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Open EHR – the key to digitalizing healthcare

05 July 2017

Interview with Johan Höglund and Tomaž Gornik, Co-Chair of openEHR Foundation and CEO at Marand.

Electronic health records (EHRs) are stored on closed systems. This is the biggest obstacle to fully digitalizing healthcare. In Sweden, Tieto wants to lead the way in building open ecosystems for EHRs and believes this will improve healthcare and even create jobs.

For decades, EHR systems have been designed to store data in proprietary formats that are unique for each vendor. As healthcare now moves towards being more ”data driven” this approach is causing serious problems.

– The biggest problem is that it’s impossible to have a holistic view on the patient’s medical history. Over the course of a life lots of valuable medical data is recorded and stored but in different applications and in proprietary formats. Integrations are possible but complicated and costly, says Tomaž Gornik, Co-Chair of openEHR Foundation and CEO at Marand.

The use of proprietary data formats makes it difficult to share data between different institutions. But what is even more troubling is that it also causes problems within an institution, for example a hospital, which typically has many different types of application to handle different needs. Even if a hospital manages to find one vendor to purchase a single ”all-purpose” system from, this system will only cover the needs right now. As time goes on new needs will develop which are not covered by that system and, consequently, new applications will be introduced – applications that probably won’t use the same format as the original system.

– Usually hospitals have a lot of applications, some they don’t even know about. There are examples of hospitals admitting to this problem and the numbers are huge, as much as 500-1000 applications in one institution. So there is really no such thing as ”one application”, Tomaž Gornik explains.

To combat this issue the openEHR Foundation has developed a standardized format that ensures that data is not controlled by any one vendor. The goal of this standardized format is to create an open ecosystem in which vendors create applications that share data with other vendor applications.

The openEHR Foundation has been around for 25 years but it’s standardized format is now gaining popularity due to the increased focus on the digitalization of healthcare. In addition, healthcare, like many other industries, is being disrupted by small innovative companies which target one specialized niche area. Today’s best healthcare institution systems, therefore, are no longer provided by one single vendor, but are rather a mix of systems from many vendors. One of the most recent companies to recognize this trend and sign up to the openEHR Foundation, is Tieto.

– Tieto has been quite ”closed” in the past. We have had monolithic systems with proprietary data formats but we have realized that the world is changing. We see a future where clinical applications come and go but the data remains. We see that customers are out for a ”best of breed” solution, not a vendor lock-in. Tieto also realizes that we cannot be best at everything. Instead we want to provide the core and then work within an ecosystem of specialist partner systems from different vendors, says Johan Höglund Vice President, Healthcare and Welfare at Tieto

According to Johan Höglund the move to openEHR is not only a question of providing hospitals with the best possible applications. Two equally important issues are innovation and job creation. As Johan Höglund sees it, the problem for Swedish healthcare is that proprietary formats force hospitals to buy monolithic EHR systems. In the current market that limits their choice to one or two large American vendors who build all-encompassing systems.

The effect of this, according to Johan Höglund, will be that small and innovative Swedish companies will have a harder time establishing themselves. They will effectively be locked out of the market. Instead he thinks that an open ecosystem, based on the openEHR standard, will give Sweden the best chance to both improve its healthcare system and create new jobs in this growing sector. On this point Tomaž Gornik agrees fully.

– We believe that innovation in healthcare will largely come from smaller companies. This is already the culture in the Nordics. So it is a surprise to me that people go for the big ”mega suites” that limits thems and their futures – not to mention increase their costs.

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