Epic or open platforms? The choice facing European hospitals (Nils Hellrung)

Most interoperability debates focus on exchange formats. In this discussion with Dr Nils Hellrung, medical informatician and CEO Strategy & Operations at vitagroup, Nils focuses on the need for shaping hospital IT with governance and financing.

Linking proprietary systems through standards, he says, will always lose meaning, which is why he backs openEHR as a vendor-neutral clinical data core, with FHIR used for exchange. vitagroup in providing the data platform for Catalonia, and just signed a contract with a large hospital group in France. The discussion touches different market approaches to interoperability and challenges of markets such as Germany, where each federal state has its own authority to regulate and implement as they please. Tjasa Zajc and Nils Hellrung talk about what "AI-native" data integration means in practice, why 95% accuracy of AI is not good enough in healthcare, and whether Europe ends up with monolithic US EHRs or open platforms.

This episode is supported by vitagroup.

GUEST

Dr Nils Hellrung — CEO Strategy & Operations, vitagroup; medical informatician; co-author, "Health Information Systems: Architectures and Strategies"

Host: Tjaša Zajc

WHAT THE CONVERSATION COVERS

Why hospital IT architecture reflects governance, trust and financing: three professors, three PACS

Billing versus therapy: why German hospital and ambulatory systems don't talk to each other

AI in healthcare: the widening gap between what is possible and what happens in practice

Why Europe doesn't have to be slower than the US in digital health

Data availability as the main barrier to digital health implementation

openEHR vs FHIR: clinical data repository vs communication standard

FHIR version changes and national profiles: the semantic interoperability problem

Is European Health Data Space (EHDS) interoperability achievable, or only for a core data set?

Catalonia's single patient record on openEHR: 18 months to go-live and the next step to an open health platform

Why Catalonia's single health system makes adoption easier

Germany: 16 federal states, 17 data protection authorities, and a 20-year-old electronic patient record (ePA) programme

Alliance SIH in France: competitors agreeing on a shared health data layer

AI as a translator between clinical data and clinicians

AI-native vs AI-enabled software, and why data pipelines must stay deterministic

Deskilling risk: clinicians who stop thinking because AI seems to have the answer

Epic at Charité, monolithic EHRs vs open platforms, and European digital sovereignty in healthcare

Europe's health IT ecosystem in 2036: best, worst and realistic scenarios

CHAPTERS

02:30 From textbook to practice: 15 years of health information systems
03:00 Why hospital IT looks the way it does: three professors, three PACS
06:50 Is AI speeding up healthcare? The gap between possible and real
10:39 EHDS and data availability: the biggest barrier to digital health
14:00 openEHR vs FHIR: how health data normalisation works in practice
16:40 Is European interoperability achievable? The semantic problem
20:00 Catalonia: why a single health system makes adoption possible
26:48 Germany: 16 states, 17 data protection authorities
30:45 France: Alliance SIH and a shared data layer
32:14 The data layer as Europe's AI advantage
35:38 AI in data integration: why "convincing" is dangerous
41:48 Agentic AI, guardrails and the risk of deskilling
45:00 Europe in 2036: Epic, open platforms and a "very nineties decision"

FACES OF DIGITAL HEALTH

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