The paper "Converge or Collide? Making Sense of a Plethora of Open Data Standards in Health Care" by Guy Tsafnat and colleagues [1] has catalyzed unprecedented collaboration in the health informatics field since its April 2024 publication. The proposal to converge on three standards—openEHR for clinical care, FHIR for data exchange, and OMOP for longitudinal analysis—has generated substantial professional discourse culminating in formal cooperation between major standards organizations. While receiving broad institutional support, the paper has also prompted thoughtful academic critique about implementation contexts and open-source ecosystems. The reception has been characterized by constructive professional engagement rather than divisive debate, with concrete implementation initiatives emerging across working groups, conferences, and technical guides. Most significantly, the paper has successfully reframed the standards conversation from competition to collaboration.
Standards Organizations' Unprecedented Unity The most significant endorsement materialized as formal collaboration between HL7 International and openEHR International, announced in May 2025 and culminating in the Amsterdam "Converge or Collide?" conference on June 2-3, 2025 [2]. Rachel Dunscombe, CEO of openEHR International, declared this "a landmark moment, filled with energy and a clear vision for how our communities can work more synergistically." The organizations identified five strategic collaboration areas with dedicated working groups and committed to 12-month progress reviews. OHDSI, representing OMOP, officially congratulated the authors in their April 15, 2024 Weekly Digest [3], completing trilateral support from all three standards bodies.
Government and Regulatory Alignment The UK NHS has emerged as a significant supporter, with openEHR UK noting that vendor-neutral approaches are gaining recognition from the government and NHS as necessary to ensure long-term sustainability and flexibility [4]. The NHS allocated £3.4 billion for digital transformation in 2025/26, with openEHR UK submitting formal responses to the Single Patient Record initiative. This governmental backing represents crucial validation of the convergence approach.
Industry Vendor Positioning Major health IT vendors have embraced multi-standard strategies aligned with the paper's vision. InterSystems IRIS for Health demonstrates this approach by incorporating both FHIR repository capabilities and full support for the OMOP Common Data Model, enabling healthcare organizations to leverage multiple standards within their platform [5]. BridgeHead Software, Whitefox, and The Hyve have published supportive technical analyses, with BridgeHead's Adam Coombes memorably noting: "They're not in competition – they're playing different instruments in the same orchestra" [6].
Professional Blog and Commentary Support Code24's technical blog endorsed the framework, stating: "An interoperable health system would use openEHR to collect data, FHIR to transmit data between systems and organizations, and OMOP to find insights in the data" [7]. Medblocks adopted the three-standard framework as an organizing principle for their technical guidance [8], while Veratech's Diego Boscá argued that "collaboration and convergence of these standards represent a significant opportunity to improve the quality of healthcare" [9].
Kapitan et al. (2025) - Primary Academic Critique Published in JMIR as "Data Interoperability in Context: The Importance of Open-Source Implementations When Choosing Open Standards," this response paper provides the most substantive critique [10]. The authors, from institutions including Eindhoven University of Technology and Maastricht University Medical Centre, argue:
● Core Critique: "Open standards are a necessary but not sufficient condition to achieve health data interoperability"
● Trichotomy Challenge: "The proposed trichotomy is too restrictive and therefore of limited use in guiding design choices to be made in real-world scenarios"
● Evidence-Based Analysis: GitHub data showing FHIR's 8,497 contributors versus OMOP's 1,019 and openEHR's 429 suggests ecosystem vitality matters more than architectural elegance
● Context-Specific Examples: Case studies from federated learning and low-income countries where FHIR effectively serves all three proposed domains
● Constructive Conclusion: While supporting the convergence goal, they advocate for flexible, context-aware implementation rather than rigid domain assignments
Technical Community Nuances Several technical analyses have raised implementation concerns without rejecting the core proposal:
● Questions about handling edge cases where domain boundaries blur
● Concerns about transformation costs between standards
● Need for robust tooling to support multi-standard environments
● Recognition that regulatory mandates may override theoretical frameworks
Academic and Technical Documentation Multiple papers and guides have adopted the three standard framework as a reference point without explicit endorsement:
● "From OpenEHR to FHIR and OMOP Data Model for Microbiology Findings" [11] demonstrates practical mapping challenges
● Nature Scientific Data crosswalk studies explore metadata harmonization across the three standards [12]
● Implementation guides treat the framework as one of several viable approaches, such as the HL7 FHIR to OMOP Implementation Guide [13]
Daniel Vreeman, Chief Standards Development Officer, HL7 International [2]: "This collaboration is about the mutual benefit of bringing together the complementary strengths of HL7 and openEHR. The workshop highlighted many key areas where the communities, tools, and methodologies of both organizations can together advance interoperability that improves health around the world."
Rachel Dunscombe, CEO, openEHR International [2]: "This event has been a landmark moment, filled with energy and a clear vision for how our communities can work more synergistically. We are immensely encouraged by the enthusiasm of all involved towards developing a concrete, collaborative plan for future projects."
