Healthcare Standards
VPR is built on two foundational healthcare standards: OpenEHR and FHIR. These standards provide complementary capabilities for clinical data management and interoperability.
Overview
OpenEHR
OpenEHR provides a vendor-independent architecture for storing and managing clinical data with built-in versioning, semantic interoperability, and clinical knowledge separation.
VPR uses OpenEHR for:
- Clinical record structure and composition model
- EHR status tracking and identity linkage
- Version-controlled clinical data management
- Archetype-based semantic definitions
Read more about OpenEHR in VPR →
FHIR
Fast Healthcare Interoperability Resources (FHIR) is a modern standard for exchanging healthcare data via RESTful APIs, with emphasis on ease of implementation and web-friendly formats.
VPR uses FHIR for:
- Coordination repository wire formats
- Messaging thread semantics (Communication resource)
- Future API projections and integrations
- Interoperability with external systems
Complementary Roles
OpenEHR and FHIR serve different but complementary purposes in VPR:
| Aspect | OpenEHR | FHIR |
|---|---|---|
| Primary focus | Long-term clinical data storage | Real-time data exchange |
| Architecture | Repository-based, versioned | API-first, resource-based |
| Granularity | Document-level (Compositions) | Element-level (Resources) |
| Versioning | Built-in, audit-focused | Optional, implementation-specific |
| Clinical modeling | Archetypes + Templates | Profiles + Implementation Guides |
| Best for | EHR systems, clinical archives | HIE, mobile apps, integrations |
VPR’s Hybrid Approach
VPR combines the strengths of both standards:
OpenEHR for Clinical Records:
- Compositions stored in clinical repository
- Full version history via Git
- Archetype-based semantic structure
- Long-term clinical archive
FHIR for Coordination:
- Communication semantics for messaging
- RESTful API patterns for future integration
- Resource-based wire formats
- Interoperability with external systems
This hybrid approach provides:
- Best-in-class storage: OpenEHR’s robust clinical data model
- Best-in-class exchange: FHIR’s practical API standards
- Future flexibility: Can project either standard externally
- Standards alignment: Both use standard terminologies (SNOMED, LOINC)
Design Principles
Semantic Preservation
VPR maintains the meaning of both standards:
- OpenEHR composition structure is preserved
- FHIR resource semantics are followed
- Mappings between standards are explicit
- No information loss in either direction
Implementation Pragmatism
VPR adapts standards for version-controlled storage:
- YAML instead of JSON/XML for human readability
- Git instead of database for version control
- File-based storage for simplicity and auditability
- Cryptographic signing for integrity
Progressive Enhancement
VPR can add standard APIs incrementally:
- Core storage model is standards-aligned
- APIs can be added without changing storage
- Multiple projections possible (OpenEHR API, FHIR API, GraphQL)
- Storage remains authoritative source
Standards Governance
OpenEHR Foundation
- Develops and maintains OpenEHR specifications
- Curates archetype repositories (Clinical Knowledge Manager)
- Provides conformance testing
- International community of users
VPR Compliance:
- Uses OpenEHR Reference Model structures
- Declares RM version in all files
- Follows composition and versioning semantics
- Compatible with OpenEHR tooling (parsers, validators)
HL7 International
- Develops and maintains FHIR specifications
- Manages terminology and code systems
- Provides implementation guides and profiles
- Large ecosystem of vendors and implementers
VPR Compliance:
- Uses FHIR resource semantics (conceptual alignment)
- Wire formats map to FHIR resources
- Can project to FHIR REST API
- Compatible with FHIR tooling (validators, servers)
Further Reading
- OpenEHR in VPR - Detailed coverage of OpenEHR usage
- FHIR in VPR - Detailed coverage of FHIR integration
- Clinical Repository Design
- Coordination Repository Design
- Technical Architecture