from:"Andrew Ho"

Tim,

I published this invention back in 1998 titled Patient-Controlled
Electronic Medical Records. Please see:
http://www.txoutcome.org/scripts/zope/readings/patient-controlled
and referenced here: http://www.txoutcome.org/scripts/zope/readings/oio

This work has been online and retrievable via Google and other search
engines for many years. Performing a Google search using
patient-controlled electronic medical records as the search term
retrieves this paper as the first hit.

I wonder if the Australian pharmacists read my invention and is now
trying to steal it? It would be amazing if they neglected to run a
Google search on related prior art. :-)

Best regards,

Andrew
-- 
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

On Tue, 23 Nov 2004 13:29:24 +1100, Tim Churches [EMAIL PROTECTED] wrote:
 There is some concern here in Australia over a patent application lodged
 by the Pharmacy Guild of Australia over some rather generic features of
 EHRs. These concerns are reported here:
 
 http://australianit.news.com.au/common/print/0,7208,11467621%5E15319%5E%5Enb%20v%5E15306,00.html
 
 or here:
 
 http://snipurl.com/atst
 
 The application has been lodged under the international PCT (patent
 co-operation treaty), and it appears that country level applications
 have been lodged in at least the UK, Canada and the US, as well as
 Australia.
 
 At a glance, there would not appear to be much in the way of novelty in
 the claims, and several groups here in Australia plan to lodge
 objections to the application. Others may wish to object to the
 applications in their own countries. If anyone can suggest clear prior
 art which was published before April 2002, and ideally before April
 2001, then please let me know (or post details to this list so the prior
 art can be shared around).
 
 The details of the patent application, and a related one filed on the
 same date, are as follows:
 
 METHOD AND SYSTEM FOR SHARING PERSONAL HEALTH DATA can be found here:
 
 http://v3.espacenet.com/textdoc?CY=epLG=enF=4IDX=WO02073456DB=EPODOCQPN=WO02073456
 
 or here:
 
 http://snipurl.com/atol
 
 Click on the tabs at the top to see the details of the patent claims.
 
 The details of the CR Group application for METHOD AND SYSTEM FOR
 SECURE INFORMATION can be found here:
 
 http://v3.espacenet.com/textdoc?DB=EPODOCIDX=WO02073455F=0
 
 or here:
 
 http://snipurl.com/ator
 
 The filing dates for both are 14 march 2002, with earliest priority
 dates of 14 March 2001.
 
 Just to whet your appetite, here is Claim 1 of the Pharmacy Guild
 application:
 
 CLAIMS : 1. A method for a health care provider to obtain personal
 health data relating to a consumer, the method comprising the steps of :
 the consumer causing personal health data to be stored in a secure
 repository, said repository requiring authentication of the consumer's
 identity before the consumer is provided access to the repository; the
 consumer selecting items of personal health data to share and
 identifying a health care provider, or class of health care providers,
 to whom access will be provided for those items of personal health data;
 a health care provider providing authentication of their identity to the
 consumer's secure repository and being provided access to those items of
 personal health data of the consumer for which the health care provider
 has been identified for sharing; the health care provider using the
 personal health data of the consumer to determine health care advice or
 the provision of a health care service for the consumer; and the health
 care provider recording details of the consultation and the advice or
 service provided to the consumer in the secure repository of health data
 of the consumer.
 
 If this patent issues, we (or our govts) may find ourselves having to
 pay royalties to the Pharmacy Guild of Australia to use any EHR
 applications which meet this description, or having to challenge the
 patent in court (expensive). Hence there is value in demolishing it with
 prior art in the application stage - assuming that it survives the
 examination phase (which it shouldn't, but as we know, the US patent
 office seems willing to approve a patent for just about anything, no
 matter how obvious or well-known the idea is, and the Australian patent
 office managed to issue an innovation patent for the wheel a few years
 ago...true!).
 
 Tim C

Re: A patent application covering EHRs

On Tue, 23 Nov 2004, David Forslund wrote:

And if you do a google on Virtual Patient Record you will see as the
first hit the pre-published version of our (Kilman and myself) CACM
paper outlining how do do all of this, from February, 1996.

Dave,
I just read your virtual patient record paper at
http://openemed.net/background/TeleMed/Papers/virtual.html
and I could not find text in this paper that specifies the patient's
role in controlling who should have access to the records. If I missed it,
please point to the section of the paper that spells this out.

This is prior to Andrew's patent, but describes the role of a patient in
managing their own health record and how to implement it.

I must have missed it. Did your NJC prototype (briefly
mentioned in this paper) include patient-controlled records feature?

The implementation of this now resides in the OpenEMed architecture and
software and existed earlier in the 1994 version of TeleMed (see
reference in the above paper).

It is one thing to have a access control policy module but that is not
the same as giving patients control over those policies.
The same goes for trying to use FreeMed, FreePM, GnuMed, and TkFP as
relevant prior art. As far as I know, they do not have the
patient-controlled feature. If we want to use them as prior art, we need
to point to specific designs or implementations that reads-on Philip,
Vasken, and Trevor's patent
(http://v3.espacenet.com/textdoc?CY=epLG=enF=4IDX=WO02073456DB=EPODOCQPN=WO02073456).

I don't consider any of this inventions, simply understanding how to
build robust distributed healthcare systems that meet the needs of
people.

Where these simple understandings may be deemed non-obvious and
signficant by patent reviewers, they are patentable. :-)
This means writing documentation to fully disclose innovative
system features and filing some patents from time to time may become
increasingly important for free software projects.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Dave Forslund
Original Message
From: Andrew Ho [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Cc: Openehr-Technical [EMAIL PROTECTED]
Date: Tue, Nov-23-2004 9:56 AM
Subject: Re: A patent application covering EHRs

Tim,

I published this invention back in 1998 titled Patient-Controlled
Electronic Medical Records. Please see:
http://www.txoutcome.org/scripts/zope/readings/patient-controlled
and referenced here: http://www.txoutcome.org/scripts/zope/readings/oio

This work has been online and retrievable via Google and other search
engines for many years. Performing a Google search using
patient-controlled electronic medical records as the search term
retrieves this paper as the first hit.

