Over the years, there have been multiple publications in which a comparison was made between HL7 FHIR and openEHR. The conclusion was often the same: both standards have their own strengths and their own place in the healthcare IT ecosystem. Parties such as EY have already mentioned how the combination of FHIR and openEHR can advance interoperability in healthcare.
Even so, more elaborate collaboration between both organisations has remained limited - until last month. On May 23, Charles 'Chuck' Jaffe and Rachel Dunscombe published a joint announcement on behalf of HL7 International and openEHR International: both parties agreed to explore whether certain standards and specifications can be aligned, "for the common good".
A historic moment?
The healthcare technology community on LinkedIn was almost unanimously enthusiastic. There was talk of a historic moment - or, as Clinical Informatician Heather Leslie said: “Did you feel it too? Did the digital health standards world shift on its axis just a little?”
It has long been clear to most that both standards should be used side by side - FHIR for data exchange and openEHR for the standardised storage and modeling of data. However, when different standards have to communicate with each other, this can lead to loss of information or context. Therefore, both communities benefit from increased harmonisation between both standards and the sharing of knowledge and tools. The fact that both parties are now looking into how this can take shape is an important step.
Challenges
Ultimately, both standards have their own vision and a long history of development. In the announcement, Rachel and Charles already asked some challenges they expected to discuss. For example, they state that the strength of the individual standards (such as the open, innovative culture of openEHR and the strongly established process of FHIR) should not suffer when merging aspects of both.
Fortunately, there is immediate active participation within both communities. For example, Health Informatician Severin Kohler took to the openEHR forum to suggest the creation of a public mapping library, where the mapping files could be added to the openEHR CKM. FHIR founder Graham Grieve suggested something similar during his session for the openEHR Masterclass.
Forward!
Luckily, HL7 and openEHR also have a lot in common: both are open and want the best for the global digital healthcare ecosystem. In addition, both have an enormous amount of knowledge and many experts in their respective communities. That openness would provide a good foundation from which to explore together how the standards can reinforce each other. Collectively, we should then no longer talk about 'openEHR versus FHIR', but about 'openEHR and FHIR'.
Within the Netherlands, there are also choices to be made. For example, the National Vision and Strategy explicitly opted for FHIR as the standard for exchange, but no standard has been established for storing data. It would be good if it was also stated at government level that openEHR is the preferred option. There is also a lot of work to be done regarding governance - both communities can play a role in this, together with parties such as the Ministry of Health, Welfare and Sport and Nictiz.
From our perspective
CODE24 has been an openEHR Gold Partner for years. Ever since we were founded, we have also been working with HL7 for data exchange with the various healthcare systems. We thought the time was right to also join HL7 Netherlands.
Our perspective is still that true data availability must be achieved based on standardised modeling and storage of healthcare data, but we also realise that there needs to be a place within the healthcare ecosystem for standardised data exchange - and this is where HL7 FHIR excels. We are also curious about how the announced collaboration between the two standards will improve healthcare IT. We are looking forward to participate in the discussion.