David Ingram

A founding president on decades of health informatics, the care information utility, and why community and trust outlast technology.

Part of the 2024 openEHR interview series, recorded in London on 11 December 2024, shortly after the openEHR conference.

Seventy-five years of digital health innovation

Emeritus Professor of Health Informatics at University College London.

I characterise it as a care information utility - it needs to exist a bit like water, such that people barely notice it's there. You notice it when it's not functioning.

About David Ingram

Professor David Ingram was appointed Professor of Medical Informatics at The Medical College of St. Bartholomew's Hospital, University of London, in 1990 and served as founding Director of the UCL Centre for Health Informatics and Multiprofessional Education (CHIME) at University College London from 1995 to 2011, where he helped establish the foundations for archetype-driven electronic health record specifications.

He is a founding member and the Founding President of the OpenEHR Foundation, and previously led the EU GEHR Project (1991-1994) that underpinned the development of ISO-adopted standards for electronic health records.

Interview summary

David Ingram is one of the founding figures of openEHR - the person who assembled and held together the original group, secured the European funding that launched the GEHR project in 1989, and wrote the documents that defined what the openEHR mission should be and how its community should operate. His interview is less about technology than about the longer arc: why the problem matters, what it took to keep a community together through decades of uncertainty, and what has been lost by spending trillions on fragmented solutions rather than common foundations.

His background is unusual in scope - theoretical physics at Oxford, a PhD in mathematical modelling of human physiology, the first chair in medical informatics in the UK - but what runs through all of it is an orientation toward community and trust rather than technology alone. He frames his three pillars as rigor, engagement, and trust. The technology, he argues, was always secondary to the question of whether diverse groups - clinical professionals, IT engineers, industry, government - could be held together around something they all had reason to trust.

On funding, his observation is pointed: the trillions spent on health IT over 35 years may actually have been a disadvantage, enabling endless fragmented activity while the common ground that everything depends on received almost nothing. He cites Arthur Guyton's insight that beyond a certain point, investment produces diminishing and then negative returns - and suggests the industry may be well past that point in some areas. The openEHR community, by contrast, has survived and grown on far less, precisely because its organic, community-driven nature makes it more resilient than projects that switch off when funding runs out.

His vision of the destination is the care information utility - health information that works like water or electricity: invisible when functioning, noticed only when it fails. Getting there requires an ecosystem ten times cheaper, ten times more agile, and ten times more effective than what exists today. The barriers are not technical but structural and cultural: procurement locked to incumbent vendors, governance frameworks that don't yet exist, and clinical professionals who have yet to fully engage with what digital transformation demands of them. His closing answer, when asked his greatest achievement, is characteristically precise: he has survived.