FHIRconnect: Towards a seamless integration of openEHR and FHIR

TL;DR

FHIRconnect addresses a persistent interoperability challenge between openEHR and FHIR by introducing a YAML-based domain-specific language and an open-source engine to enable bidirectional data transformation. The approach uses a triple-layer architecture (model, extension, context mappings) to maximize reuse across projects, achieving 65% mapping reuse in a PoC mapping 24 international archetypes to 15 FHIR profiles across seven clinical domains. The work provides a formal DSL specification, an open-source engine (openFHIR), and a base library of mappings to support community-driven standardization, reducing reliance on bespoke ETL pipelines. It also discusses the role of openEHR as a stable persistence layer for FHIR data and outlines future work to broaden archetype coverage and validate transformations on diverse real-world datasets.

Abstract

Healthcare interoperability between openEHR and HL7 FHIR remains challenging due to fundamental differences in their data modeling approaches and the absence of standardized transformation mechanisms. This paper presents FHIRconnect, a novel domain-specific language and open-source transformation engine that enables standardized, bidirectional data exchange between openEHR and FHIR. Our approach addresses critical interoperability gaps through a triple-layered architecture that achieves 65% mapping reuse across projects by leveraging international archetype-based foundations while supporting local customizations. Using this framework, FHIRconnect successfully mapped 24 international archetypes to 15 FHIR profiles across seven clinical domains. Key contributions include the first comprehensive DSL for openEHR-FHIR transformation with a formal specification, an open-source execution engine (openFHIR), and an accessible mapping library covering high-impact clinical archetypes. Together, these components establish the technical basis for community-driven mapping standardization, reducing reliance on custom ETL solutions and advancing syntactic and semantic interoperability in healthcare IT systems built on open standards.

Figures (5)

• Figure 1: Interaction between FHIRconnect mapping files and the engine
• Figure 2: Overview of the different mapping file types defined in FHIRconnect.
• Figure 3: FHIRconnect mapping snippet for problem diagnosis.
• Figure 4: Steps of an openEHR-to-FHIR mapping
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