I wonder if the Australian pharmacists read my invention and is now
trying to steal it? It would be amazing if they neglected to run a
Google search on related prior art. :-)

Best regards,

Andrew
--
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

On Tue, 23 Nov 2004 13:29:24 +1100, Tim Churches
[EMAIL PROTECTED] wrote:
There is some concern here in Australia over a patent application
lodged
by the Pharmacy Guild of Australia over some rather generic features
of
EHRs. These concerns are reported here:

http://australianit.news.com.au/common/print/0,7208,11467621%5E15319%5E%5Enb%20v%5E15306,00.html

or here:

http://snipurl.com/atst

The application has been lodged under the international PCT (patent
co-operation treaty), and it appears that country level applications
have been lodged in at least the UK, Canada and the US, as well as
Australia.

At a glance, there would not appear to be much in the way of novelty
in
the claims, and several groups here in Australia plan to lodge
objections to the application. Others may wish to object to the
applications in their own countries. If anyone can suggest clear
prior
art which was published before April 2002, and ideally before April
2001, then please let me know (or post details to this list so the
prior
art can be shared around).

The details of the patent application, and a related one filed on the
same date, are as follows:

METHOD AND SYSTEM FOR SHARING PERSONAL HEALTH DATA can be found
here:

http://v3.espacenet.com/textdoc?CY=epLG=enF=4IDX=WO02073456DB=EPODOCQPN=WO02073456

or here:

http://snipurl.com/atol

Click on the tabs at the top to see the details of the patent claims.

The details of the CR Group application for METHOD AND SYSTEM FOR
SECURE INFORMATION can be found here:

http://v3.espacenet.com/textdoc?DB=EPODOCIDX=WO02073455F=0

or here:

http://snipurl.com/ator

The filing dates for both are 14 march 2002, with earliest priority
dates of 14 March 2001.

Just to whet your

Re: A patent application covering EHRs

On Tue, 23 Nov 2004, Daniel L. Johnson wrote:

 On Mon, 2004-11-22 at 20:29, Tim Churches wrote:
  There is some concern here in Australia over a patent application lodged
  by the Pharmacy Guild of Australia over some rather generic features of
  EHRs.

 More prior art...

 Dr. Thomas Payne used WAN technology to distribute his own EHR between
 his clinic, hospital, and local nursing home in 1990, using a DOS-based
 system.

 And, of course, there's the Logician Internet software that maintained a
 central data repository and served practices over the net, circa
 1996-98.

Dan,
  But do these prior systems provide the follwing set of functions?

comprising the steps of : the consumer causing personal health data to be
stored in a secure repository, said repository requiring authentication of
the consumer's identity before the consumer is provided access to the
repository; the consumer selecting items of personal health data to share
and identifying a health care provider, or class of health care providers,
to whom access will be provided for those items of personal health data;
a health care provider providing authentication of their identity to the
consumer's secure repository and being provided access to those items of
personal health data of the consumer for which the health care provider
has been identified for sharing; the health care provider using the
personal health data of the consumer to determine health care advice or
the provision of a health care service for the consumer; and the health
care provider recording details of the consultation and the advice or
service provided to the consumer in the secure repository of health data
of the consumer.
Quoted from Claim 1 of
http://v3.espacenet.com/textclam?CY=epLG=enF=4IDX=WO02073456DB=EPODOCQPN=WO02073456

Prior art that do not read on the claims of the patent are not relevant
to this discusssion. Specifically, subset implementation does not
infringe a patent. This means if we build software that does not do all
the steps spelled out above, it does not infringe.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: A patent application covering EHRs

On Wed, 24 Nov 2004, Tim Churches wrote:

 Andrew Ho wrote:
  Tim,
 
  I published this invention back in 1998 titled Patient-Controlled
  Electronic Medical Records. Please see:
  http://www.txoutcome.org/scripts/zope/readings/patient-controlled
  and referenced here: http://www.txoutcome.org/scripts/zope/readings/oio
 
  This work has been online and retrievable via Google and other search
  engines for many years. Performing a Google search using
  patient-controlled electronic medical records as the search term
  retrieves this paper as the first hit.

 OK, many thanks. Your paper covers many of their claims, although it
 does not mention controlling selective uploading and access to
 particular data items via a template, which is also part of their claims

Tim,
  You are welcome!
  Even if all we have is prior art that reads on their claim 1, then
their patent is already significantly narrowed. If you know how to reach
any of these 3 inventors, perhaps we ought to invite them to join us for a
discussion on the OpenHealth list?

 - but I have found another paper which desribes that.

  Do you have an URL or reference that you care to share?

 But your paper covers their other claims nicely - the more the merrier!

  ok.

  I wonder if the Australian pharmacists read my invention and is now
  trying to steal it? It would be amazing if they neglected to run a
  Google search on related prior art. :-)

 Possible but I doubt it. I suspect it is more a case of a set of
 solutions which are fairly obvious to anyone who considers the problem
 in detail.

  Often this type of patent is never used to sue anyone. We should not get
too alarmed (yet) but instead read it as any other kind of publication and
try to contact the authors.

 The Pharmacy Guild was part of a multi-sectoral committee
 which considered design issues for a shared medication record for
 Australia (now called MediConnect). They just happened to file this
 patent application just after that design work was winding down - which
 allegedly came as a surprise to the other committee members.

  Interesting!

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

when published spec predates patent, was Re: A patent application covering EHRs

On Tue, 23 Nov 2004, David Forslund wrote:

 Thus the patent you describe would make the RAD OMG specification a
 violation of your patent, since it provides a mechanism to specifically
 what you say plus a lot more?

Dave,
  No, if RAD OMG spec is a superset of any subsequent patent, then the
patent is invalid.

 Note that the RFP for this was issued in February, 1998:
 http://www.omg.org/cgi-bin/doc?corbamed/98-02-23. The result is a
 specific way to provide the capability you describe in your patent in a
 scalable, implementable way over a distributed network.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: when published spec predates patent, was Re: A patent application covering EHRs

On Wed, 24 Nov 2004 10:08:57 +1100, Tim Churches [EMAIL PROTECTED] wrote:
...
 Yes, but if the patent is issued regardless (as very often seems to
 happen), then its invalidity needs to be proven in the courts - very
 expensive. 

Tim,
  Going to court and the associated expense may not be necessary. For
US Patents, we can add citation:
  
http://www.uspto.gov/web/offices/pac/mpep/documents/appxr_1_501.htm#cfr37s1.501
or ask for re-examination:
  
http://www.uspto.gov/web/offices/pac/mpep/documents/appxr_1_510.htm#cfr37s1.510
  Ex partes re-examination costs $2520.

