Objective: To make the case and show the path for domain knowledge governance in health care. Background: In the field of open Electronic Health Records (EHRs), openEHR as an archetype-based approach is becoming increasingly recognised. Results: The adoption of an archetypes-based approach – clearly separating knowledge and information – is essential to enable semantic interoperability in health care. To avoid significant overlaps and ‘rank growth’ during the archetype development, archetype development needs to be coordinated nationwide and beyond and also across the various health professions. Archetypes need to be easily accessible and need to be maintained after creation. Domain knowledge governance comprises all of the above tasks. Essentially, we propose a health-wide umbrella organisation to coordinate the archetype development and to organise domain experts in inter-disciplinary archetype development teams. Discussion: The dimensions of domain knowledge governance have huge implications for the health industry. The adoption of a set of processes that enable the creation, organisation, dissemination and use of knowledge is required. Collectively this will create the knowledge environment required to effectively foster semantic interoperability between EHR systems. Conclusion: We conclude that we should no longer be concentrating on the development of standard terminologies alone but we should divert our efforts toward the development of archetypes. The development of terminologies remains crucial as part of this effort.