FHIR compared to openEHR

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Ler en Español (traducción – Diego Boscá Tomás)

日本語で読むShinji Kobayashi による翻訳)

I see a growing number of organisations and individuals posing the old standards comparison question, today, in the form of: how does HL7 FHIR compare to or relate to openEHR?

It’s always fun to revisit this question from time to time, especially as some of the questioners are fortunately young enough not to know too much of the history of e-health standards. To understand the question requires looking at a few basic health informatics concepts. Below I’ve tried to do this as objectively as possible, but of course I know more about openEHR than FHIR at the detail level.

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Initial foundations for clinical workflow

Over the last 6 months or so I have been working on two projects, but one theme: implementing computable clinical workflow. For as long as I can remember, ‘workflow’ and ‘process’ are the main words that excite most clinical professionals in health informatics. They get mildly enthused about data, modelling tools, and applications, but what they really want is for the IT layer to help them work with other clinicians and the patient through time. From my point of view, they’ve always been right, but I’ve also thought we needed to get something working in the data layer to even have a chance at solving process.

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Elisabeth Geetruida Wassenbergh – The Doctor’s Visit

Today I think we have enough going in terms of a semantic health data platform in openEHR, and some of the smarter EMR systems, such as at Intermountain, Kaiser etc to consider the next layer. Serendipitously, I’ve recently had the chance to concentrate on the process question.

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Future of the EHR: adaptive clinical workflow support

In the time since I left Ocean Informatics (the company I started with Dr Sam Heard and others in the late 1990s), I have been working with Intermountain Healthcare as well as various other openEHR vendor companies, notably DIPS (Norway) and Marand (central/south-east Europe). With both groups I am working on what could be described as the next layer of the open EHR: process.

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openEHR technical basics for HL7 and FHIR users

openEHR_what_is_it

Recent discussions on the FHIR chat forum with various HL7 people around the topic of how openEHR and other architectural frameworks (e.g. VA FHIM, CDISC) could work with FHIR led to a realisation that some people in HL7 at least don’t understand some of the technical basics of openEHR. This might simply because they have not been involved enough to learn them, but now that we appear to be in the era of FHIR, in which no e-health solution can be without FHIR (according to the now pervasive FHIR hype), I would argue that HL7 now needs to understand some of the basics of the other major architectural frameworks and model-based platforms in e-health – all of which precede FHIR.

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e-Health standards – beyond the message mentality

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[a monk’s retreat near Thalori village]

I just spent a few days in Crete at an experts workshop of the European e-Standards project that aims to bridge well-known gaps in e-health standards and SDOs. I’ll comment on that effort in another post, for now I will just say thanks to Catherine Chronaki for the invitation, wonderful choice of venue and excellent workshop.

As is usual in these situations, being present in a beautiful place (Thalori village, southern Crete) with many interesting people (some old friends, others new acquaintances) and especially that vital ingredient: a world-class traditional band of musicians who played the paint off the walls of the Taverna until 3:30 am Saturday morning led to some new thoughts on standards (as well as a vastly improved appreciation of Cretan music).

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The e-Health platform as a standards integration project

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[image: (c) 2014 Imogen Brand Rakers Photography]

I have argued for an open platform approach in e-Health for some years now, as have others (Ewan Davis’s Nobody Can Own the Platform post is a nice summary of the issue). It’s clear that the idea is starting to resonate in some places like the NHS, bits of ONC thinking, the VA, and in some other countries. But how can governments and other fund-holders go about realising an e-Health platform?

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Making FHIR work for everybody

FHIR is the HL7’s modern approach to connecting components in the health computing space. Unlike the HL7v2 message approach, FHIR is oriented to enabling applications connect to back-ends. It has been running for a few years now, and is doing good work on how to use REST, terminology, and generally make the application programmers experience better.

It is also over-hyped. That’s not mainly the fault, as far as I can tell, of the core developers but more of an industry exhausted by attempts to make HL7v3 work, but still desperate for solutions. Some of the hype would have you believe that FHIR solves all health informatics problems; common sense says this is not true. A lesser version of the hype would have you believe that FHIR solves all interoperability problems in health. A superficial inspection shows this is also not true. Both versions of the hype are leading some vendors, providers and even some government programmes astray.

My point here is not to criticise FHIR, it’s to encourage those trying to solve the problems of e-health to take a step back, have a good look at the list of problems we know about, and then understand which of those FHIR is going to help with.

This post takes a look at what FHIR’s scope is today, and makes a proposal to significantly extend its capability, in a way that could even help to end the ‘health informatics wars’.

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