openEHR professional member, Koray Atalag talks about his journey into openEHR

“I’m still enthusiastic about openEHR – it’s like a religion to me.”

I’m originally from Turkey, and I started with computers back in 1982 when my best mate’s uncle brought a Sinclair ZX Spectrum computer from the UK, where it was first launched. It was a remarkable introduction to technology, and I’ve been fascinated ever since.

My friend and I learned programming through machine code, programming zeros and ones to create our own games. As the industry evolved, from Apple PCs to faster models, I remained deeply involved in its progress. But during high school, I took a break from my tech pursuits, focusing more on typical teenage interests. And after high school, I enrolled in medical school.

Around my fourth year of medical school, a friend of my father, who worked in anatomical pathology, approached me with a problem: “I have this terrible program”, he said, “which is not working anymore”. I was eager to help, which is how I fell back into programming.

In 1995, Koray developed an anatomical reporting software that was ahead of its time. It featured images, annotations, and integrated SNOMED coding, and the synthesis of composite codes to create new meanings. It actually predates SNOMED’s official adoption of pre-coordination and post-coordination by about a decade.

By the time he graduated from medical school, Koray’s program had become very popular and widely used in universities and hospital labs, particularly those with a focus on research and teaching.

At its peak, I had 2 .5 million people’s records on my system. I was a 20 something and I didn’t make lots of money because at that time nobody was willing to pay for software. I was just doing it mostly for fun. 

After completing medical school, Koray pursued a PhD in molecular biology and genetics, leading him into the field of bioinformatics, where he applied computer technology to genomics and related disciplines. A year later, he collaborated with a close friend to establish a health software company in Istanbul. Together, they founded Medikod Health Information Systems, which specialised in providing customised healthcare software solutions. He even coined the term “health information systems” to highlight the company’s focus on managing healthcare-specific information. Starting with their proprietary software, they expanded their offerings to include applications for endoscopy and a generic Electronic Health Record (EHR) system tailored for surgical practices. They also acquired exclusive distributorship of a large USA based EMR, Shared Medical Systems (SMS), which was then acquired by Siemens to become Soarian and then Cerner!

The biggest challenge for us was the lack of structured data standards across medical specialties and institutions. I tried to leverage existing standards rather than reinvent the wheel and my research led me to the ASTM – the American Society for Testing and Materials – which had developed a rudimentary framework (DTDs) similar to what I had in mind, albeit using XML. I adapted their data model for our purposes, but I found it very clunky. Still, we published and presented our work to the wider community….

Then… disaster struck when a massive earthquake hit Turkey in the summer of 1999 which adversely affected the business so Koray left his PhD without submitting a thesis and returned to medical school in Ankara and kickstarted Turkey’s first health informatics department. At the same time he started a PhD in Information Systems (back then health informatics wasn’t even coined!)

In 2001, I attended a conference in Berlin and by chance, found myself staying in the same hotel as Tom Beale – the inventor of Archetypes and one of the founding members of openEHR. I didn’t know who he was at first but we struck up a conversation in the elevator and bonded over a shared interest in luxury UK cars, particularly Bentleys.

We made our way to the conference venue together and when I listened to his presentation on Archetypes, I recognised its perfect fit. This led to a fruitful collaboration with the openEHR family, including Sam Heard, Dipak Kalra and of course the legendary David Ingram, and I became heavily involved in openEHR and contributed extensively to specification and software development, drawing upon my understanding of clinical and genomic aspects. My participation in the community felt like stepping into Wonderland. I embarked on a PhD focusing on modelling endoscopy systems using openEHR, identifying gaps and making improvements to the architectural definition language and reference model.

But by that time, I had just become a father and I was disillusioned with Turkey’s trajectory, so we made the decision to relocate to New Zealand upon completing my PhD.

Koray continued his research on openEHR, with a particular focus on Open Systems. He was fortunate enough to win a fellowship – which was funded by a wealthy individual in New Zealand whose son had a strong involvement in computers – before he tragically passed away in a car accident. Koray was selected for his contributions to open systems (open standards and open source) and his work with openEHR. Teaming up with an exceptionally talented programmer called Hong Yul Yang, they collaborated on assessing the impact of openEHR compared to traditional software development on the maintainability and externalisation of medical knowledge from software code.

To validate their findings, they developed an openEHR version of his endoscopy reporting software (GastrOS) Koray developed using Visual Basic and Access database based on exactly the same functional requirements.Real-world change requests from a teaching university hospital in Turkey provided the basis for their evaluation, with recording of time and lines of code generated. They used ISO software quality standards (ISO 9126) to measure software complexity and maintainability metrics. Their results revealed a staggering tenfold increase in productivity when using openEHR. This study stands as a unique contribution to the literature, spanning beyond health information systems to encompass the broader realm of software engineering.

During this period, openEHR faced challenges as a growing organisation. I was elected as an independent member to the inaugural management board and I served for about three years or so. I was working at the University of Auckland at the time, heavily involved in various programs like localisation, specifications, clinical modelling work, as well as forming committees to bring people together. 

