After reading It’s Time To Destroy Selfish Platforms by Daniel Siders, who is one of the architects of the Tent protocol, it seems pertinent to raise the profile of openEHR as a platform that is designed to be open, diverse and provided from different suppliers using different technologies. It is the second part of this excellent article that is important; where he draws attention to the difficulties of the current platforms on offer. Siders draws attention to the difference between email (where you can use whatever app you like and share information with other apps) and platforms which provide apps which are specific to that platform.
“Ultimately all platform companies fall prey to the same fallacy, that they can build the API to rule them all: a single platform for all the world’s users, applications, and data. This goal and their position of immense power incentivizes many platform companies to become bad actors in their ecosystems, hurting developers and users alike. Platforms act as intermediaries between users and developers, depriving both of a direct relationship with each other and an open market. This consolidation and potential for abuse of power is unsustainable for the ecosystem as a whole. Systems of significant value to society always becomes commoditised eventually. Initial development of technology is often centralized, closed, and proprietary, because this allows for more experimentation and faster iteration–which is beneficial to consumers. Once a product permeates the market, competing alternatives emerge. Eventually these systems need standardization, interoperation, and in some cases, disruptive intervention.”
To paraphrase Siders’ problem with current platforms, which he likens to file systems and protocols before the Web, it is unimaginable that we would have to have special handsets and usage plans to call our friends on other mobile carriers or all have to use the same email application to store and forward emails. These services are based on standard protocols. Current platforms behave quite differently, “Users are forced to be a citizen of only one platform cut off from their relationships, data and applications that are the exclusive citizens of another.”
Sider’s ambition is to create a protocol (called the Tent Protocol) which allows us to have our data on diverse platforms using the same apps to access the data wherever we choose to store it. Some readers may not remember that before the Web users had to dial up to notice boards and download what they wanted. The Tent Protocol aims to store and retrieve our data, synchronise devices and communicate with those we want regardless of the platform. There will be many providers.
My immediate thought is that this is the aim of openEHR although focussed on health records – we are a generous or selfless platform and although we have not developed a specific protocol as yet, the early specifications for the entire platform have begun. Many implementations are developing APIs that are necessary to support applications and the community is endeavouring to keep these aligned. It would not seem too far off to have a URL something like “https://openehr.tophealth.com/medicalimages” return all your radiology reports from one online health record provider and a little further in future a URL like “openehr://redcross.org/medicalimages” might return them from another provider. As a citizen I could consolidate these on another providers site or maintain a list of all my providers myself and log in to these sites individually. Clearly it is likely that money will change hands to provide these services without encumbrance but advertising or public funding may play a role.
More from Siders’ vision. “Applications need to be portable between service providers and accounts on different service providers need to be interoperable. It should not matter what provider you use–you should be able to communicate with anyone on any provider, using any app, and be able to take your apps with you when and if you change providers.” This should certainly be true for our health records. The basic tenets of the Tent Protocol are listed here.
It is the integrated openEHR stack that will put us firmly out in front of EHR developments: from ‘crowd sourced’ clinical modelling (to specify content) which is governed and transparent, to multiple applications working from the same EHR service, to those same applications (and new ones) working on different services, to secure sharing and consolidation of our health records and finally to a distributed set of services that support health care.
While this was a dream when we set out 10 years ago, the reality is now firmly within our grasp. Thank you to all who are contributing to this ground changing effort.
Sam Heard
Chairman, openEHR Foundation
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