Annual General Meeting at UCLB, October 22nd, 2018
Report from the Chair – Professor David Ingram
Today’s AGM brings openEHR to an exciting new juncture in its evolution.
In this final report to UCL, as the sole member organisation of the Foundation, I would like to recognise and record thanks to many colleagues and groups, without whose efforts and staying power, over many years, we could never have got this far in pursuit of such an important, ambitious and complex mission. I hope I have committed no egregious errors in this – of commission or omission. If I have, I apologise in advance; please let me know and I will try to put them right later.
It has been a very difficult year for several of us, preoccupied with overriding family illness and concern. This has unavoidably delayed the conclusion of the legal changes in Foundation governance that were set in train at last year’s AGM. We are now ready to proceed. Both boards should feel proud that they have supported one another so well through some very tough times, ensuring that the mission has held together and made good progress. Merridy Heard and Hildegard McNicoll have contributed so much, and in so many ways, to openEHR. I’d like also to record our special thanks and appreciation to them, today.
The Management Board has been notably successful over the year, funding new activities and achieving a good positive cashflow from a growing body of subscribing members and partners, as demonstrated in the 2017-18 year-end accounts.
2. Management Board
The work of the Management Board and its associated committees, companies and regional ambassadors has continued to be outstandingly successful in furthering the detail, comprehensiveness and outreach of openEHR. The leadership provided by the co-chairs - Ian McNicoll of FreshEHR Ltd and Tomaz Gornik of our industry partner, Marand - has been magnificent.
Our thanks go to Koray Atalag, from New Zealand, and Rong Chen, from Sweden, who have retired after their period of office. A second round of elections has brought Xudong Lu, a Professor at Zheijang University and the openEHR co-Ambassador in China, and Bjorn Naess, who works for our Norwegian industry partner, DIPS, onto the Management Board.
Thomas Beale and Heather Leslie and Silje Bakke have continued to put their considerable talents and efforts into leadership of the technical specifications and clinical modelling groups. Extension of the record specifications to embrace workflow, has been a notable focus. Ocean Health Systems has, through Sebastien Garde, put considerable effort into developing and supporting the Clinical Knowledge Manager. Marand, Ocean, DIPS and Tieto have had an increasingly high-profile year in bringing openEHR to the health systems marketplace. Through the excellent and growing wider community of collaborating companies and engineers, much new open source tooling and core software for openEHR implementations has been implemented and made available. Good progress has been made with the EtherCIS opensource implementation of core openEHR functionality, led by Tony Shannon, Christian Chevalier and the Ripple Foundation. Pablo Pazos has continued to drive forward the openEHR agenda in South America, as have our ambassadors in China, Japan and the Philippines.
I would also like to recognise and thank Renata Tarnowska of UCLB and Jill Riley for the business and administrative services they have provided, and Adriana Danilakova for her work on the web site design and development.
I’m sure the above list is not comprehensive, but all such contributions have been invaluable and are hugely appreciated by the Foundation. They all find a place on the openEHR web site.
3. openEHR Governance
Articles of Association for the new openEHR Community Interest Company and revised articles for the Foundation are brought to this AGM for final consideration and approval. There has been extensive discussion about these over several years, as recorded in previous Minutes. The gestation period has been prolonged but there has been benefit in allowing ideas to be debated and new structures tested and agreed. The option to invite the Wellcome Trust to participate as a member organisation of the Foundation, replacing UCL, was explored. Wellcome was unable to consider taking on the role at this time but wished us well and was complimentary about openEHR’s achievements. I would like to record thanks to Gunnar Klein for his considerable help and support as we explored the options for the new governance structure.
The new articles have been prepared for us by Bates Wells Braithwaite (BWB), with the assistance of the Apperta Foundation, chaired by Bill Aylward. BWB has preeminent expertise in charity and social enterprise law. Apperta has made model CIC legal documents available to guide us, at no charge. I would like to record thanks to Bill, Apperta and Peter Coates of NHS Digital, and his team, who have been very supportive of this legal process throughout the year.
Cengiz Tarhan, who represents UCL in its role as sole member of the openEHR Foundation, recently announced his decision to retire at the end of 2018. He advised and encouraged us that UCL should cease to be a member organisation - its corporate role in underwriting openEHR mission, providing cover for our efforts to establish openEHR as a free-standing and sustainable entity, having been successfully fulfilled. He suggested that a membership model based on key individuals at the heart of the mission, might best be adopted. This model was considered appropriate by Bates Wells Braithwaite, for both CIC and Foundation.
For the openEHR Foundation, the members should be representative of the openEHR community and the wider health informatics domain. Sam Heard, Thomas Beale and I will initially become members of the Foundation, as co-founders and leaders of the openEHR mission since its inception. Ian McNicoll, Tomaz Gornik and Silje Bakke will also become members, as representatives of the constituencies of individual subscribing members, industry partners and organisational partners on the first elected Management Board. The current Management Board members will be the subscribers to the memorandum establishing the openEHR CIC, along with Sam and Thomas, who will be the initial representatives of the Foundation as members and directors of the CIC, as provided for in the CIC articles.
The revised articles of the Foundation, brought to this AGM from the Board of Governors, for approval, reflect these discussions and the agreements reached.
After adoption of the new governance arrangements and resignation of UCL as Foundation member, BWB will finalize legal establishment of the openEHR CIC and the revision of the articles of the openEHR Foundation. The Foundation will continue as owner of the now very extensive openEHR IP, as proposed and agreed at the 2016 AGM and reconfirmed in 2017. Once the openEHR CIC has proved itself a stable and sustainable entity - we envisage somewhere in the region of five years being needed for this to become clear - further consideration will be given to transferring the IP to the CIC and closing the Foundation.
