Enhancing a Healthcare System to Meet openEHR Specifications



A Norwegian provider of healthcare solutions improved its propriety system—built back in the 1980–90s. Brief results of the cooperation with Altoros:

  • Now, the system is on its way to full compliance with the Open Electronic Health Record specifications (openEHR), which is becoming a standard for healthcare data in Scandinavia, Australia, and some of the European countries.
  • Used by 80,000+ of medical staff countrywide, the application now features dynamic report-building functionality.
  • One of the modules also features functionality for supporting decision making, such as evaluating risks of diseases based on patient data.

The customer

The customer is a leading supplier of healthcare solutions to Norwegian hospitals. The catalog of the products includes EHR (electronic health record), information, and laboratory systems. These solutions aim at automating medical personnel’s daily activities, improving the quality of patient care, and increasing patient security.

The need

The customer turned to Altoros to participate in transforming its proprietary system—developed back in the 1980–90s—to a brand new platform built around open standards and new technology stack. The main goal was to meet the requirements of the Open Electronic Healthcare Record (openEHR) specifications. Therefore, the components of the platform (and its core) should be rebuilt in accordance with this strategy (including the development of new runtimes, modules, plugins, workflows, etc.). Finally, the system should provide dynamically customisable reporting, business intelligence, and decision-support functionality.

So, to accelerate development and time-to-market, the customer turned to Altoros to enhance the team with highly professional talent.

The challenges

In the course of the project, the following challenges were outlined:

  • The openEHR standards are constantly evolving, so the system should be flexible enough to maintain the changing demands.
  • The healthcare industry has a variety of regulations / standards, which the system should meet.
  • Using the Guideline Definition Language (GDL), the medical staff can set up various algorithms / processes for analyzing patient data. So, the system should be adaptive to the challenges applied.
  • Only a Java implementation of the system’s module for parsing GDL data existed, while the solution was developed in .NET.

The solution

Previously, the system used RTF files for datasheets, bills of health, etc. One of the first steps to openEHR compliance was the development of an XSLT module for transforming openEHR data to the RTF format recognized by the legacy system.

The system relied on the Guideline Definition Language responsible for setting up the algorithms and rules for analyzing patient data. For instance, personnel can set processes for estimating risks of health incidents and sending warning alerts. To enable such a workflow implementation (recommendations, alerts, etc.), engineers at Altoros delivered a GDL parser and a runtime. The parser enabled the system to process a text file into an object model. As there were no .NET implementation of the GDL editor, the Altoros team transformed the editor’s Java version with IKVM to develop a GDL parser for .NET.

By enabling validation of patient data templates, our specialists simplified the process of finding errors and generating alerts in case of the existing data and edited template being incompatible.

Utilizing Oracle BI Publisher, the Altoros team developed a module for data analysis and dynamic report-building based on patient health records, medical prescriptions, etc.

To guarantee a faultless performance of the system, it was covered with unit tests to the maximum degree possible (85–90% of the code base).

The outcome

By partnering with Altoros, the customer significantly improved its advanced healthcare system used by 80,000+ medical personnel daily in regional health trusts, including five of the six university hospitals. Alongside with meeting the openEHR standards, the system allows for data analysis, report building, and sending alerts to healthcare staff. The solution also features decision-support functionality that helps to evaluate risks of diseases based on patient data.

Technology stack

Server Platform/Application Server

Windows Server, IIS

Programming languages



ASP.NET MVC, IKVM, GDL Editor, Workflow Foundation, WPF, Windows Foundation, Oracle BI Publisher



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Alex Tsimashenka
Business Development Director
+1 (650) 419-3379