Patient-Centered Interoperability: Insights from EHRcon25

---

The EHRcon25 Congress, held in Barcelona on October 16 and 17, 2025, marked a milestone in the advancement toward a more interoperable, open, and people-centered digital healthcare system. Over two intense days, international experts, clinicians, managers, and technology leaders shared experiences, strategies, and perspectives on the role of open standards in transforming healthcare.

---

Day 16: Global Strategies, Artificial Intelligence, and the Future of openEHR

The first day of the event featured a series of presentations and panels focused on the future of clinical interoperability, artificial intelligence (AI) in healthcare, and the strategic role of openEHR as a clinical data architecture. Here are the key takeaways:

Keynote: Global Opportunities for openEHR (Douglas Brown, Black Book Research)

Douglas Brown presented an international study assessing the readiness of over 30 countries to adopt openEHR as the foundation for interoperable clinical infrastructures. Regions such as Catalonia, the Nordic countries, the UK, and Brazil were highlighted for their favorable conditions. Brown emphasized that openEHR is not just a standard but an architecture capable of supporting digital transformation, semantic interoperability, and AI in healthcare. Key challenges include limited technical knowledge, institutional resistance, and the need for sustained governance.

Lessons from Large-Scale Analytics with openEHR (Dr. Seref Arikan, Ocean Health Systems)

The transition to openEHR 2.0 revealed the need to engage clinicians and design solutions that are ready for clinical environments. AI was highlighted as a strategic enabler, always complementing the Clinical Data Repository (CDR). Trust, governance, and AI competency development were identified as essential for progress.

AI from a Regional Perspective (Dr. Jordi Piera Jiménez, CatSalut)

Catalonia faces significant fragmentation in its HIS/EMR systems. Jordi Piera proposed an open, federated platform based on open standards and terminologies, with the CDR as the single source of truth. He warned against AI hype and semantic inconsistency, framing the European Health Data Space (EHDS) as a regulatory opportunity.

Panel: AI, Standards, and openEHR (Experts from CatSalut, AWS, and Ocean Health Systems)

The panel discussed how to bring AI into the hands of users, using openEHR to accelerate time-to-market. A hybrid implementation model was proposed, combining high-impact pilots with strengthening the semantic core. The recommendation: engage stakeholders and build AI competencies for safe and sustainable adoption.

The Impact of AI on Digital Regulation (Rory Macmillan, Macmillan Keck)

AI regulation in healthcare was addressed from a legal perspective. The EU AI Act imposes strict obligations for high-risk use cases, effective from August 2026. Recommendations included preparing governance programs, risk assessments, and supplier contracts to distribute responsibilities.

Panel: Strategic Evolution of Health Information Systems

This panel emphasized that it is no longer necessary to prove openEHR works—now is the time to learn by doing. The importance of hybrid leadership, co-creation between IT and clinicians, and reforming public procurement processes to support open ecosystems was highlighted. The approach was strategic, technical, and cultural.

OneLondon – What Now? (Luke Readman, NHS London)

Luke Readman presented London’s digital health strategy, designed to address care pressure and talent retention. He advocated for large-scale programs over isolated pilots, structured in three layers: shared health record (Oracle/IHE), universal care plan (openEHR/Better), and a data layer in Azure/Snowflake for analytics, operations, and research. With over 2.5 million monthly views and 8 million citizens contributing data daily, the goal is full adoption in under 12 months. Nationally, a “single patient record” model is being evaluated, based on openEHR principles and open data, moving away from legacy monoliths. The strategy combines governance, collaborative procurement, and a cultural shift inspired by Transport for London.

Open Health Data Platforms and AI (Dr. Nils Hellrung, Vitagroup)

Dr. Hellrung shared Vitagroup’s vision for an open, interoperable, and secure health data platform for AI. The Health Intelligence Platform (HIP), based on openEHR and FHIR, operates in over 140 hospitals in Germany and international projects like Catalonia, managing over 13 billion clinical records. The platform focuses exclusively on the data layer, ensuring vendor neutrality. Use cases included regional health records, real-time data integration, and secondary data reuse, as well as synthetic data generation for safe AI model training. The approach was technical and strategic, emphasizing governance and open ecosystems.

Transforming Healthcare Delivery: Cooperation Between openEHR and AI (Benjamin Muhič, Better)

Benjamin Muhič proposed a new way to develop clinical software, where openEHR and AI work together to overcome data fragmentation and improve decision-making. He introduced Better Studio as a low-code platform enabling clinicians and developers to create forms and queries automatically using AI, reducing implementation time while ensuring transparency and governance. Practical examples of auto-generated queries and digital forms based on openEHR archetypes showcased the potential of this synergy to transform healthcare delivery.

---

Day 17: Open Standards, Global Collaboration, Hospital Strategies, Standards Convergence, Semantic Governance, and Open Platforms

The final day of the event focused on the future of standards in digital health, international collaboration, and organizational transformation from hospitals and national systems. Below are the key highlights:

Keynote: The Future of Standards (Grahame Grieve, HL7)

Grahame Grieve, creator of FHIR, argued that the success of standards lies not only in defining rules but in aligning community values and processes. He advocated for open collaboration as the foundation for creating public digital goods, even if it challenges traditional business models. He warned against tribalism and emphasized that interoperability requires sustained consensus. Regarding AI, he stated that standards are more critical than ever to ensure quality, governance, and coherence. He closed with a personal reflection on the real-life impact of standards on patients.

