health organisation. This can be an initial challenge as most health organisations do not immediately have the skills or capacity to undertake the work of maintaining the semantic cohesion necessary inside a platform-based environment, so this tends to be outsourced to specialist informatics consultancies. However, at least in the UK, organisations are starting to build up the learning and capacity to take more of this 'in-house' . This is a fundamental change in the 'locus of control' and I think will prove to be the most compelling reason for institutions and localities to adopt 'open platform', though for some health IT vendors, openEHR is just a better way to handle complex health data management. --- ## Post #33 by @d.tarenskeen Thank you all for replies on the open platform question! I will answer after reading the links. --- ## Post #34 by @joostholslag [quote="Evelyn_Hovenga, post:16, topic:2107, full:true"] 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. [/quote] Hmm that’s a hard question to answer in text, easier in a meeting, because it’s not straightforward. It’s a story about a boy that likes helping people, enjoys understanding technology, is a good study, goes to med school, gets fed up with medical culture and terrible IT systems, joins a vendor that uses openEHR. It peaked my interest for various reasons, I was struggling for something to do and got involved in a project where someone had to help a customer do openEHR modelling. Then I discovered with openEHR I’m able to make something that shows up on a screen and I’m again able to help someone, powerful feeling! Then I got into reading the specs, mostly for intellectual curiosity, and got amazed by how much understanding of the domain of healthcare and health informatics (now my domain!) it contained. Which made me In parallel I discovered CKM and hoping to contribute/help others I checked the box for receiving review invites. I like the aspiration of being able to contribute a bit to something bigger than my own life. To feel good about myself for the good the modelling program does. To heal my wounds inflicted by terrible IT. And to leave my little mark on the world that might live beyond my life. Then I got involved with the editorial community and really enjoyed the early pre work meetings with people from all over the world especially @ian.mcnicoll @heather.leslie and @varntzen, because I liked us volunteering for a common cause, the different perspectives people from the other side of the world bring. I also very much enjoyed engaging with these experienced and knowledgeable people. And I got flattered by discovering my views and experience actually were helpful to these giants in the field. Publication of the advance intervention discussions archetype was a real victory moment. Later on I improved my understanding of the technical side of the specs (studying nights and weekends) and started to find a way to contribute tiny bits to them (mostly typo’s, very gratifying to see my nitpicking being appreciated by them being corrected). Then I started to be more involved on this discourse by helping beginners (even more junior than I am) understand how to do something in openEHR. It’s really nice to be able to help others again with this hard earned skill. And only recently I start to see the shortcomings of the spec and really enjoy engaging with the technical experts on those, especially @thomas.beale. Convincing him on archived status for persistent compositions was another prove that I have something to offer this great project of openEHR. As I wrote on twitter (somewhere) the biggest feat of openEHR is the community of informaticians and clinicians investing in deeply understanding each other. Another big consolation for the frustrations of fighting with IT ‘people’ on the tiny stuff of being put into the doctors table, which would save me costly minutes each day when generating the many letters I had to write. And the hit to my ego from being refused without any effort to understand my side. (Probably the IT people have many similar stories from doctors unwilling to understand their problems). And now I’m a valued member of this great community of crazy smart people solving one of the hardest and most laborious and most important problems in the world by bridging the worlds of medicine and informatics :smiling_face_with_three_hearts: That’s why I’m spending an hour of my Saturday morning on writing this message. --- ## Post #35 by @DavidIngram A wonderful and impactful personal statement, Joost. Thank you. There are so many important general points and messages embedded there. I’m going to print it out and frame it alongside the certificate of incorporation of the openEHR Foundation, which hangs above my desk at home. --- ## Post #36 by @Evelyn_Hovenga Thank you for sharing this reflective personal journey @joostholslag , you have provided a very useful insight regarding how we need to engage newer generations and you confirmed the value of multidisciplinary collaboration. I'm a nurse who learned about computing in the late 1970s. I have been convinced about the value of adopting openEHR since its early days, working with @Sam, Dr Peter Schloeffel, and @sebastian.garde working out how to teach others about object modelling and its value twenty years ago. This led to the development of the first CKM prototype when we realised there needed to be repository for these models. --- **Canonical:** https://discourse.openehr.org/t/openehr-international-vision/2107 **Original content:** https://discourse.openehr.org/t/openehr-international-vision/2107