2024 openEHR conference series
Interview at EHRCON24 5th November 2024, Reading, UK
Ian McNicoll
Clinician‐Led OpenEHR: Ian’s Journey, Micro‐Innovations and Community Governance
Dr Ian McNicoll is Chief Executive Officer of FreshEHR Clinical Informatics Ltd, a UK-based consultancy specialising in openEHR-driven clinical information modelling and implementations.
He served as Co-Chair of the openEHR Foundation Management Board and as the Foundation’s representative on the INTEROPen board, advancing interoperability and standards adoption within the UK health and care sector.
Interview summary
Ian McNicoll is a former GP turned clinical informatician who came to openEHR almost by accident, looking for open-source data models to experiment with and finding instead something he initially could not understand — and then could not stop thinking about. Over 15 years working almost exclusively in openEHR through his consultancy FreshEHR, he has arrived at a clear view of what makes it significant: not the technology itself, but the governance and cultural shifts it enables.
The central insight is architectural. openEHR separates apps, data models, and the underlying database into independent layers. Clinicians can define and deploy new data models — archetypes — without going through a software vendor or an engineering team. The NHS, not the supplier, owns the data standards. This shifts the locus of control in a way that is, as Ian puts it, not just an engineering change but a governance change and a cultural change.
In practice, this has produced concrete results. A seven-month NHS London migration — which Ian believes could not have been achieved any other way — succeeded in part because 70% of the required data models already existed in the open-source community library. New care modalities including sickle cell, frailty, dementia, and communication profiles for patients with autism are being added rapidly and shared back internationally. The sickle cell example is particularly striking: a patient arriving at an unfamiliar casualty department can now present a trusted, clinician-governed record rather than a piece of paper that staff have no reason to believe. The future direction — cautious patient write-back using a pull request model borrowed from software development — would make the patient a genuine participant in their own record rather than a bystander to it. Ian's ask of government is simple: formally adopt the principle of the longitudinal patient record, and recognise that the community delivering this has done so on less than 1% of what digital health programmes routinely spend.