 Better to oppose the patent application before it issues, to
 prevent it ever becoming a patent - still surprisingly expensive, 

Filing a Protest before the patent is issued does not look expensive
at all from here:
  http://www.uspto.gov/web/offices/pac/mpep/documents/1900.htm
In fact, I don't even see the mention of any filing fee.

 but less expensive that a court case.

Sure, but there are lots of things that can be done before ending up in court. 

Best regards,

Andrew
-- 
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

spam problem, Re:

2004-11-01 Thread Andrew Ho

On Mon, 1 Nov 2004, Aho wrote:

 :))

I did not write that one either.

These bogus messages with potentially harmful attachments just kept
coming.

Since the attachment size is 19k, I propose that we limit message size to
10k and disallow attachments altogether. This should get rid of most spam.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

email address harvested, was Re: Hi

2004-10-31 Thread Andrew Ho

On Sat, 31 Oct 2004, Tim Churches wrote:

 On Sun, 2004-10-31 at 10:07, Aho wrote:
  :))

 Presumably this message is the result of someone misusing Andrew's email
 address to send out malware.

Tim et al,
  I hope nobody got hurt.
  I also received the same malware labeled as from:
Paolonebigpaul [EMAIL PROTECTED]
Please be very careful even with messages that appear to come from trusted
colleagues on the OpenHealth list.

 In this instance, they have even mimicked Andrew's characteristic use of
 smileys.

I disagree, I don't think they are that sophisticated yet - I always use
:-), never :))

:-)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: physician prescribing tool development (fwd)

2004-10-31 Thread Andrew Ho

Dear colleagues,

Sandy Boyer sent me important information about the FDA's electronic
package insert project. This is a subject that many of us are interested
in and need to work with. Since she is not a subscriber, she could not
post directly to the OpenHealth List. So, here is her email to me in its
entirely.

Until she is able to subscribe, we can include her email address on our
response and forward her message to the List (like I am doing now).

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

-- Forwarded message --
Date: Sat, 30 Oct 2004 13:28:54 -0700
From: Sandy Boyer [EMAIL PROTECTED]
Subject: Re: physician prescribing tool development

Dr. Ho -

I recently came across this thread on the openhealth-list regarding
development of physician prescribing tools that will utilize electronic
package inserts.

A misconception is being perpetuated on that thread that I would like to
correct. I have not been able to get on the list, so I hope you will share
this.

Gunther Schadow did not develop the Structured Product Labeling standard
for package inserts. I was the FDA consultant in its design and the
project leader on the HL7 committee responsible for its development.

The editors of the standard are myself and Dr. Robert Dolin. In August
2004 it became an official HL7- and ANSI-approved standard and is
available through HL7 (contact information is available at
http://www.hl7.org). All labeling is to be submitted to FDA and made
available to the public in this XML-based format by June 2005.

It should be referenced as:

Boyer SL, Dolin RH (eds). HL7 Structured Product Labeling, Release 1.0.
Ann Arbor, MIch: Health Level Seven, Inc. 2004.

Dr. Schadow's participation in the development of the standard was the
same as that of numerous others in the HL7, who reviewed and commented on
it as it went through balloting. We appreciate his contributions, as we do
those of everyone who participated in the standards development process.

A collaborative working group involving industry, vendors, and FDA
representatives has developed an implementation guide and is currently in
the process of initiating pilot testing of SPL for package inserts.

If anyone would like any additional information about the standard, I
would be more than happy to assist. (I'm located in Laguna Beach.)

Sandy Boyer

Re: NHS/IA revisionism

2004-10-26 Thread Andrew Ho

On Tue, 26 Oct 2004, Joseph Dal Molin wrote:
...
 Colin Smith. In the fall of 2001 Nigel Bell, the then CEO of the NHS IA
 gave the following interview:

 http://www.infomaticsonline.co.uk/news/1125702

Joseph,
  Thanks for the reference. Reading this article, it does look like the
NHS seriously considered open source.

 It may be valuable to document all the bits and pieces, especially given
 the risk of the billion pound effort to boil the ocean from above

From the article:
- begin quote
But open source is not a universal panacea, and there's still a place for
proprietory software. The Department of Health is currently negotiating a
?20m deal with commercial vendors including Microsoft, said Bell.

In simple terms we are sitting on the fence, and are not going to be
committing ourselves either way because we don't need to.
- end quote

  My interpretation is that NHS decided to fund proprietary software at
the expense of open source software (for obvious reasons). With that
decision made, they realized sitting on the fence gives a public
appearance of confusion and thus pulled Colin Smith's paper.
  Rather than blaming NHS, I give them credit for valuing and publishing
Colin Smith's paper and seriously considering open source in the first
place (and also sponsoring OSHCA 2001). Just because NHS got off the fence
and gave money to proprietary vendors this time, it does not mean they
won't make a different decision next time.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

RE: NHS/IA revisionism

2004-10-26 Thread Andrew Ho

On Wed, 27 Oct 2004, Tim Churches wrote:
...
 Richard Grainger, the head of the NHS IA, spoke at a seminar that I attended
 in Melbourne about 6 months ago. I asked him about open source, and his
 response was that he had no objections, provided there were open source
 organisations who could tender and then deliver on projects with 18 month
 delivery schedules and budgets of several hundred million pounds.
...
 the impression that, armed with the 6 billion pound budgetary promise from
 Tony Blair, he felt that he could, if not boil the ocean, at least part the
 sea

Tim,
  Unfortunately, it may be easier to boil the ocean than to
acquire/produce open source software.

 - that is, exert a great deal of influence on and be able to extract
 much, much better deals out of existing commercial vendors and system
 integrators.

  Whatever influence 6 billion pounds can buy - it is clearly not
_perceived_ to be enough to buy an equivalent open source deployment.
Some organizations (e.g. NHS) clearly knows the value of having an open
source infrastructure - but they may not be willing to pay for those open
source advantages (with their time and money).

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

100+ year perspective, was RE: NHS/IA revisionism

2004-10-26 Thread Andrew Ho

On Wed, 27 Oct 2004, Tim Churches wrote:

 From: Andrew Ho [mailto:[EMAIL PROTECTED]
  Just because NHS got off the fence and gave money to
  proprietary vendors this time, it does not mean they won't
  make a different decision next time.

 I suspect that next time will be at least a decade hence, given the scale
 of investment and the long-term nature of the contracts which the NHS is now
 entering into.

