I had the pleasure of being invited to the annual DIPS Forum Tromsø, Norway 2-5 June 2013, to present on openEHR. DIPS is the main Norwegian hospital information system supplier, and the DIPS forum is its annual user/vendor meet-up. (Presentation – YouTube; 32 mins).

Something possibly unique is going on in Norway. DIPS is a vendor that originated in hospital IT, and morphed into something like a normal company. Abnormally, it remains very close to its users in the clinical community, under a visionary clinical and engineering leadership that has its eyes firmly on the long term, while never forgetting its audience.

The DIPS Forum is evidence of this relationship: 24 years long, with 650 or so attendees in 2013, it’s larger than an HL7 meeting, and yet consists almost 100% of users from only one country, and only one vendor (plus the odd foreigner;-). My impression is that what the user community really appreciates is the relationship and engagement. It’s the kind of thing bureaucrats dream of creating by ‘programmes’ or ‘reorganisation’ but in fact it can only ever really be ‘grown’ into place. It’s what ensures the product, while probably not perfect on any given day, keeps up with (and sometimes probably overtakes) user needs and aspirations.

DIPS has committed to the openEHR platform in its new Arena product, using both the openEHR reference model and the archetype formalism. This changes everything for a vendor. Firstly, development is no longer a hermetically sealed activity inside the company, with periodic attempts to obtain ‘user requirements’ from front-line users. On the contrary, it is now a symbiosis between the clinical community and the vendor, where the clinicians source and/or build archetypes, advise on screens (workflow etc), and the vendor builds templates and screens into the product (along with much other functionality).

In this regime, a lot of clinical work is done outside the vendor boundary, saving the vendor time and greatly increasing the possibilities for the system to actually represent and process the information real users work with. It’s also a risk, since the vendor is no longer in total control – there is now somewhat of a dependency on the user base. It’s an exciting place to be, because ‘building the system’ is now in a real sense something done collaboratively by the vendor and the user base. I don’t know if this is happening in any other domain, and even in health locations where openEHR is in use, I would guess that Norway is now at the forefront.

There are always more challenges to solve in openEHR, but the solid foundation is there, and it’s changing the way computing is done in health. It seems to me not unreasonable to wonder if the concept of ‘product’ should become instead a symbiotic process, whose output on any given day is the best solution available according to the current analysis of the participants. This is the reverse of how some vendors work. My advice to them is to take note, and to procurement to think very carefully about what it is you are actually trying to buy.

Thanks to all the great DIPS people and people from the regional Norwegian health authorities for a friendly welcome and a stimulating time, especially in the local Tromsø pubs under the midnight sun….

Beale-Thomas-openEHR-DIPSforum2013 (PDF of presentation).