As healthcare systems around the world confront growing demands for interoperability, governance, and trusted clinical data, the conversation around open platforms has never been more important. In this Q&A, Ocean Health Systems speaks with Jordi Piera-Jiménez, CEO of openEHR International, about the lessons learned from Catalonia’s digital health transformation, the realities of implementing interoperable systems at scale, and why clinically governed, vendor-neutral data models are critical to the future of healthcare. From lifelong electronic health records to the foundations needed for trustworthy clinical AI, Jordi shares his vision for the next chapter of digital health and the evolving role of openEHR in building connected, learning health systems.

Q&A

You hold degrees in computing science and telemedicine and completed a PhD on the economics of digital health innovation. Early in your career, you helped develop Catalonia’s electronic medical and social care records. How have these academic achievements and hands-on experiences prepared you to lead openEHR, and how will they influence your vision for openEHR’s role in the future of health systems?

Answer. That story starts in my first years in Badalona. My early years were spent trying to build something resembling a longitudinal health record for a population that received care from primary care teams, a hospital, mental health services, and social care, all running on different systems, with different identifiers, and different ideas about what a patient even was. We stitched it together one interface at a time, and the experience left me with two convictions that have shaped everything since. The first is that integrated care is not a clinical model bolted onto an IT layer, but a data architecture decision made years earlier, for better or for worse. The second is that the lifelong electronic health record, the thing that should follow a person across decades and settings, is impossible to build sustainably if every new use case demands yet another integration project.

Everything else fell into place around those convictions. The computing science training gave me the engineering view of systems that need to last. Telemedicine taught me that what looks like a data problem is almost always a clinical workflow problem first. The doctoral work on the economics of digital health innovation made me obsessive about value, about who pays for what, and about why so many promising initiatives never make it past the pilot. The later years at the Catalan Health Service showed what becomes possible when a public health authority decides, at population scale, to invest in an open platform rather than another generation of ad hoc interfacing.

For openEHR, all of this points in one direction. Our specifications, our community, and our adopters have already shown that the lifelong health record is buildable when the underlying data model is shared, vendor-neutral, and clinically governed. The next chapter is about making that pattern easier to deploy, easier to fund, and easier to evidence as the substrate for learning health systems, and for the kind of clinical AI that clinicians should actually be able to trust. That is the contribution I want openEHR to make in this period.

As Director of Catalonia’s Digital Health Strategy, you spearheaded initiatives like deploying the openEHR-based Clinical Knowledge Manager to unify health data models. What lessons did you learn from implementing open-platform solutions and interoperability in Catalonia, and how will those insights inform your strategic direction for openEHR globally?

Answer. Three lessons stand out, and all of them are uncomfortable. First, the technology was the easy part. The hard work in Catalonia was building shared governance across providers and vendors so that clinical models meant the same thing on Monday as they did on Friday. Second, modelling is a clinical exercise, not an IT exercise. Every shortcut we took to push faster ended up costing us twice as much to unwind. And third, vendor neutrality is a slow dividend. It pays back enormously over a decade, but very little in the first eighteen months, which is exactly when most procurement decisions get made. What this means for openEHR globally is that we cannot only invest in specifications. We need to invest in the ecosystem that makes specifications usable: tooling for modellers, training for implementers, shared catalogues that reduce duplicated work, and credible evidence that the open platform pattern delivers on its promises. The Catalan experience also showed me how much can be achieved when a public health authority commits to open standards as a deliberate policy choice. Helping other jurisdictions build that case, with evidence and with peers rather than slideware, is one of the most useful things we can do as an international community.

Rachel Dunscombe led openEHR through a period of significant growth, forging partnerships and strengthening links with global initiatives (JIC, IHE, the EU Health Data Space, xShare, IPS, etc.). As you follow in her footsteps, which aspects of that legacy will you build on? What new ideas or initiatives do you envision introducing to guide openEHR’s next phase of development?

Answer. Rachel handed over an organisation that is almost unrecognisable from the one she inherited. The relationships with HL7, IHE, SNOMED International, the Joint Initiative Council and the European Health Data Space are real working relationships now, not aspirational lines on a slide. The xShare and International Patient Summary tracks have put openEHR squarely inside the conversations that matter for European patient mobility. None of that gets paused. If anything, my job is to lean into it harder. Where I want to push next is the agenda I set out at our Dublin conference this May, which I called “What comes after convergence.” Convergence between openEHR and HL7 is now substantially proven at the architectural level. The next three questions are governance, funding, and evidence. How do we govern shared artefacts across organisations without slowing implementers down. How do we sustainably fund the open commons that everyone benefits from but nobody quite owns. And how do we build the empirical base that lets ministries and procurement officers choose open platforms with confidence rather than courage.

The announcement of Rachel’s move to HL7 noted it will “further cement the close relationship” between openEHR and HL7 International. How do you plan to deepen collaboration with HL7 and other standards bodies (for example, Ocean Health Systems, HL7 FHIR or SNOMED CT), and how might these partnerships shape openEHR’s strategy under your leadership?

Answer. Rachel moving to HL7 is one of those (rare) moments where personal continuity will reinforce institutional collaboration. We already speak constantly, and I expect the joint work between our organisations to accelerate rather than slow. The intellectual case for cooperation is clear in any case. FHIR has become the lingua franca for health data exchange. openEHR provides the persistence and modelling layer that lets the data exchanged through FHIR remain meaningful and queryable over a clinical lifetime. SNOMED CT, LOINC and other terminologies supply the semantic anchors. These are complementary roles, not competing ones, and the implementers who actually deliver care systems have understood this for years. Ocean Health Systems is a good example. Your work, alongside that of many other implementers in our community, is what turns specifications into running software that clinicians can rely on. Standards bodies write the grammar. It is companies like yours, together with public health authorities and research groups, that write the literature. My job is to make sure the conditions for that work remain healthy: stable specifications, clear governance, predictable processes, and a credible international voice in venues like the Joint Initiative Council. If we get those conditions right, the partnerships largely take care of themselves.

openEHR has emphasised continuity under the management of a strong core team during this leadership transition. With that solid foundation, what are your top priorities and new initiatives for openEHR in the coming year? Are there particular opportunities (such as emerging technologies, new regions, or partnerships with health systems) that you are especially excited to pursue?

Answer. My priorities for the coming year cluster into four areas. The first is organisational maturity. openEHR International has grown faster than its operating model, and we need to professionalise governance, finances and member services so that the secretariat scales with the community. The second is the evidence agenda. We are going to invest seriously in research collaborations, peer-reviewed publications, and shared real-world evaluations of open platform implementations. Our EHRCON26 conference in Amsterdam in September, and the associated Frontiers in Digital Health research topic, are part of that push. The third is reach. There is enormous appetite for open platform thinking in regions where we are currently under-represented, particularly in parts of Asia, Latin America, and the Global South. The work conducted by WHO-ITU on the Reference Architecture for a Digital Public Infrastructure for Health opens doors there that simply did not exist a few years ago, and we want to support local communities rather than parachute in. The fourth is the implementer experience: better tooling, better training, easier onboarding, and a clearer pathway from a first openEHR project to a sustainable production deployment. What I am most excited about, honestly, is the convergence of all this with AI. Open, semantically rich, longitudinal data is exactly what trustworthy clinical AI needs, and openEHR has a unique role to play in making sure that future gets built on solid foundations.

To learn more about openEHR, visit https://openehr.org/

For the Clinical Knowledge Manager, provided to openEHR International by Ocean Health Systems under a pro bono licence for international use, please visit https://ckm.openehr.org.