Tim,
  A decade to establish an infrastructure that can continue to be used for
several hundred years is not bad at all. As UK NHS deploys its new
proprietary system, we will continue to learn from this experience and
mature our open source / free systems.
  Some governments (e.g. Brazil) have already announced funding for open
source health software project. Who knows, with consultants like Joseph
and Colin, it may take less than ten years for the UK NHS to change
direction.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Medical Record Location(s) was: Virtual Privacy Machine - reprise

2004-10-22 Thread Andrew Ho

On Fri, 22 Oct 2004 09:35:44 -0700, Tim Cook [EMAIL PROTECTED] wrote:
...
 In the real world though my medical record needs to be accessed fairly
 often when I'm not there.  One example is when lab test results come
 back to the ordering physician.  

Tim,
  I agree. However, also having a portable copy of your records in
your pocket (in addition) can still be useful.

 These results could sit and wait in an
 electronic holding bin until I come back in with my record in hand but
 they are relatively useless from a clinical standpoint without the
 context of the complete (or significant parts) medical record.  So if I
 carry it around with me I may have to come in to see if the doctor needs
 to see me again..There might be a workflow issue or two with this
 scenario. g

  The portable copy can be synchronized with the doctor's-office-copy
in various ways: at the next office visit, from home via Internet,
etc.
 
 I still contend that my primary health record should be at my primary
 care provider's location where ancillary data can be pushed into it.  Be
 this a radiology report, lab report, hospital discharge letter or
 cardiologist results.  Using this approach there is no need for huge
 MPI's (that invariably contain errors) and there are no socio-political
 concerns about unique patient identifiers and their abuse.

  Right - of course, we still need a reliable way to
transfer/synchronize records between different doctors' offices,
hospitals, etc. MPI is exactly designed to serve that function - but
there are other ways to do it.
 
 At any one point in time I have a unique patient identifier. Because my
 records are on file in Dr. Smith's office on Broadway in MyTown and the
 file number is 12345 I can have any pertinent information sent to my
 record.  When I decide to switch to Dr. Jones on Main Street in
 AnotherTown I can do so and still have a unique patient (record)
 identifier.just not the same one I had before.

  What ends up happening in the absence of a master patient index
(MPI) is that we use record-location, date of birth, SSN, + name to
serve the record matching function. This is the current state of the
field. It has advantages and disadvantages - but adopting electronic
medical records systems (EMR) does not mean we have to adopt MPI.

Best regards,

Andrew
-- 
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Medical Record Location(s) was: Virtual Privacy Machine - reprise

2004-10-22 Thread Andrew Ho

On Fri, 22 Oct 2004 12:22:10 -0600, David Forslund [EMAIL PROTECTED] wrote:
...
Right - of course, we still need a reliable way to
  transfer/synchronize records between different doctors' offices,
  hospitals, etc. MPI is exactly designed to serve that function - but
  there are other ways to do it.
 
 More than an MPI is needed.   Tags as to the origin of the data need
 to be provided in some way so that data duplicates can be handled.  These
 are distinct from the process of identifying the patient.

David,
  Good point!
  It seems to me that we really must get together and work on this.
Maybe via the hxp effort? http://hxp.sourceforge.net/

...
What ends up happening in the absence of a master patient index
  (MPI) is that we use record-location, date of birth, SSN, + name to
  serve the record matching function. This is the current state of the
  field. It has advantages and disadvantages - but adopting electronic
  medical records systems (EMR) does not mean we have to adopt MPI.
 
 Well if every location or system uses a different identification mechanism
 it makes the patient identification even harder, in my opinion.   You are effectively
 adopting an MPI process.   Having a relatively more uniform process and
 separating out the service explicitly would make it all much easier.

  I agree. 
  Maybe we can work out a sufficiently uniform process and implement
it in our respective software packages?

Best regards,

Andrew
-- 
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: CPOE time studies.

2004-10-14 Thread Andrew Ho

Nandalal,
  I think you meant:
http://www.inference.phy.cam.ac.uk/dasher/
  I did look at it and it does look interesting. I have not installed
it on my machine yet.
   Have you tried it?

Best regards,

Andrew


On Thu, 14 Oct 2004 07:12:21 -0700 (PDT), Nandalal Gunaratne
[EMAIL PROTECTED] wrote:
 Andrew,
 
 I want you to look at http://www.dasher.com
 
 Nandalal
 --- Andrew Ho [EMAIL PROTECTED] wrote:
 
  On Mon, 4 Oct 2004, Don Grodecki wrote:
 
   Sounds to me like a job for Tablet Computers!
 
  Don,
As far as I know, lack of full-size keyboard
  dramatically diminishs the
  utility of tablet computers for applications that
  require text data entry.
 
  Best regards,
 
  Andrew
  ---
  Andrew P. Ho, M.D.
  OIO: Open Infrastructure for Outcomes
  www.TxOutcome.Org
 
 
 
 
 ___
 Do you Yahoo!?
 Declare Yourself - Register online to vote today!
 http://vote.yahoo.com
 
 


-- 
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Issue of freedom and migration, Re: CPOE time studies and a word from the other side.

2004-10-13 Thread Andrew Ho

On Wed, 13 Oct 2004, Nandalal Gunaratne wrote:
...
 There is a loss of British, Australian, Austrian and
 others who also move to the USA for example. This is
 promoted by the USA too. The number of British
 scientists who have been recruited in such a manner to
 the US is well known. Do you think the British have
 not lost?

Tim and Nandalal,
  Looking at it a different way, both British and U.S.  (and the entire
human race) gain when individuals migrate and maximize their opportunity
to contribute their talents. This is analogous to free software developers
who abandon one project and re-direct their time and energy to a different
project.

 The other problem is that the skilled medical or others in the poorer
 countries are not given the facilities to work. They can be thoroughly
 frustrated as a result. Their knowledge and skill is NOT appreciated in
 their own country. They maybe too qualified and skilled for the country
 of their origin. They try really hard to do something useful but nobody
 cares to help - particularly the administrators.

  Right, they should have a choice to migrate if they so choose. Employers
and societies should freely compete for the time and energy of their
workers - this is a feature of free market economy. Organizations (e.g.
countries, cities) exist to serve their members, not the other way around.

 They can be lost to their own citizens.  What if some other country can
 make use of them to help their own people, and they want to have a
 better health care system, and can and will give them the conditions
 they need to work to the best of their skill and knowledge? Must they be
 lost to everyone?

  Well said. This is why barriers to free flow of human resources hurt
everyone in the end.

 Take away migration. Many of them do NOT want to migrate,

  It takes lots of work to migrate. However, sometimes there are
sufficient reasons for people to do so.

 They want to work w few years in another country which will allow them
 to improve their skills and knowledge and also earn enough to save
 something and go back to their own country.

