openehr from the source – the route to better healthcare it

Healthcare has struggled for years with data trapped in silos. Every healthcare organisation has its own systems, and these systems store patient data according to their own, closed information models. The result is well known: endless data extractions, bespoke interfaces, information blocking and high integration costs. At regional and national level, initiatives are emerging that attempt to address this problem by placing an openEHR layer over closed healthcare systems. This is an understandable and pragmatic interim step. However, it does not structurally address the root cause of the problem.

the real root cause of the healthcare it problem

The root cause is not the absence of federation or a central platform. The root cause is that most healthcare systems (EHRs, care records and other clinical information systems) store healthcare data according to a vendor-specific, closed information model. As long as these systems remain in place, healthcare data remains ‘trapped’. Every time that data needs to be reused – locally, regionally, nationally or for secondary use – it has to be extracted, transformed and copied again. This is costly, error-prone, sometimes even impossible, and fundamentally unsustainable.

Many regional initiatives are making the strategic and pragmatic choice to replicate healthcare data from existing silos into an openEHR Clinical Data Repository (CDR). This is understandable as long as most healthcare systems remain closed. However, this approach has two structural limitations.

1. Loss of control and source of truth
   
   Once healthcare data is copied, you lose the direct relationship with the original record. Who accessed or changed what, and when? What was the exact context in the source system? Every synchronisation creates a risk of discrepancies between the original and the copy. This is undesirable in a healthcare environment where high-quality and safe care come first, and where legal and clinical accountability are critical. Instead of freeing healthcare data at the source, you create a second, parallel reality.
2. Read-only as a structural limitation
   

   In practice, healthcare data that reaches openEHR through extraction and transformation can generally only be used in a read-only manner. Writing data back to the closed source system is generally not possible, technically complex and legally risky. The result: the openEHR layer becomes a ‘shop window’. Applications and partners across the care chain can read the healthcare data, but cannot write back to it. This means true interoperability – bidirectional, real-time and at the source – remains out of reach.

   These limitations can be traced directly back to an approach that leaves existing closed systems intact and simply extracts healthcare data from them.

The structural solution: healthcare systems that use openEHR from the source

The future-proof route is not to keep copying healthcare data, but to replace closed healthcare systems with systems that use openEHR from the source. Healthcare data is then stored at the point of registration in a vendor-neutral, open information model (openEHR). There is no need for data extraction. No transformation is required. No synchronisation is needed. Other healthcare systems – whether a regional platform, a national service or a partner elsewhere in the care chain – can reuse the data through open APIs, both for reading and writing. The healthcare data remains under the control of the organisation that records it, exactly as the privacy-by-design principles (Separate, Minimise, Hide) prescribe. This is not a theoretical dream. It already exists.

proven in practice

At GGZ Noord-Holland-Noord, the complete EHR from CODE24 runs entirely on an openEHR CDR from Cadasto. All healthcare data is recorded in openEHR from the moment it is captured. There is no parallel silo. There is no copying process. The healthcare data is immediately available for both reading and writing through open APIs to other healthcare systems across the care chain. This is not a later stage on a long-term roadmap. This is reality today.

The result:

• No more endless data extractions and transformations.
• Full control over source data, which remains with the healthcare organisation.
• Bidirectional reuse of healthcare data across the care chain becomes a natural part of the architecture.
• New use cases and applications can be built directly on existing healthcare data, without additional synchronisation processes.
• Transitioning to federation or national networks becomes easier because the data is already modelled in an open and consistent way.

why this story needs to be told now

The market, governments and regions are facing a choice. Do we continue investing in increasingly complex copying and federation infrastructures on top of closed systems? Or do we make the structural transition towards systems that are built on openEHR from the source?

With our many years of experience in healthcare IT – both from the perspective of healthcare organisations and from the vendor side – CODE24 and Cadasto made that choice 16 years ago. We do not provide an openEHR layer on top of a silo. We provide applications that capture healthcare data in openEHR at the source. Healthcare data is not freed. Healthcare data is born free.

That is the message we at CODE24 and Cadasto are deliberately putting forward. Not as criticism of regions that have to work with the resources and systems available today, but as a clear alternative for anyone seriously considering the next generation of healthcare IT. The technology exists. The practice exists. The question is whether we are prepared to address the root cause structurally by choosing systems that make healthcare data open from the source.

The future of healthcare data starts at the source. Open. From the source. openEHR!