2024 openEHR conference series
Interview at EHRCON24 5th November 2024, Reading, UK
Heather Leslie
Standardising Clinical Data: A Collaborative OpenEHR Archetype Governance
Dr Heather Leslie MB BS, FRACGP, FACHI is Chief Clinical Information Officer at OpenEHR International and principal of Atomica Informatics, a consultancy specialising in clinical information modelling and governance, with over 20 years' experience in clinical system design and data standards.
She led the OpenEHR Clinical Modelling Programme (2008-2021) and administered the Clinical Knowledge Manager (CKM) from its inception in 2007 until 2023, delivering over 60 clinical modelling workshops globally across national eHealth programmes.
Interview summary
Heather Leslie is a clinician-turned-informatician with over 25 years in the field, newly appointed as CCIO for openEHR with responsibility for all clinical modelling operations. She was there at the very beginning of openEHR's archetype library - critiquing the first two archetypes Sam Heard had written, blood pressure and adverse reaction - and has spent her career since building and governing the models that now form openEHR's clinical knowledge base.
Her background gives her an unusual vantage point. She came into informatics through building one of Australia's first GP computing systems, and learned the hard way that having three products - a personal health record, a primary care system, and a hospital system - means nothing if the back ends do not align. That experience of building without interoperability in mind became the foundation of her conviction that getting the data right is everything.
Her description of the knowledge engineering process at the heart of openEHR is one of the most precise in the interview set. The underlying ontology - the hierarchy of observation types, evaluations, instructions, and actions - is what she calls the secret source: the structural logic that allows archetypes to fit together without overlap or gaps. When applied to infectious disease surveillance, this revealed nine different ways that twelve disease datasets described a patient as dead. Standardising that single concept across all twelve is, as she puts it, kitchen table common sense - but it requires the ontology to make the problem visible.
Her sharpest observation concerns the monkeypox outbreak: when she offered a validated, publicly available dataset to a doctor in Kenya dealing with an outbreak, she was told every country had already built its own. The disease is the same everywhere; the symptoms, risk factors, and outcomes are the same everywhere; but the data describing them is not. This is the mindset problem she identifies as the most urgent gap - not technical but cultural. The shift required is from looking down at your own project to looking up at the horizon: asking first what already exists that can be reused, rather than building yet another silo. Her conclusion is direct: the silos are going to kill us.