  True, that can happen too. A key question is _who_ should decide where
and when to move?

 This is good for both countries. If this is encouraged and made easier
 to do, but migration is not, then neither side will lose.

  My view is that it is up to each society to attract and keep their
productive memebers.  A permanent migration can become a temporary one if
sufficient incentives are given to recruit the individuals back to their
country of origin. Similarly, a temporary migration can become permanent.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: browser vs. desktop, was Re: access keys, was Re: physician prescribing tool development

2004-10-13 Thread Andrew Ho

On Wed, 13 Oct 2004, Karsten Hilbert wrote:

  In the meantime, I wonder what are the critical differences that
impede your efficiency?
   A browser cannot access card readers unless quite
   sophisticated add-on code is installed locally.
 
What about USB-accessible cards? Most operating systems have built-in
  support to read from these.
 And the browser accesses these, uhm, like, how ?

Karsten,
  File upload dialog?

...
   Then, why not install a conventional application if one has
   to install code locally anyways ?
  1) It remains easier to install/upgrade a few new web-browsers than all
  the desktop (conventional) applications.

  2) It becomes increasingly unnecessary to install additional code locally
  as web-browsers incorporate additional functionalities.

 Which is, what, Good(tm) ?

  I see your point.
  Actually, I do think it is good to have increasingly capable (and
complex) web-browsers. This is the same as having increasingly complex
operating systems. The reason why this trend is Good(tm) is that the
applications can become increasingly simple by capitalizing on
increasingly complex infrastructure underneath.

...
  Desktop applications can just as easily (if not even more easily)
  compromise system security.

 Sure, but the user is expected to know that. Contrary to that
 the user expects browsing a site to be safe (contrary,
 again, to what it sometime is).

On the other hand, it is easier to build generic tools that put
web-browsers inside a secure sandbox than to do the same for diverse
varieties of desktop applications.

It boils down to web-browsers being a common application OS that in turn
runs KDE on Linux OS vs. desktop application that run natively on KDE on
Linux OS, for example. One could argue the pros and cons of having this
extra layer between the user and the hardware for each specific
application. At the same time, more capable hardware and web-browsers will
continue to shift the balance towards favoring the use of web-browsers for
more and more applications.

  Browser-based applications are no panacea. However, it is possible for
  them to approach the behavior of current desktop applications. Note that
  there is a time-lag between having capable browsers and having
  web-applications make use of the features.

 Why would they be called browser then ? I suppose it'd be
 fair to rename them to Mozilla-OS or, perhaps more
 appropriate MozillaDesk.

I agree. Hence Microsoft was quite serious about winning the browser
war a few years ago.

 I would then want to install a simple browser for browsing. Which begs
 the question why there should be two browsers on my system.

Just as there are reasons why people run both Windows and Linux, I am sure
some will find it useful to run multiple web-browsers :-).

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: access keys, was Re: physician prescribing tool development

On Tue, 12 Oct 2004, Karsten Hilbert wrote:

In the meantime, if we can have a time-based requirement document, then
  we will be able to objectively evaluate how far/close we are to usable.
  This documention can include maximum number of seconds required to perform
  xyz function, for example. What do you think?

 Who would disagree with that ?

Karsten,
  I don't know. I thought maybe you or someone might have a different
opinion.
  I have not run into such a requirement document before - have you? How
about benchmark information on time-required to perform specific medical
information tasks?
  Maybe it is not so easy to construct? Maybe no one else believes it will
be useful?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Issue of freedom and migration, Re: CPOE time studies.

On Tue, 12 Oct 2004, Karsten Hilbert wrote:

   When the UK, Canada or Australia recruits such a person to work in the
   UK, Canada or Australia, do they reimburse the South African government
   for the cost
 
  Double standard you use.
 No. Or rather, yes. Question is WHY a double standard is used.
 Tim believes applying a double standard is the morally right
 thing to do in this particular situation.

This discussion needs to include consideration of personal freedom and
discrimination (or preferential treatment) based on country of origin.
Furthermore, intentionally discriminatory policies may have very limited
effects anyways within a free market economy.

Best regard,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

browser vs. desktop, was Re: access keys, was Re: physician prescribing tool development

On Tue, 12 Oct 2004, Karsten Hilbert wrote:
...
In the meantime, I wonder what are the critical differences that
  impede your efficiency?
 A browser cannot access card readers unless quite
 sophisticated add-on code is installed locally.

Karsten,
  What about USB-accessible cards? Most operating systems have built-in
support to read from these.

 A browser does not offer sophisticated entry tools without
 requiring a lot of add-on code being installed locally.

Specifically, what do you mean by sophisticated entry tools?

 A browser most of the time makes using screen real estate
 efficiently and consistently hard for the programmer (unless
 add-on code is installed locally).

Absolute coordinate / xy placement are now supported without add-on code.
You might want to look at and play with the drag-and-drop elements:
  http://www.walterzorn.com/dragdrop/dragdrop_e.htm

 Then, why not install a conventional application if one has
 to install code locally anyways ?

1) It remains easier to install/upgrade a few new web-browsers than all
the desktop (conventional) applications.
2) It becomes increasingly unnecessary to install additional code locally
as web-browsers incorporate additional functionalities.

  Would new browser features such as access keys
  (http://www.cs.tut.fi/~jkorpela/forms/accesskey.html) change your
  opinion?
 No. If they are under the control of the application running
 inside a browser they can potentially conceptually compromise
 browser security.

Desktop applications can just as easily (if not even more easily)
compromise system security.

 If they are under the control of the browser executing the application
 assignment of key to action is arbitrary.

Typically, there is an option to abided by application's recommended
key-assignment or to override them. This is the same for browser and
desktop applications.

 Pick your poison.

Browser-based applications are no panacea. However, it is possible for
them to approach the behavior of current desktop applications. Note that
there is a time-lag between having capable browsers and having
web-applications make use of the features.

 Something a browser interface IS suited for is *displaying*
 drug information for perusal.

That's a start. :-) Care2002, OIO, OSCAR, FreeMed etc are web-based and do
more than displaying drug information. Someday, they may even become
speedy enough to satisfy your time-performance requirements, especially if
these requirements are measurable.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: browser vs. desktop, was Re: access keys, was Re: physician prescribing tool development

On Tue, 13 Oct 2004, Tim Churches wrote:

 On Wed, 2004-10-13 at 06:12, Andrew Ho wrote:
...
  Karsten,
What about USB-accessible cards? Most operating systems have built-in
  support to read from these.