Kapitan et al., Academic Response Authors [10]: "Following the proposal by Tsafnat et al (2024) to converge on three open health data standards, this viewpoint offers a critical reflection on their proposed alignment... We argue that open standards are a necessary but not sufficient condition to achieve health data interoperability. The ecosystem of open-source software needs to be considered when choosing an appropriate standard for a given context."
Adam Coombes, BridgeHead Software [6]: "FHIR, OpenEHR, and OMOP walk into a bar... They're not in competition – they're playing different instruments in the same orchestra. You just need to make sure your app's not trying to use a flute as a drumstick."
Code24 Technical Blog [7]: "That the organisations behind the standards themselves are now also exploring how openEHR and FHIR can reinforce each other is a good and important step."
openEHR Official Twitter/X [14]: "'Converge or collide? Making sense of a plethora of open data standards in healthcare.' - by @GuyTsafnat @ukpenguin, @DaveraG, @GrahameGrieve & Christian Reich."
The most persistent theme across responses emphasizes that implementation context—including resource constraints, regulatory requirements, existing infrastructure, and developer availability— often overrides theoretical domain alignments. Kapitan et al.'s [10] case studies from low- and middle-income countries, where FHIR's simplicity and broad ecosystem make it preferable across all domains, exemplify this reality. This suggests that while the three-standard framework provides useful guidance, rigid application may be counterproductive.
Multiple responses highlight that standard selection depends as much on surrounding tooling, community support, and implementation resources as on technical specifications [8-10]. The stark disparities in GitHub activity—FHIR's nearly 8,500 contributors dwarfing OMOP's 1,000 and openEHR's 429—suggest that ecosystem vitality may determine practical success more than architectural elegance [10]. This "implementation ecosystem" perspective represents a significant addition to the original paper's framework.
Perhaps the paper's greatest achievement is reframing the standards conversation from zero-sum competition to collaborative coexistence. The Amsterdam conference [2] title directly echoing the paper, joint HL7-openEHR working groups, and FHIR-to-OMOP implementation guides [13] all demonstrate this shift. As evidenced by the formal collaboration between HL7 and openEHR [2] and the development of cross-standard implementation guides [13], the community has moved from debating competing standards to developing practical interoperability solutions between them.
Several analyses note that external forces—particularly government mandates for FHIR in over 20 countries—create implementation realities that supersede theoretical frameworks [4,10]. The UK NHS's vendor-neutral approach and massive digital transformation investment [4] demonstrate how policy decisions shape standards adoption independent of technical considerations. Epic's continued FHIR focus, processing 184 billion API transactions annually [15], shows how market leaders influence de facto standards regardless of academic recommendations.
Industry responses consistently prioritize practical implementation guidance over theoretical debate [5-8]. Vendor blogs focus on "when to use which standard" rather than "which standard is best" [6,8]. Technical guides emphasize transformation pathways between standards rather than exclusive domain ownership [11-13]. This pragmatic approach suggests the community values interoperability solutions over architectural purity.
➔ December 23, 2023: Preprint posted on JMIR Preprints, initial academic circulation
➔ March 30, 2024: openEHR International promotes paper via Twitter/X, generating 1,325 views [14] ➔ April 9, 2024: Official publication in Journal of Medical Internet Research
➔ April 15, 2024: OHDSI Weekly Digest congratulates authors [3], signaling OMOP community support ➔ May 2024: HL7 and openEHR International announce formal collaboration discussions [2] ➔ July-December 2024: Multiple industry blogs publish analyses (Code24 [7], Medblocks, Whitefox) ➔ January 2025: Kapitan et al. critical response paper published in JMIR [10]
➔ May 2025: Joint HL7-openEHR pre-conference announcement [2]
➔ June 2-3, 2025: Amsterdam "Converge or Collide?" conference with 50 invited participants [2] ➔ July 2025: BridgeHead Software publishes widely-shared humorous technical analysis [6]
Geographic Distribution Responses span globally with notable concentrations:
● Europe: Netherlands (strong openEHR adoption) [2,7], UK (NHS initiatives) [4], Spain (Veratech) [9]
● North America: US standards organizations [2,3,13], vendor responses [5,6,8,15]
● Australia: Authors' home base, continued advocacy [1]
Professional vs. Public Engagement The paper generated substantial professional discourse but limited viral public engagement:
● High Professional Impact: Conferences [2], working groups [13], implementation guides [13]
● Moderate Social Media: 10 "tweetations" [16], extensive LinkedIn discussions with at least 14 posts from organizations including openEHR International, openEHR Netherlands, Carefluence, and individual thought leaders [17]
Stakeholder Alignment Different stakeholder groups showed varying responses:
● Standards Organizations: Strongly supportive, collaborative action [2,3,13]
● Academic Community: Supportive with constructive critique [10-12]
● Vendors: Pragmatic multi-standard support [5,6,8,15]
● Developers: Focus on practical implementation [7,8,13]
● Government Bodies: Cautious support for vendor-neutral approaches [4]
The Tsafnat et al. paper [1] has achieved what few academic position papers accomplish: catalyzing concrete action and shifting an entire field's discourse. While the specific proposal of rigid domain assignment to three standards faces legitimate critiques about implementation flexibility and ecosystem considerations [10], the paper's core message—that the health informatics community must converge rather than collide—has resonated powerfully. The transformation from theoretical proposal to practical collaboration, exemplified by the Amsterdam conference [2] and multiple implementation initiatives, represents a significant victory for standards harmonization. The paper's lasting contribution may not be the specific three-domain framework but rather the reframing of standards relationships from competitive to collaborative, a shift that promises more pragmatic and effective interoperability solutions for global healthcare.
