Opal platform transitions to open-source software, seeks partners

A team at the Research Institute of the McGill University Health Centre (RI-MUHC) developed Opal into a well-known patient information platform that was used by thousands of patients.

However, with the move in Quebec to a province-wide EHR deployment from a large, proprietary vendor, the MUHC’s support for Opal ended in December 2024. Rather than marking an endpoint, this transition has catalyzed a new phase: Opal’s release as open-source software in 2025.
Now, the Quebec-made Opal platform is positioning itself as a Canadian alternative: an open-source, patient-in-the-loop digital health infrastructure designed to re-centre care and interoperability with the patient as an integral member of their care team.

John Kildea, director of the Opal Health Informatics Group (OHIG), is looking for partners for Opal’s open-source adventure – if you are a vendor or a foundation with an interest in supporting open-source digital health solutions and connecting patients with their health data, you can contact him at john.kildea@mcgill.ca.

Opal began in 2014 at the Research Institute of the McGill University Health Centre (RI-MUHC) as a collaboration between a patient, a physician, and a researcher. Launched clinically in 2018, Opal operated for more than six years at the MUHC, serving thousands of patients.

Upon its launch in 2018, it provided real-time access to test results alongside educational content, appointment tools, and patient-reported outcome questionnaires (opalmedapps.com).

In 2021, Opal became the cornerstone of the Quebec SmartCare Consortium (quebecsmartcare.com), a $10 million public-private multi-partner initiative to scale the platform into a secure, interoperable, patient-in-the-loop data infrastructure.

Today, by making its code openly available (github.com/opalmedapps), Opal aims to support digital sovereignty, avoid vendor lock-in, and spur innovation.

In April 2025, the OHIG formed a strategic partnership with the foundation behind OpenEMR, the world’s most popular open-source electronic medical record system, opening new doors to partnerships worldwide.

As Kildea explained, “Our approach stands in contrast to the monolithic foreign systems that dominate Canadian healthcare. If Canadian decision-makers were to insist on an open backbone infrastructure, standards, and strong governance, as is the case in Estonia for example, digital health could stimulate the Canadian economy rather than being a burden on it. It could support Canadian jobs while ensuring that our health data and taxpayer dollars don’t cross the border.”

At its core, Opal advances a simple but transformative principle: patients should be full members of their care teams, not just passive participants. It reimagines care as “patient-in-the-loop” rather than “patient centered”.

Today’s healthcare systems are built around institutions and clinicians. Data flows between providers, while patients receive partial, delayed, or fragmented views of their own information. Opal flips this model by insisting that patients should have the same access to their data as their clinicians.

Susie Judd, DevSecOps manager of the OHIG who first encountered Opal as a cancer patient, describes the shift: “The patient is not only their own most important caregiver, they are also the only member of their care team who is always present. If we were to build a data infrastructure that treats patients like clinicians, we would break down siloes and inherently solve the interoperability problem.”

A key operational concept of patient-in-the-loop data is the once-only principle: patients should not have to repeatedly provide the same information; things like smoking history, alcohol use, previous surgeries, etc.

Opal aims to facilitate structured data entry once, with reuse and controlled sharing across systems. Using SMART Health Links and standards such as FHIR and the International Patient Summary, Opal supports patient-in-the-loop interoperability across providers and jurisdictions, laying the groundwork for a fully interoperable ecosystem.

Healthcare is entering an era defined by agentic AI and retrieval-augmented generation, which depend on high-quality, structured, and accessible data.

According to Judd, “from a patient perspective, access and control over your own data changes everything. When your data is structured and accessible, it means tools like AI can actually support you safely. That’s not easy to do in closed systems where the data is fragmented or inaccessible.”

Opal represents more than a technology, it is a proposition. As Canadian healthcare systems face rising costs, increasing patient expectations around data sovereignty, and the demands of AI, the question is no longer whether change is needed, but how it should be achieved.

As Kildea puts it, “The status quo no longer delivers. The path forward is to bring patients into the data loop, open the system, and work together to build our own digital health future within Canada.”