 Yes, but Karsten's excellent point is that in order to use such
 resources, you need to give the browser-based application (as opposed to
 the browser itself) a degree of autonomous access to your local
 filesystem.

Tim,
  Why is it necessary for the browser to have autonomous access to any
local file system? It may be sufficient for the end-user to be prompted
for permission to upload an authentication token from the USB device to
the web-server.

...
 AFAIK, browsers do not provide the ability to allow certain privileges


As far as I know, browsers are not permitted to read or write anything
from the local file system except for the cookies files. Even this
privilege can be revoked by changing the browser configuration.

...
 In other words, Web browsers are promiscuous.

Everything is relative:

Web browsers (when running Mozilla on Windows OS, for example) are not as
promiscuous as desktop applications (running on the same Windows OS).

On the other hand, maybe Microsoft Internet Explorer is special:
http://groups.google.com/groups?hl=enlr=selm=9lqunr%24ea41%40secnews.netscape.com

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: access keys, was Re: physician prescribing tool development

2004-10-11 Thread Andrew Ho

On Sun, 11 Oct 2004, Tim Churches wrote:
...
 Different effects in different browsers when you press a given access
 key for a given Web page could lead to grief.

Tim,
  1) This is no more grief than having different buttons on different
web pages.
  2) Different desktop applications also support different hot keys
(=access keys).

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: access keys, was Re: physician prescribing tool development

2004-10-11 Thread Andrew Ho

On Mon, 12 Oct 2004, Tim Churches wrote:

 On Mon, 2004-10-11 at 16:59, Andrew Ho wrote:
...
  Tim,
1) This is no more grief than having different buttons on different
  web pages.

 It is when **the same application** behaves differently with different
 browsers.

Tim,
  No matter how different each web-browser behaves, it is no worse than
running different desktop applications, each with their own unique
interface and features. Going back to what Karsten said, browser features
such as access keys (and XUL) allow browser-accessible applications to
emulate functionalities of desktop applications. As this trend continues,
web-based EMR systems will become increasingly useful.

2) Different desktop applications also support different hot keys
  (=access keys).

 Sure, but that is not analogous. If you re-read the Web page to which
 you referred, you'll see that the same hot-key keystrokes in the same
 Web application but under different browsers will result in different
 actions.

There are several ways to resolve this issue. We encountered the same
situation with using SVG for making graphs and diagrams in the OIO system.
Our solution is to recommend using Mozilla with SVG built-in. :-)

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: access keys, was Re: physician prescribing tool development

2004-10-11 Thread Andrew Ho

On Mon, 11 Oct 2004, Karsten Hilbert wrote:
...
  emulate functionalities of desktop applications. As this trend continues,
  web-based EMR systems will become increasingly useful.
 We are not talking useful. We are talking usable. Remember
 that number of patients being seen in a given time ?

Karsten,
  Your point is very well taken. For your situation (and perhaps many
others), web-based systems will have to change quite a bit more to reach
the threshold of usable.
  In the meantime, if we can have a time-based requirement document, then
we will be able to objectively evaluate how far/close we are to usable.
This documention can include maximum number of seconds required to perform
xyz function, for example. What do you think?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: information capture, was Re: CPOE time studies.

2004-10-05 Thread Andrew Ho

On Tue, 5 Oct 2004, Calle Hedberg wrote:
...
 I don't think you will find many (over-worked?) doctors willing to wade
 through 20 or 30 years of (other doctor's) handwriting imagery to find
 facts pertinent to current problems or treatment regimen.

Calle,
  There will always be a mix of free text and structured data input. What
we are talking about is capture of free text as image vs. character-code
via keyboard entry.

 In other words, unless you classify/interpret information along the way
 it will not be retrivable in practice.

  This is true for free text stored either as image or as character-code.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

fitting EMR to existing workflow, was Re: CPOE time studies.

2004-10-05 Thread Andrew Ho

On Tue, 5 Oct 2004, Wayne Wilson wrote:
...
 I can't say too many times how important workflow is, technology often
 disrupts workflow or perhaps better phrased, re-organizes workflow.

Wayne,
  I agree completely. All EMR systems impose a specific workflow. Their
ability to support/facilitate modification of their embedded workflow/data
model is typically limited.

 All too often, technologists don't understand what they have wrought and
 spend a lot of time 'dismayed' at the poor uptake of our wonderful new
 technologies.

  I think some are beginning to understand and even trying to take a
different approach. :-) For example:

  We have been doing an OIO-based EMR implementation for a network of
clinics since Jan 2004. I think it should be classified as a semi-custom
application since it contains custom workflows/reports + standard OIO
forms. It looks and feels like a fully-custom application built-to-fit the
specific needs of a specific care-delivery operation. However,
implementation time/labor/risks have been much lower due to use of OIO
components (compared to using other tools/frameworks or modifying existing
EMR).

  To give some background, this is a replacement system for their in-house
developed Coldfusion and Microsoft SQL Server/Access system that became
too expensive to maintain. They were able to use OIO to model aspects of
their existing workflow/data model that they wish to keep. The bonus is
that they can further modify their data model (=OIO forms) and workflows
as their needs change in the future at very low cost (time +
labor-skill-level + risk).

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: information capture, was Re: CPOE time studies.

2004-10-05 Thread Andrew Ho

On Wed, 6 Oct 2004, Thomas Beale wrote:
...
 'raster images of text'. I would have thought the latter should be
 avoided at all costs apart from signatures and a few other odd
 situations;

Thomas,
  This is exactly the paradigm that we are challenging. Maybe at all
costs is too extreme a position to hold?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: CPOE time studies.

On Mon, 4 Oct 2004, Don Grodecki wrote:

 Sounds to me like a job for Tablet Computers!

Don,
  As far as I know, lack of full-size keyboard dramatically diminishs the
utility of tablet computers for applications that require text data entry.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Issue of freedom and migration, Re: CPOE time studies.

On Mon, 5 Oct 2004, Tim Churches wrote:

 On Tue, 2004-10-05 at 08:01, Calle Hedberg wrote:
...
  Add to that the fact that UK, Canada, Australia and other countries
  systematically poach doctors and nurses from SA (we have over 30,000
  vacant nurse positions now) - the impact on workload should be
  obvious.

 Yes, and it is a totally unconscionable trade in human resources.

Calle and Tim,

  Why is it unconscionable to freely trade human resources? Have you
interviewed individuals who chose to migrate? I have.