I co-founded a company called The Clinician, where we focus on patient-reported outcome measures. Essentially, we provide questionnaires for patients to fill out at home, helping us understand their symptoms and quality of life.

The Clinician has grown significantly, working on national programs in places like Singapore, Israel and Australia, and now expanding into Europe and the US. Despite its success, I decided to go part-time and established my own consultancy business in Dubai, to capitalise on opportunities in the Middle East. My involvement in standards organisations like HL7 and my understanding of both openEHR and HL7/FHIR standards have uniquely positioned me in the healthcare tech space. I’m providing broadly management consultancy, including  integration, semantic interoperability, clinical coding, as well as investing in startups and kind of helping their founders to grow their businesses – fast!

So, I’m really enjoying connecting the dots and creating some real-world applications. But I’m also passionate about bringing like-minded people and different talents together to initiate project ideas and get things going.

That’s why I want to spend my time this way, rather than as a software developer, which might not be the best use of my time. So, I’m re-engaging with the Foundation.

Having a CEO is a new experience for me. Before, it was all of us doing all the work. But now, with a professional team in place, it’s great. I feel well-rounded and ready to roll as I come back to openEHR. Most of my time and effort are dedicated to openEHR.

After his time in computer science and population health departments, Koray transitioned to Auckland Bioengineering Institute and engaged in entirely different pursuits, such as computational models and mathematical simulations of human physiology to create digital twins.  

It was quite a leap for me, but the learning curve was significant.

Now, his department has developed models ranging from molecules to cellular structures, cell organelles, entire cells, cell groups, tissues, organs, body parts, individual people, and even populations.

That’s why I founded GALATA-Digital. I’m on a mission to develop a digital twin, incorporating everything I’ve learned. And at the heart of it all is openEHR, a perfect data fabric for persisting simulation data, experiment results, animal lab data, EHR data, genomic data – you name it.

We’ve reached a point where we can realistically simulate the entire human body, complete with neural systems, hormonal interactions, and cell-to-cell communication, to an impressive degree. 

The Auckland Bioengineering Institute, where Koray worked until mid 2023, is at the forefront of this global initiative. Their director, Distinguished Professor Peter Hunter is an exceptional scientist, and is also one of the founders of Human Physiome Project and the Virtual Physiological Human project in Europe.

The crux of Koray’s work involved using openEHR to connect patient-specific healthcare data with these computational models. This integration allows them to simulate various scenarios, such as a patient’s response to a drug, disease prognosis, or the risk of a cardiac event within a specific timeframe.

It’s like something out of Star Trek, but it’s all grounded in reality. We used an openEHR-based repository to link computational ontologies, genomics, and healthcare data, resulting in the creation of what they call digital twins.

I’m noticing a lot of buzz around certain concepts lately, especially with the hype cycle in full swing. It seems like everyone’s got an opinion, but not everyone truly understands the ins and outs. However, the Physiome Society, the Virtual Physiological Human in Europe and numerous similar initiatives in the US have been quietly toiling away at this for decades, which is quite fascinating.

Thanks to advancements in computational capacity, cloud technology, and AI, what seemed like a distant dream is now becoming a reality. There has been a recent computation related breakthrough which opens doors for creating real-world clinical applications that are accessible and affordable.

Plus, everything we’re doing is open source, which makes it even more exciting.

But without these essential components, particularly mechanistic models of human physiology and anatomy, AI would be producing garbage in, garbage out. The quality of data in EHRs leaves much to be desired, to say the least. In fact, I’m currently working on a paper with my colleagues from Australia, focusing on how to enhance EHRs to propel AI to the next level. The openEHR section plays a significant role in our findings.

So, what’s next? 

I feel like I’ve reached a stage where I can step back a bit and focus on the bigger picture, empowering others and bringing everything together.

I’m really passionate about both commercial pursuits and volunteering, giving back in a non-profit capacity. I’ve got plenty of time because I actually delegate a lot of tasks to people who are keen to learn. I’m constantly mentoring and upskilling those around me.

Despite my interests, I still make time for my family and other hobbies. 

I’m passionate about motorbikes; I’ve been tinkering with them for years and haven’t owned a car in 15 years. I enjoy delving into mechanics and electronics. What fascinates me is how these technical and scientific fields often share underlying principles. For instance, electronics can be likened to plumbing, with similar regulatory mechanisms applicable to human physiology.

I’ve noticed that many people in data technician roles tend to focus solely on the data without considering its broader applications. It’s as if they’ve overlooked the potential impact on areas like healthcare and patient outcomes. Personally, I find it intriguing to explore how data concepts can translate across various domains, whether it’s in motorbikes, plumbing, or electricity.

And, yeah, I’m still enthusiastic about openEHR – it’s like a religion to me. I don’t have a religion, so if people ask me, I’ll either say Jedi or openEHR. 


One response to ““I’m still enthusiastic about openEHR – it’s like a religion to me.””

  1. Joost Holslag avatar
    Joost Holslag

    Wonderful story

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