Global Adoption of openEHR Clinical Data Repositories: A Vendor and Community Survey

Imagine a hospital where every doctor, nurse, and specialist speaks a different language. One records a patient's history in a system that cannot talk to the system used by the lab, while another stores research data in a format that the local clinic cannot read. For decades, this has been the reality of healthcare information. While computers have become powerful tools for saving lives, the way they store and share medical data has often remained fragmented, locked behind proprietary walls that prevent different systems from understanding one another. To solve this, experts developed a set of rules called openEHR. Think of it not as a specific software program, but as a universal blueprint for how clinical information should be structured. It allows doctors and researchers to define what a "blood pressure reading" or a "diagnosis" looks like in a way that any computer system following the blueprint can understand, regardless of who built the software. This approach promises a future where patient data can travel seamlessly across borders and institutions, fueling both better individual care and large-scale medical research.

Despite the promise of this blueprint, no one knew exactly how many hospitals or countries were actually using it in the real world. For over twenty years, the technology existed, but its global footprint remained a mystery, documented only in scattered reports and academic papers. To clear up this uncertainty, a team of researchers conducted a comprehensive survey, reaching out directly to the companies that build these systems and the professionals who use them. They wanted to map the landscape: where is this technology being used, how deeply is it embedded in daily care, and what stops it from being used everywhere? The result is the first clear picture of how openEHR has moved from a theoretical standard into the actual infrastructure of healthcare systems across the globe.

The researchers found that openEHR is far more widespread than previously thought, with deployments reported in twenty-two countries across five continents. However, the way it arrived in these places tells two different stories. In some nations, such as Sweden, Norway, and Finland, the technology spread through a market-driven approach. Here, regional health authorities chose to buy systems built on the openEHR blueprint from commercial vendors. This happened without a single national law forcing them to do so; instead, local health leaders simply decided that this standard worked best for their needs. As a result, openEHR now covers the vast majority of health regions in these countries, serving as the primary system for millions of patients. In other countries, including Ireland, Greece, Malta, Slovenia, and Jamaica, the approach was different. Governments themselves built or purchased national health record systems based on this technology, establishing it as the foundation for the country's entire digital health infrastructure. In these cases, the technology is the bedrock of the national system, even if the government documents do not explicitly name the standard itself.

Yet, a closer look at how these systems are used reveals a significant gap between potential and reality. While the technology is designed to serve two purposes—direct patient care and secondary research—the data shows a heavy imbalance. About sixty-one percent of the reported deployments are used only for the immediate care of patients. Only twelve percent of systems are set up to support both patient care and research simultaneously. This means that in most places where the technology is active, the rich data collected during a doctor's visit is not being easily reused to improve public health or advance medical science. The researchers identified a specific reason for this: a lack of specialized knowledge. The most consistent barrier reported by practitioners, regardless of where they live, is simply not having enough people who understand how to make the system work for research purposes. It is not a technical failure of the software, but a human challenge of expertise.

Another surprising finding is that the technology is not being used in isolation. In many places, it works alongside another popular standard called HL7 FHIR, which is often used for exchanging data. Rather than competing, the two are often used together, with one handling the long-term storage of complex medical records and the other handling the quick exchange of information between systems. This practical combination suggests that the perceived rivalry between different data standards is less of a battle and more of a partnership in the field. However, the study also highlights a structural weakness. Despite its widespread use, the researchers found no single country where openEHR is explicitly named in a binding national law or regulation. In places like Sweden and Finland, the adoption is entirely driven by market choices and local decisions, not by government mandates. This creates a situation where the infrastructure is real and functional, but it remains vulnerable. If a government changes its mind or a procurement contract ends, the entire system could be dismantled, as there is no legal requirement to keep it in place.

The study concludes that while openEHR has successfully moved from a research concept into a working reality for millions of patients, its future stability depends on more than just market success. The technology has proven it can scale to national levels, but it remains fragile because it lacks the protection of formal regulation. The researchers suggest that for this infrastructure to become permanent and fully realize its potential for research, it needs to be recognized in laws and policies, similar to how other standards have been adopted in the past. Until then, the global health system possesses a powerful, interoperable foundation that is currently underutilized and at risk of being reversed by the next political or economic shift. The path forward requires not just better software, but a commitment to training more experts and enacting policies that secure these digital foundations for the long term.