- begin quote

  The German free-market economist Wilhehm Roepke once suggested that
modern nationalism and collectivism have, by the restriction of
migration, perhaps come nearest to the servile state . Man can hardly
be reduced more to a mere wheel in the clockwork of the national
collectivist state than being deprived of his freedom to move 

- end quote from In Defense of Free Migration, Richard Ebeling, The
Future of Freedom Foundation http://www.fff.org/freedom/0691b.asp

 It's okay for rich countries to fight amongst themselves for trained
 health staff,

I see. There are different kinds human beings: those born to rich
countries and those born to poor countries? And it is _harmful_ to offer
the same opportunities to individuals from poor countries?

As we all know, major motivation for free software is to increase freedom
and lower costs. If vendor lock-in impedes progress and adds to
information costs, country-of-birth lock-in carries even higher human and
economic costs.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Issue of freedom and migration, Re: CPOE time studies.

On Mon, 5 Oct 2004, Tim Churches wrote:
...
   Yes, and it is a totally unconscionable trade in human resources.
 
  Calle and Tim,
 
Why is it unconscionable to freely trade human resources?

 It is unconscionable because the rich countries do not pay a fair price

Tim,
  The concept of trading freely includes mechanism for establishing
fair pricing that is acceptable by both seller and buyer.

...
 For example, it probably costs the South African government (and hence
 the South African people) between US$50,000 and US$150,000 to train a
 medical student through to being a specialist physician or surgeon.

So what?

It probably costs the same or more to train an U.S. medical student. Does
that mean it is unconscionable for the people of France or South Africa
to offer a position to this physician?

 When the UK, Canada or Australia recruits such a person to work in the
 UK, Canada or Australia, do they reimburse the South African government
 for the cost

Double standard you use. If I decide to move to South Africa, would South
Africans reimburse the U.S. government?

...
 That situation seems unconscionable to me, especially when the relative
 need for trained health staff in South Africa is so much greater than in
 the UK, Canada and Australia.

Needs typically exheed the ability to fill the need; this is called
scarcity in economics, please read:
http://www.socialstudiesforkids.com/articles/economics/scarcityandchoices1.htm

With greater scarcity, each unit of goods/service will command a higher
price. In a free market, the higher price will eventually cause increased
availability of the goods/services and reduction of scarcity. On the other
hand, if price-control is instituted, then the relative shortage will
never be resolved.

...
   And it is _harmful_ to offer
  the same opportunities to individuals from poor countries?

 It is harmful for governments of rich nations to actively recruit and to
 facilitate the migration of desperately needed, expensively-trained
 individuals from poor countries.

It is not as simple as that.
Most expensively-trained and talented individuals choose to migrate even
in the face of active discouragements and barriers.

  As we all know, major motivation for free software is to increase freedom
  and lower costs. If vendor lock-in impedes progress and adds to
  information costs, country-of-birth lock-in carries even higher human and
  economic costs.

 Neither Calle or I, or anyone else, have suggested that people be
 prevented from migration.
...

ok - as long as you are not advocating discrimination based on
country-of-origin.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: CPOE time studies.

On Mon, 4 Oct 2004, Don Grodecki wrote:

 - Original Message -
 From: Andrew Ho [EMAIL PROTECTED]
 Don,
   As far as I know, lack of full-size keyboard dramatically diminishs the
 utility of tablet computers for applications that require text data entry.

 Andrew,
  Why not capture the Doctor's input as a handwriting image? That's what
 happens on paper systems.

Don,
  Good point, maybe that's exactly what we aim for.
  With sufficient digitizer resolution, network bandwidth, and storage
capacity, this might become feasible.
  Have you tried current generation of tablet PC? I am interested to know
whether you think they are sufficient for capturing handwriting image.

Best regard,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

drugref conversation, was Re: physician prescribing tool development

2004-10-01 Thread Andrew Ho

On Fri, 1 Oct 2004, Daniel L. Johnson wrote:

 First of all, this is not an announcement; this is merely conversation,

Dan,
  Thanks for the invitation to converse.

 1: to test the utility of the new FDA-mandated computerized package
 insert (Dr. Schadow was an FDA consultant in its design).

  Do you know how these package inserts from FDA's electronic labeling
(http://www.fda.gov/bbs/topics/NEWS/2003/NEW00991.html) requirement will
be published? It seems that current package inserts can be freely
re-published on the Web (e.g.
http://www.druginfonet.com/index.php?pageID=official.htm).

  I would like to see integration of any electronic labeling info via
efforts such as Horst et al's DrugRef.Org. From there, we can begin to
build applications that make use of the information.

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

California can no longer ignore open-source software

2004-08-13 Thread Andrew Ho

Saw this on Slashdot today:
  http://it.slashdot.org/it/04/08/13/1317236.shtml?tid=103tid=117tid=185tid=98

The link to the California Performance Review recommendation:
  http://www.report.cpr.ca.gov/cprrpt/issrec/stops/it/so10.htm

The California Performance Review lists over 1200 recommendations that
aim to save the state $32 billion over the next 5 years and guide
California's government into the 21th century. I think it is highly
significant that SO10 (10th recommendation for statewide operations) lists
open source. Much of the other 31 information technology recommendations
also seem very reasonable 
(http://www.report.cpr.ca.gov/cprrpt/issrec/stops/it/index.htm).

Even this one --
  http://www.report.cpr.ca.gov/cprrpt/issrec/stops/it/so06.htm
which may lead to an open-source code repository. :-)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: documentation gap, was Re: medical systems framework

2004-06-15 Thread Andrew Ho

On Tue, 16 Jun 2004, Tim Churches wrote:

 On Tue, 2004-06-15 at 18:52, Aidan M McGuire wrote:
  It's a good job the Linux community didn't adopt that strategy ;-)

 And just about every other successful open source project...

 Seriously, the code-to-documentation and code-to-test ratios tell you a
 lot about a project.

Tim,
  That sounds interesting. We are seriously behind on writing
documentation for the OIO software. :-) I am curious what that tells you
about the OIO project, for example.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: modeling with OIO, was Re: HXP

2004-06-01 Thread Andrew Ho

On Sun, 30 May 2004, Adrian Midgley wrote:
...
  right, use unlimited number of tables to model unlimited number of
  services. That's the same as using unlimited number of OIO archetypes
  (forms) to model unlimited number of services.

 Those look exactly opposite to me - normalising the table should allow an
 unlimited number of services to be stored in one fashion (a normal form, in a
 very relevant sense) within one table.