I have recently met the senior UCL vice-Provost, Professor David Price, to brief him of these upcoming changes in governance. He has asked me to keep him closely informed of openEHR’s progress and to meet the Life Sciences Dean, Geraint Rees, to brief him as well.
There were no changes in board membership during the year. Bill Aylward has indicated that he will formally resign as a director at the preceding board meeting today. I would like to record both collective and personal gratitude to him for his many years of service to the Foundation. I have also seen his outstanding polymath talents in evidence in the creation of the OpenEyes open source software for ophthalmology records. This project was taken forward originally by Moorfields Eye Hospital and the OpenEyes Foundation Charity. It will now become an activity of the Apperta Foundation. The concept of a generic, open source and openEHR-based platform for electronic health records evolved in discussions between Bill, Ian, Seref Arikan, Thomas and me, some five years ago. We aimed to implement OpenEyes and several other open source record projects evolving within the NHS, as exemplars of integrated digital care records. This was the subject of our Orsini (Open record standardisation initiative) proposal to the NHS, which proved unsuccessful. Now some years on, the concept is progressively being crystallised and realised in the Apperta Open Platform initiative. We may have been too far ahead of the game in this, but we have, nonetheless, undoubtedly helped to change the game for the better!
5. UCL and Ocean Informatics (now Ocean Health Systems)
This will be the last AGM of the Foundation with UCL as sole member organisation, represented here by Cengiz Tarhan. In this time, openEHR has established itself as world-leading methodology for the standardisation of electronic health records. Implementation of the Foundation’s open specifications has continued to develop and spread in practical healthcare contexts across the world, thereby informing their ongoing refinement and extension, as fully documented on the openEHR web site. The specifications have had a strong influence and become integral with the recent ISO and CEN 13606 standards for electronic health record communication.
Cengiz has been our foremost UCL supporter and mentor from the start of openEHR. He has helped in all stages of the creation and development of the Foundation and in the changes in governance brought here for approval, today. Having successfully piloted the management board arrangements over the past three years, openEHR is now well-placed to take off as a free-standing Community Interest Company.
We owe Cengiz immeasurable thanks and gratitude for his support and wish him well in his retirement years. openEHR would not exist were it not for the backing within UCL that he has represented, so generously. After an initial research-funded phase lasting some 10 years, openEHR has always seen itself as an outward facing and experimental mission, centred on learning by doing in the wider world of healthcare industries and services. As such, it has progressively been led and guided by clinicians and implementers and their working experience in real world healthcare settings. This has been, and remains, a very difficult context and openEHR can be justly proud of its achievements. The commitment and staying power of the colleagues at the core of openEHR has been tremendous, invaluable and inspirational.
Sam Heard and then Thomas Beale were early core members of the research team whose pioneering work led to the creation of openEHR. They subsequently collaborated in creating the Ocean Informatics company in Australia, which became a founding member of the Foundation, along with UCL. They have been primi inter pares among the central figures that have created and sustained openEHR from the earliest days – outstanding clinical and technical pioneers working across healthcare organisations, companies supplying systems, academia and standards bodies.
Ocean Informatics was at the centre of the early progress of openEHR into the commercial world, as Marand and other large industry partners are, today. Sam, Thomas and their Ocean colleagues, notably including Heather Leslie, have contributed hugely to the Foundation; they took many personal career and financial risks, and suffered many blows in doing so. Had they not done so, there would be no openEHR today, on which new and larger companies are finding themselves able to build and grow.
My departmental academic mission at CHIME in UCL, to which Sam, Thomas and now Ian have been regular and much valued contributors, evolved into one of embodying a home, vision and leadership for the openEHR mission, interfacing with diverse disciplines, communities, organisations and jurisdictions.
The progress achieved through incorporation of key elements of openEHR within the ISO/CEN 13606 standard for EHR communication, was due in very large part to the work of my former doctoral student and colleague, Dipak Kalra, and David Lloyd, both of CHIME and UCL. Dipak was active in openEHR for many years. I would like to record here my admiration and appreciation of his contributions and my personal indebtedness for the wholehearted support he gave me, leading to the creation of the Foundation. Also, that for my successive sponsoring UCL Provosts, Vice-Provosts, Deans and NHS Trust leaders, starting with Derek Roberts, Helene Hayman, John Pattison and David Patterson, followed by Chris Llewelyn- Smith, Mike Spyer, Malcom Grant, Leon Fine and Ed Byrne, who all trusted, supported and gave me the space and opportunity to do this.
6. Looking ahead
The PhD thesis of my former student and now close friend and colleague, Seref Arikan, exploring new frontiers for openEHR in the era of big-data and artificial intelligence, is very widely and extensively downloaded from the UCL thesis repository. Supervising Seref’s ground-breaking research in his extended doctoral programme, opened me to an incisively independent, intelligent and modernising eye over the evolving openEHR mission. I record here my thanks and admiration for Seref, too.
After passing my pastoral and organisational responsibility for the openEHR mission to the leaders of the openEHR CIC, a new goal will be to write a personal history of the field, covering now nearly 50 years. In this, I will recognise the many great and illustrious people and colleagues across the world, that academic study and life has privileged me to know, and some largely unsung (in part because ahead of their times) heroes. I hope thereby to help inspire a new generation of heroes to step up, join in and keep the openEHR mission moving forward.
Finally, and although this extensive narrative may sound otherwise, I do not feel in retirement mode at this key moment of transition for openEHR! Indeed, freed from my central leadership role and responsibility for maintaining and defending the ideas and values underpinning openEHR, I hope to be able to engage more widely, once again, in its future advocacy, development and dissemination.
David Ingram, October 22nd 2018
Emeritus Professor of Health Informatics at UCL,
President and Chair of the Board of Governors of the openEHR Foundation