Democracies have a small radius of trust

No government data store for more than 5 million - they devolve to regional data stores.

England’s 57 million population is not devolved so not stored, instead pull on-demand from the local primary care settings.

PHR funding is insufficient

Netherlands: none of the companies is making money from the market and the government stopped funding.

England: little funding for PHRs, only PEPs.

India: no funding for PHRs, PHR companies making money from commissions on transactions.

Many governments created companies that they own and buy exclusively from on a cost-plus model.

FHIR is what every government is heading for

From India to the Netherlands, every government is heading to FHIR, with the USA leading on FHIR 4.

No one is using OpenEHR.