In an exclusive interview with Talkstandards, Professor David Ingram of openEHR, one of the most innovative players in the eHealth field, outlines some of his expectations for the future of ICT in the health care sector. This transcript has been prepared from notes taken during a telephone interview on February 22nd.

Part III: Openness, implementation and governance

(This is the last of three parts of the interview. Read Part I on The future of eHealth here, and Part II on eHealth in an international perspective here.)

Talkstandards [TS]: openEHR is well known for its advocacy of open standards and specifications, what is the rationale behind this view?

David Ingram [DI]: Insecurities are more easily avoided and safety is promoted by allowing users to “open the hood” of a specification.

This conjecture is based on my own experience, coming from physics and moving into medical services and being close to the implementation of health IT, as I have often witnessed a discrepancy in how users think a system will work and how it actually functions. When people can view the specifications beforehand they are more prepared on what they get. This helps implementation. Keeping an open process also helps making specifications better.

The issue of IPR is complex but I believe that open source is important in academic areas, it helps sharing and handling of information and contributes to a stronger development process. I also believe that there is an issue with patenting something that everyone uses; it would be like Pythagoras patenting his theorem. Open source specifications provide a body of knowledge that can serve as public education.

TS: The three usual activities of openEHR are said to be “…implementation, implementation, implementation”. How far has Europe come in implementing eHealth technologies? And what are the main barriers for further deployment?

DI: I believe that implementation is important because it offers a learning-by-doing approach to answering questions. There is much implementation in the process and healthcare is getting constantly better. Implementation of eHealth technology provides valuable knowledge and ensures that new solutions are built on a solid foundation and thus serves as a promoter of innovation.

The healthcare sector is traditionally conservative, putting much effort in maintaining ethical responsibilities, which to some extent could inhibit innovation. Although changes are coming fast, systems are evolving and we are constantly learning there is still a long way to go in developing eHealth solutions. We need to find a balance between innovation and professional assurance and I am optimistic about the direction developments are taking.

I do wish, however, that governments would prioritize moving further toward learning about the scope of the challenges we are facing and experiment with different solutions. More transparency need to be brought to the teamwork between organizations, governments, clinical practitioners etc, and openness in that collaboration is critical; this is also what we learned from the early NHS projects that brought into healthcare people with valuable knowledge.

TS: You have expressed a need to restructure the organization of openEHR and work to better meet the growing interest from different regions and sectors. Can you comment on this?

DI: I have stated that openEHR needs a new form of governance, mainly as recognition of the fact that the organization has grown to include many different stakeholders. The goal is to make barriers to adoption of our specifications as small as possible and provide a better public understanding of the practical details of the organization. openEHR has from the start been very flexible in the innovation of specifications, but providing a commercial interface as an open source environment for adoption has taken a bit longer.

We recognize that the currently small executive group brings agility and flexibility but it can also stand in contrast to the image of a truly democratic organization. Bringing openEHR to where we are today has taken time and resources we simply cannot continue to spend. We are actively seeking partnerships with other organizations of which the most predominant are those with IHTSDO and EuroRec. This sort of partnerships will offer us a chance to follow other examples of basic principles and practical approach, but also to bring governance forward and handle the growing size of openEHR.