Making Waves – the past, present and future of Ocean Health Systems

It’s not often that you come across a company that so comprehensively bridges the gap between strategic data management and specialised patient care, but Ocean Informatics – trading as Ocean Health Systems – stands out by offering a robust foundation for openEHR usage through its Clinical Knowledge Manager, while also providing a highly specialised product – Multiprac – that showcases openEHR in action at the patient level. 

This dual approach not only supports the standardisation of electronic health records but also enhances patient care through precise, actionable insights. By integrating these solutions, the company demonstrates the transformative potential of openEHR from a strategic and practical perspective, setting a new benchmark in healthcare technology.

We talked to two Ocean Health Systems team members – Dr Sebastian Garde, CKM Product Lead, and Linden Bungey, Sales and Business Development Executive – about the organisation’s origin story, their recent rollout of CKM 1.20.0 and where the company is headed next.

Sebastian: It was Dr. Sam Heard who first started me on this path – I think 2004 or 2005 – when I was a post-doctoral and research associate with Professor Evelyn Hovenga at Central Queensland University (CQU). In his role as an Adjunct Professor of CQU, Sam gave a presentation on openEHR. It was so early on, with perhaps only about 10 people who really believed in it – I may have been the 11th. We set up a research group in that department of CQU and at Austin Health in Melbourne, too, and that’s how it all began. That’s where we came up with the first ideas of what would become the Clinical Knowledge Manager. We didn’t even have a term for it yet.

So, were you instrumental in building the CKM?

Sebastian: At the time, with zero visibility into what openEHR could do, we were looking for a set of archetypes or clinical models that could be reused, ideally globally. That was the revolutionary element – that you don’t have to do it over and over but could share these models. We had this Archetype Editor which Sam had hacked together, but not much more. So, we started figuring out how to actually share them. If you want real interoperability, it’s not enough to just define archetypes. You have to share them and make sure they are reusable. The other part of the equation was the openEHR approach as a whole – and it changed a lot for the organisation – making these archetypes public by just putting them out there.

Did you know you were on to something? 

Sebastian: I had a very strong belief in what we were building, and we were happy even though it was a hectic time. In May 2008 I found myself with two babies: CKM and my first-born son who were both welcomed to the world in the same month as we made the platform public and uploaded the first set of archetypes.

The first four people who officially created a CKM account are still involved in openEHR today:  Dr Heather Leslie, who really bootstrapped the archetype editorial work, Dr Sam Heard, Thomas Beale and myself. Today CKM has registered users from 114 countries.

Heather ran the review rounds for the archetypes. If I remember correctly, it took eight review rounds for the first archetype – the blood pressure one – to be published because we were really diligently trying to figure out the process. We would do another review round for things as small as full stops – an exaggeration, but you get the idea. Now, the editors typically do publish in two or three review rounds, depending on the situation and complexity.

In the early days, we iterated constantly, which made scaling challenging. We started by publishing archetypes individually and then added templates. In the future, it might be more efficient to release all approved archetypes together, ensuring they work seamlessly as an official openEHR release.

Release sets are currently addressing this need, tailored for regional CKM customers like CatSalut in Catalonia or HighMed in Germany. For instance, CatSalut uses these sets to create cohesive archetypes and templates for their systems. They are fully committed to openEHR, integrating these sets to ensure consistency, which is exactly what CKM guarantees.

Have you seen a lot of evolution in the CKM since 2008? 

Sebastian: CKM has evolved significantly. Initially, we had lenient governance, focusing on collaboration without structured projects. Now, we have stricter governance and formal projects. Early efforts centred on gathering input, reviews, and discussions.

As we publish more archetypes and federate them for reuse in national and regional programs like those in Norway, CatSalut, HiGHmed, and Apperta UK, stricter governance becomes essential. These regions pull archetypes from the international CKM to create local templates, ensuring consistency.

This demands more governance, particularly for published archetypes. CKM serves two essential user groups: those who want to use approved archetypes and templates, and those who want to develop, edit, and manage them. Our goal is to support both groups effectively within one tool.

What are you involved in now? You’re the product lead of the CKM – what does that look like, day-to-day?

Sebastian: I lead CKM as a product, but over the years, Dr. Heather Leslie, Dr. Ian McNicoll, and Dr. Sam Heard have played crucial roles. The key task is deciding our next steps. We have a long backlog of ideas, and coordinating feature requests from the international community is vital.

We also cater to national and regional customers with their own feature requests, such as a major Canadian hospital group using CKM in unique ways. We need to ensure everything integrates smoothly. This is where Linden also gets involved.

Linden: We work very much as a team, and because CKM has such a substantial set of features – it is not particularly easy to understand without clear guidance. So, we work very closely together. I deal with the business, and Sebastian works on the product details, as the product lead.

