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FHIR + openEHR — 2022

I first started working in healthcare in 2009, having spent almost a decade prior to that in a range of different industries, including fin-tech — although we didn’t call it that then — and the public sector. The thing that struck me most entering healthcare was the complexity of the domain. Everything about it was an order of magnitude more complex than anything I had experienced before — from the clinical workflows that I was trying to digitise through to the compliance and governance of getting a digital solution into production. Oh, and the data. That turned out to be complex too.


A lot of the early projects I worked on utilised HL7 v2, v3 or CDA, but it wasn’t until around 2015 that I started playing with the latest new standard from HL7. One that would be influenced by the lessons of its predecessors to deliver a next-generation standard that would hopefully solve the biggest problem of them all — interoperability.


So, I jumped in and emersed myself in this new world — and it was great. Everything felt so simple — from the well-documented website to the growing collection of open-source tooling. I was able to get a FHIR server up and running in no time.


It was also around this time I had some new projects coming up that felt like a great fit for this emerging standard. So, faster than you could say “interoperability” I was running a DSTU 2 FHIR Server in production. And guess what? It was great. The initial use-cases were mostly greenfield, were quite simple (by healthcare standards) and (ironically) didn’t involve a lot of data sharing. I wrote a few articles around this time relating to my experiences — including Building and Running a Healthcare Platform in the Cloud.


But these early projects grew beyond their MVP (minimum viable product) into more complex problem spaces. Alongside this, FHIR continued to evolve quickly and very soon a FHIR server running DSTU 2 felt like legacy technology. So, it was around 2017 that I started looking around for other options to address some of the challenges I was starting to see emerge.


So about 20 years after it was invented, I discovered openEHR. At first sight, openEHR appeared to be a more academic version of FHIR, which led me to publish some articles to this effect — including FHIR vs openEHR . But it wasn’t until 2019 that the penny dropped, and I realised that these two standards were not in fact competitive, but instead complimentary — leading me to publish FHIR + openEHR.


This article is intended as a summary of these experiences. Hopefully, it will provide some guidance to people who have use-cases they are considering for FHIR and/or openEHR.




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