Open industry specifications, models and software for e-health
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History 2002 - 2018

David Ingram,
Emeritus Professor of Health Informatics at UCL, 
March 2019

openEHR has developed in three phases.

The first and pioneering phase, from 1992-2003, was essentially exploratory and research-driven, becoming an integral part of the academic mission of the CHIME health informatics group at UCL in London. This phase, and a record of appreciation of those principally involved, is described under Origins of openEHR.

The openEHR Foundation was formally established at UCL in 2003, as an asset-locked and not-for-profit company, designed to take the emergent openEHR mission forward and to engage with industry, national health IT programmes and international standards bodies.

The second and developmental phase, from 2003-2014, focused on engagement with these wider stakeholders and was still highly adaptive and exploratory in its approach. Progress in the mission was consolidated slowly, but steadily. By 2008 the prototype openEHR Architecture Review Board (ARB) had evolved well-defined systems for specifications governance.  With the ongoing development of the openEHR Clinical Knowledge Manager (provided by Ocean Informatics), structured governance evolved also for openEHR clinical models, starting with a prototype Clinical Review Board (CRB). The scope and international dissemination of this work has likewise grown and consolidated steadily.

The progressive development and refinement of the architecture and clinical models rested on real-world, both clinical and technical implementation experience. The Foundation activities were coordinated under the umbrella of UCL academic mission, with key office holders having full or honorary appointments there. It thereby retained considerable flexibility in developing and adapting the work and approach. Progress was only sustained by the commitment, staying power and mutual regard and trust among the founding key players.

Progressively, more formal operating structures for the Foundation were explored and tested. It was realised that it could and should not be sustained indefinitely as a non-trading entity, with no funding beyond the personal contributions from its key players and the resources in kind made available through their employing institutions – ie UCL and Ocean Informatics.

By 2013 it was clear that the logical and necessary next step was to work towards a framework of self-governance for the growing worldwide community of openEHR adopters. A widening international community of clinical modellers was using openEHR modelling tools and the underlying specification of the openEHR archetype model for clinical data was becoming central to the CEN and ISO 13606 standard for EHR communications. Considerable efforts were made at this stage to align, and potentially merge, with the IHTSDO, but proved unsuccessful. An increasing number of industry partners had committed their efforts in the market place to adoption of the openEHR methodology. 

A wide-ranging review of options led to agreement in 2014 on the third and community managed phase of openEHR development - a formal subscribing membership structure, an elected management board for openEHR operations, and provision for funding through contributions from industry partners. Ocean Informatics resigned as a guarantor member of the foundation at this point.

The first election and appointment of the new management board was conducted in early 2015. It proved highly successful over a three year period and it was decided, again after wide consultation with the membership, to take it a step further by embodying it within a self-governing and asset-locked UK Community Interest Company, based in London and operating under UK law. In consultation with Bates Wells Braithwaite, leading lawyers in social enterprise law, it was decided that the Intellectual Property in openEHR would continue to be owned and protected by the openEHR Foundation which would, though, once again no longer be a trading entity.

The second and third phases of openEHR’s growth, and a record of appreciation of those principally involved throughout, is covered in the Report to the final AGM of the Foundation with UCL as its guarantor organisation, in October 2018. At this point UCL resigned as the sole guarantor of the foundation and the new articles and membership structure came into effect.

The transition to the new governance structure of openEHR as a Community Interest Company, which is now at the heart of openEHR’s future organisation, was recorded in a posting to the openEHR community in December 2018, describing the changes.



Acknowledgements: Atlassian (Jira, Confluence) | NoMagic (MagicDraw UML)
AsciiDoctor (publishing) | GitHub (DVCS) | LAMP dev community