And what can you tell us about Multiprac? Is it your flagship product?

Linden: Yes and no. At this stage CKM is predominantly in Europe, but we would like this to move into other regions including the APAC region. Multiprac is predominantly an Australian product, with plans for expansion to international areas being a focus. Multiprac Cloud provides a simpler toolset and is hosted in the cloud. This was created for developing countries, so we are targeting these markets.

Multiprac Surveillance has become the go-to healthcare-associated infection (HAI) surveillance and management solution, originally tailored specifically for the Australian market, to align with the nation’s infection control standards. But the system can absolutely be adapted for other countries’ standards. There’s no reason the language can’t be modified as well, so it’s a very flexible product that could easily be used internationally. We’ve already had inquiries from other countries who are keen to get on board. So, while Multiprac started out as an Aussie innovation, we aim to be a force in other regions. 

The numbers speak for themselves: Multiprac is deployed across over 130 hospital sites in Australia, managing more than 150 million individual openEHR clinical data instances on the openEHR platform. That’s one of the largest openEHR solutions on the market. They collect the same data types and generate scheduled reports similarly. A key benefit of openEHR is that the data is well-contained and linked.

Multiprac isn’t just big, it’s smart too. It pulls in data from multiple streams like pathology via HL7, patient admissions from the hospitals’ PAS systems, surgical procedures… Using rules-based surveillance, it automatically generates notifications for our infection control practitioner (ICP) teams to review each morning on their dashboards.

This streamlined approach is a total game-changer compared to the old paper-based methods. It saves our ICPs hours of tedious work, which means they can focus on their patients.

We now have a new reporting system based on our Analytical Data Repository (ADR) that allows the setup of cyclical reporting. Reports can be tailored for the executives or the ICPs. If someone’s away on vacation, for example, they can set their reports – their replacement just has to press a button, and it’s done.

Multiprac has the ability for expansion and development to also track antibiotic resistance, occupational exposure incidents, contact tracing – you name it. This data aligns with the Australian infection prevention and control guidelines and it integrates with BI tools for flexible visualisation and analysis across single facilities or massive multi-site groups. That’s the true power of standardised, interoperable data.

Apart from Multiprac and the CKM, what else are you working on? 

Linden:

Within Multiprac, we’re actually looking at expansion, with new products forming a suite of Multiprac products. One of the products that we are now demonstrating focuses on staff health, particularly protection of staff through immunisation. It is called Multiprac Immunize. The current Multiprac does have a staff health module, but we’ve expanded it, and it will be a standalone product.

We’ve got numerous healthcare groups interested in this because there really isn’t much out there that will record and have the capabilities of this product – ensuring staff and their patients are protected from infectious diseases.

Sebastian, what’s next for the CKM?

Sebastian: We have just rolled out a big release – CKM 1.20.0, with a lot of new or adapted functionality. 

One area where we still want to do more work is ADL2 – the Archetype Definition Language version 2. This has not been finalised by the openEHR community but is coming together. Sooner or later we will have to focus on migrating everything from ADL to the next version. which will involve migrating all the archetypes.

This has a huge impact on CKM as the repository where we keep all the data, all revisions of archetypes from 2008 until now. We have to ensure we have the whole revision history so anything can still be reproduced. So, upgrading all that is actually a major task for CKM’s future.

For the next release, we’ll be starting to enable more capabilities around archetypes and templates to communicate with other standards and platforms. Not everything is openEHR, but there’s a lot of FHIR and OMOP. So, we’ll integrate mappings to FHIR and OMOP into CKM. We’ll also move towards being able to add typical exemplar queries expressed in the Archetype Query Language (AQL) and upload them to CKM.

Of course, you have Chunlan Ma at Ocean. She’s like the AQL maestro, right? 

Yes, she presented AQL at Medinfo 2007 in Brisbane, and it was probably the most fantastic presentation I’ve ever seen there. Everybody was standing and applauding at the end – it was really impressive.

She’s made a great contribution to openEHR by inventing AQL. The more common archetypes you use, the more important it becomes to be able to not only share the archetypes but also share these queries across different applications and health record repositories. So that’s what we are picking up on with this release.

The same goes for the mappings – if you want to map to FHIR, we want to make that as easy and consistent as possible. Grahame Grieve and the team are talking a lot about how we can collaborate on this and other areas and openEHR and HL7 have just signed up to collaborate. The European standards group (CEN) have also welcomed openEHR. This is at least one step we can take for the next CKM release.

There’s also getting the next version of ADL up to speed and making the review process smoother. There will be work in many areas, but attaching secondary models such as mappings, queries and perhaps subset models to archetypes and templates, making sure it’s all consistent – will be important for the future of openEHR and its promise of life-long health records.

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