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Link to the official openEHR website.
This post is from a physician’s and not a developer’s point of view. Whenever I read more about openEHR, I appreciate the work put to in this opensource project but at the same time I get weary about its potential for success. OpenEHR promises to put the users (clinicians and other healthcare workers) in the driving seat[1]. This is done by allowing users determine what information should be collected and shared. My feeling is that uses like car drivers only care about reaching their goals in the most comfortable way. Users like drives don’t usually care what is under the hood as long as they reach their goals.
I hope I am not conveying a message that I think that openEHR is useless. To the contrary, openEHR main mission is to offer interoperability between different healthcare systems. The focus on the front line user, not like most if not all systems that focus on how to serve people in management [1,2]. It focuses on those human beings that need to see value for the effort they put in entering data into these systems. OpenEHR gives insights into how should health care systems should be developed. OpenEHR two layer architecture and spreading archetypes into observation, evaluation, instruction and action archetypes are just some proofs of this insight.
I have three concerns. I must say that my concern seems to have been thought of among openEHR developers.

1. How to balance standardization, flexibility and allowing for future growth?
Archetypes are the method used by openEHR to standardize medical information. Archetypes will allow desperate systems to understand each others. Archetypes are developed by the users based on what they think these archetypes should include. For example, there is an archetype for blood pressure and another for heart rate. There are also higher level archetypes as ”Operation Notes”. And just like objects in object oriented programming languages more general archetypes may include other more specific ones. This is called inheritance in object oriented programming. For example “blood pressure” and “heart rate” archetypes will be included in the “operation notes” archetype.
The other good thing is that openEHR developers did not restrict the number of archetypes. For example there are quite similar archetypes as “conclusion”, “problem evaluation”,” diagnosis” and “clinical synopsis” archetypes. These four archetypes are similar. Some by what to combine all these in one archetype to allow for more standardization. But, I think they did the right thing by allow for this diversity. I can see primary care physicians more inclined to use “clinical synopsis” archetype. And, an internist working in a hospital more inclined to use the “diagnosis” archetype.
OpenEHR archetypes’ developers did the right thing again by allow a lot of the archetypes’ attributes be optional. Only the bare minimum attributes are made mandatory.
But, whatever you do once you standardize, you are restricting. You are asking users to think in a pre-specified way. You could look at standardizing at different levels. The lowest level would be the language as the English language or health care standards like SNOMED CT. This low level standardization will make sure that future discoveries be easily incorporated into different systems.
If I was giving the option, I would probably go with openEHR method of standardization. I would encourage its universal use, as if this standard is not widely adapted it will be of no use.

2. openEHR has not given the electronic heath record(EHR) interface enough attention.
From what I can gather from openEHR confusing website that this is addressed in the coming API or template standards. Yet, as a user and a physician, one of greatest frustrations in health care in the EHRs ignorance for new usability principles. One of the openEHR goals was to put the users in the driving seat. But, then they started by putting the user under the hood to build the archetypes. The user should get back to the seat and enjoy the best computer human interface there is.

3. I really cannot remember what I wanted to say. Once I remember I will post it here. But for now, I really think openEHR should have less jargon on their website. I am a physician with good computer background yet, I could never make sense of what is happening.