JMIR Publications

ABSTRACT

In response to the proposal of Tsafnat et al. to converge towards three open health data standards, this viewpoint provides a critical reflection on the proposed alignment of using openEHR, FHIR and OMOP as the default standards for clinical care and administration, data exchange and longitudinal analysis, respectively. We argue that open standards are a necessary but not sufficient condition to achieve health data interoperability. The ecosystem of open source implementations needs to be considered when choosing an appropriate standard for a given context. We discuss two specific contexts, namely standardization of i) health data for federated learning, and ii) health data sharing in low- and middle income countries (LMICs). Specific design principles, practical considerations and implementation choices for these two contexts are described, based on ongoing work in both areas. In the case of federated learning, we observe convergence towards OMOP and FHIR, where the two standards can effectively be used side-by-side given the availibility of mediators between the two. In the case of health information exchanges in LMICs, we see a strong convergence towards FHIR as the primary standard, with as yet limited adoption of OMOP and openEHR. We propose practical guidelines for context-specific adaptation of open standards.