Keynote: Sparked AU – Community and Collaboration as a Driving Force for Change (Kate Ebrill, CSIRO)

Kate Ebrill introduced Sparked AU, a national Australian program accelerating standards adoption through collaboration among clinicians, industry, and federal/state governments. The strategy combines openEHR, SNOMED/LOINC, and FHIR guides, with iterative testing from the outset. She emphasized data quality at the point of care, shared governance, and capacity building. The program aligns with the modernization of national infrastructure and aims for population health traceability without adding reporting burdens. Success, she concluded, depends on fast cycles, transparency, and a sustainable community.

Data4Life Strategy – Hospital Universitario 12 de Octubre (Dr. Juan Luis Cruz Bermúdez)

Dr. Cruz Bermúdez presented the Transforma12 plan, combining the hospital’s physical renovation with a deep digital transformation. He highlighted the volume of clinical activity and the integration of hundreds of new applications designed to meet research and operational needs. The approach was both organizational and technical, with a strong focus on interoperability and providing structured data to clinical and research teams.

Keynote: Digital Wallets Workshop (Grahame Grieve & Rory MacMillan)

An interactive session explored the potential of Digital Wallets (Google, Apple, etc.) as a standard for patient identification. Their widespread use was seen as an advantage, and the types of data they could include were discussed—from basic ID to permissions over medical records. Privacy concerns and potential misuse of information were also addressed. The session had technical, legal, and ethical implications.

Keynote: Let’s Be SMART About It – Converging openEHR and FHIR (Sebastian Iancu / Dr. Sidharth Ramesh)

This session showcased how combining openEHR and SMART on FHIR enables the creation of portable, secure, and open healthcare applications. Medblocks promotes this convergence through open-source solutions, training, and technical support. While openEHR provides the structured and persistent clinical model, FHIR and SMART facilitate communication and a connectable app ecosystem. The result: an interoperable and sustainable environment that fosters innovation without vendor lock-in.

Keynote: Translating openEHR Archetypes – Shared Challenges, Smarter Solutions (Åsa Skagerhult)

Skagerhult addressed the challenges of translating openEHR archetypes, emphasizing that it’s not just about language but adapting clinical concepts to local cultural, regulatory, and organizational contexts. She compared methodologies across European countries and proposed bilingual review from the design phase, improved authoring guidelines, and international collaboration to accelerate adoption and avoid duplication.

Charité’s Future-Proof Research Infrastructure (Severin Kohler)

Charité is building a scalable and secure research infrastructure based on openEHR. Kohler explained how clinical data, imaging, and biobank information are integrated into a common framework, complying with European AI and medical software regulations. The approach combines ethical governance, risk-based processes, and an interoperable architecture that enhances scientific collaboration without compromising patient trust.

Unlocking Health Data: Driving Care, Research, and Innovation Across Europe (Pablo Serrano Balazote)

Pablo Serrano presented the Cantabrian Health Service’s vision for turning structured clinical data into real tools for direct patient care, especially for chronic and multi-pathological patients. He highlighted the shift from pilot projects to a regional interoperable ecosystem, supported by European standards like HL7 and openEHR, aimed at improving clinical decision-making, research, and health planning.

Clinical Knowledge Manager: Bridging openEHR and FHIR (Dr. Sebastian Garde)

The evolution of the Clinical Knowledge Manager (CKM) was presented as key to clinical model governance. Version 1.21.0 introduces improvements in archetype management, FHIR and OMOP integration, and visualization of Value Sets linked to terminologies like SNOMED CT and LOINC. CKM is becoming a global semantic interoperability accelerator, enabling the federation of reusable and adaptable clinical models.

Why Use openEHR for Demographics? The CODE24 Perspective (Sebastian Iancu / Martin van de Meer)

CODE24 showcased practical cases demonstrating how openEHR’s demographic model can represent and query data on patients, professionals, organizations, and care teams. Examples like CareTeam, Caseload, and Cohorts/Worklists illustrated how to model active relationships, identify patients linked to professionals, and group populations based on clinical or social criteria.

They highlighted the use of AQL for combined clinical and demographic queries, including care networks and population analysis. Although AQL doesn’t natively support the demographic model, CODE24 developed extensions using PARTY_RELATIONSHIP, enhancing the system’s analytical power and expressiveness.

Conclusion: While FHIR is widely adopted, openEHR offers unique advantages when demographic data is stored natively—semantic consistency, more powerful queries, and better performance in integrated systems.

Advancing Guideline Definition Language (GDL): Toward Process-Centric, Intelligent Healthcare (Dr. Rong Chen & Dr. Xabier Michelena Vegas)

This session presented the evolution of openEHR’s GDL language, integrating AI models in ONNX format to support automated clinical decision-making. An example was shown for lower back pain treatment, where input data from openEHR archetypes is processed by a predictive model that outputs therapeutic recommendations.

To ensure interoperability and transparency, the concept of a Model Passport was introduced—a standardized metadata framework accompanying each ONNX model, describing clinical features, data transformations, validation rules, and interpretation guidelines.

This approach enables clinical guidelines, predictive models, and normalized data to work together in an integrated, evidence-based, and automated clinical environment.

---

General Conclusion of the Event

Throughout these sessions, it became clear that the future of digital health depends on:

• Open and collaborative standards such as openEHR, FHIR, and SNOMED.
• Robust governance and sustainable communities that drive interoperability.
• Ethical, transparent, and contextualized integration of AI.
• Open platforms that enable the reuse of clinical and demographic data for care, research, and management.
• Cultural change within clinical and technical teams, with hybrid leadership and co-creation.

This event showcased the transformative potential of digital health when innovation, collaboration, and standards come together.