1. Tsafnat G, Dunscombe R, Gabriel D, Grieve G, Reich C. Converge or Collide? Making Sense of a Plethora of Open Data Standards in Health Care. J Med Internet Res. 2024;26:e55779. doi:10.2196/55779
2. openEHR International, HL7 International. Press Release: HL7 FHIR-openEHR collaboration. June 2025. Available from: https://openehr.org/press-release-hl7-fhir-openehr-collaboration/
3. OHDSI Weekly Digest. Congratulations to Tsafnat et al. on "Converge or Collide" Publication. April 15, 2024.
4. openEHR UK. openEHR UK and the future of the NHS SPR. London: openEHR International; 2025. Available from: https://openehr.org/openehr-uk-and-the-future-of-the-nhs-spr/
5. InterSystems. InterSystems IRIS for Health: Multi-Standard Healthcare Data Platform. Cambridge, MA: InterSystems Corporation; 2025. Available from: https://www.intersystems.com/products/intersystems-iris-for-health/
6. Coombes A. FHIR, OpenEHR and OMOP walk into a bar. BridgeHead Software Blog. July 2025. Available from: https://www.bridgeheadsoftware.com/2025/07/fhir-openehr-and-omop-walk into-a-bar/
7. Code24. Combining Forces: openEHR and FHIR. Code24 Blog. 2024. Available from: https://blog.code24.nl/en/comparison-fhir-openehr
8. Medblocks. Which Health IT Standard to Pick: FHIR, openEHR, or OMOP? Medblocks Blog. 2024. Available from: https://medblocks.com/blog/which-health-it-standard-to-pick-fhir-openehr-or omop
9. Boscá D. La convergencia de estándares en el sector sanitario: ¿pueden openEHR, HL7 FHIR y el modelo OMOP trabajar juntos? Veratech Blog. August 25, 2023. Available from: https://www.veratech.es/en/2023/08/25/compatibilidad-de-estandares-sanitarios-openehr-hl7-fhir-y-omop/
10. Kapitan D, Heddema F, Dekker A, Sieswerda M, Verhoeff BJ, Berg M. Data Interoperability in Context: The Importance of Open-Source Implementations When Choosing Open Standards. J Med Internet Res. 2025;27:e66616. doi:10.2196/66616
11. Rinaldi E, Thun S. From OpenEHR to FHIR and OMOP Data Model for Microbiology Findings. Stud Health Technol Inform. 2021;281:402-406. doi:10.3233/SHTI210189
12. Bönisch C, Kesztyüs D, Kesztyüs T. Harvesting metadata in clinical care: a crosswalk between FHIR, OMOP, CDISC and openEHR metadata. Sci Data. 2022;9:669. doi:10.1038/s41597-022-01792-7
13. HL7 International. FHIR to OMOP Implementation Guide. 2024. Available from: https://build.fhir.org/ig/HL7/fhir-omop-ig/
14. openEHR. openEHR on X: "Converge or collide? Making sense of a plethora of open data standards in healthcare." Twitter/X. March 30, 2024. Available from: https://x.com/openEHR/status/1774073104047698004
15. Epic Systems Corporation. Epic Interoperability Metrics Report. Verona, WI: Epic Systems Corporation; 2025. Available from: https://open.epic.com/
16. Journal of Medical Internet Research. Article Metrics for "Converge or Collide? Making Sense of a Plethora of Open Data Standards in Health Care". JMIR Publications. 2024. Available from: https://www.jmir.org/2024/1/e55779/metrics
17. LinkedIn Professional Network. Multiple LinkedIn posts discussing "Converge or Collide?" paper. 2024-2025. Posts by openEHR International, openEHR Netherlands, Carefluence, and individual contributors including Wim Vandendael, Sidharth Ramesh, Alexandre Savaris, Richard Kavanagh, Mattias Colliander, Rajaonison, and Aloha McBride. Available from LinkedIn platform.