Adrian,
  You and I may be focusing on two different aspects of the design. The
description of each new service must be stored somehow. I think this you
also agree with me.
  My point is that it does not matter really where and how this
information is stored. Regardless of where and how, for each new service,
some new information must be added. In the case of OIO, we create new
forms to describe each service. In your normalized database schema, you
may add additional rows to some set of tables.

 Not normalising the table means that each service is exceptional, and
 therefore must be handled by a new table,

Correct. It is worthwhile examining how well (or not) this fits the real
world.

 thus producing an unchecked and hard to examine growth of tables.

That's going a bit too far. There are many ways to code relationships
between tables. Not fully normalizing hardly means we have an unchecked
growth of tables. I have described previously (in response to Tim Churches
query most recently) how OIO utilizes database tables to model forms in a
measured and controlled fashion.

 Inevitably confusion will arise and some services will be added twice,
 or more, entries will be made in one place, looked for in another, and
 mistakes will be made as a result.

Same dangers (and more) can occur in poorly designed or poorly implemented
fully normalized systems. :-)

As I said above, it is important to examine how well the information
system models the real world. Normalized systems may fall short because
they have a hard time modeling exceptions.

Ask yourself this question, are there domains that are characterized by
diversity of workflow and information needs? In those domains, do we
expect to encounter modeling challenges that come from the need to
accomodate local variations and exceptions?

Finally, would medical practice and research fall into this class of
knowledge domains?

...
 I do see several people who have patiently explained why they have
 adopted some of the principles of informatics and of database design,
 which arose out of useful but unconnectable ad hoc system development a
 score or so of years ago.

Could you kindly point to some of these previous failures so that I can
learn from them?

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: HXP

2004-05-01 Thread Andrew Ho

On Sat, 1 May 2004, Calle Hedberg wrote:
...
 So flexibility must be high, OR the models must be based on the
 assumption that it will usually not be directly replicated but rather
 adapted to new countries/environments.

 Is anybody aware of any existing modelling efforts that might be relevant
 for our work?

Calle,
  You might want to consider OIO, which supports fully custom forms that
can be easily adapted to new countries/environments.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: HXP

2004-04-29 Thread Andrew Ho

On Fri, 30 Apr 2004, Thomas Beale wrote:
...
 Telephone1/telephone2 and similar ideas are really not good modelling,
 and will almost instantly break, as well as having limited use from the
 outset in widely different cultures/environments.

Thomas,
  Just as an example, how would OpenEHR model telephone1 and telephone2?

 The reason we and many others have gone to the trouble of doing more
 than simple-minded modelling is to get out of the numerous problems that
 such modelling brings with it.

  There are always design trade-offs. Let's investigate this simple
example a bit more so we can better understand the benefits and risks of
using simple-minded vs. impractical modelling approaches. :-)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: hxp, was Re: domain-expert modifiable systems, was RE: Typed untyped languages

2004-04-23 Thread Andrew Ho

On Thu, 22 Apr 2004, David Forslund wrote:
...
The hxp effort begins by indexing the various XML structures that
  different free/open-source systems use. From there, we can discuss and
  move toward standardization. This is my understanding and hope for the hxp
  project.

 What about ebXML?  This work is already done.

Dave,
  ebXML is fine too.
  I believe the usefulness of XML lies in capabilities to map and
tranform semantics between various XML structures. In other words, if we
can all agree on a single semantic framework, then we don't need XML to
start with.
  This is why I think hxp is an essential step - regardless of how perfect
ebXML may be.

 Also, indexing various XML structures may not help much unless we
 understand the underlying semantics.

Absolutely. Operationally, understand means developing artifacts to
transform between different representations and between related concepts.
I have described the need for these form-to-form translators in the
past.

Rather than waiting for a single useful standard to come down from the
  gods in the sky (or Washington D.C., HL7, etc), I think hxp offers a more
  promising approach.

 These standards should be regarded as gods in the sky but rather
 groups of people like you and me

Dave, I don't think they are anything like you and me :-).

 that want to work together to help in interoperability.

Are you sure about that? I believe there is rampant conflict-of-interest
involved that makes their godly work hopeless.

 I appreciate what HXP is doing but it may only be yet another effort in
 this area.

I believe hxp is the first free/open-source group working on
interoperability that has delivered a functioning test server!

 If it doesn't leverage the work done by many organizations and build on
 them, it will not be all that useful.

Whether hxp will or will not leverage previous work and Whether it will
ever be useful rest in our hands. Any of us can decide to contribute to a
lowly-but-practical solution or to wait for salvation via gods. There is
no money to bribe/fund and no fancy titles to award/impress. Again, quite
different from how gods operate.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Australian OpenEHR implementation, was Re: Typed untyped languages

2004-04-22 Thread Andrew Ho

On Fri, 23 Apr 2004, Tim Churches wrote:
...
 Horst Herb [EMAIL PROTECTED] wrote:
...
  On Fri, 23 Apr 2004 12:11, Tim Churches wrote:

Thomas, Horst and Tim,
  So, just to clarify.
  I gather that none you know of any specific plan to publish the
Australian implementation of OpenEHR under an open source license?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Python works with Zope like Microsoft C# works with .Net, Re: Typed untyped languages

2004-04-21 Thread Andrew Ho

On Wed, 21 Apr 2004, Tim Churches wrote:
...
 Andrew, you specified Microsoft C#, not just C#.

Tim,
  At this point, I am not aware of any difference between Microsoft C# and
C#. Both should work fine with Mono.

 Details matter.

  If you say so.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Typed untyped languages

2004-04-20 Thread Andrew Ho

On Tue, 20 Apr 2004, Thomas Beale wrote:
...
 There are various dimensions of typing in languages actually.

Thomas,
  I agree completely.
  My understanding of the object-oriented approach is that it is exactly
an extension of typing to theoretically unlimited dimensions.

 Statically typed means that the types are known at compile time.

ok. This type of system is clearly quite limited in modeling many real
world problems, for the simple reason that many useful types cannot be
known at compile time.

 Most typed OO languages have static typing with dynamic binding,

This is a step more flexible.

...
 Languages like Smalltalk are essentially weakly typed - types are not a
 feature of the language syntax or compile-time environment. As a result,
 the many checks that could have been done at compile time are not
 possible, and you discover a lot of things at runtime - in fact
 debugging your code is mostly a runtime testing activity.

I agree. This is a necessary price to pay for runtime flexibility.

If runtime flexibility is a required software feature, then choosing a
statically typed programming platform would be a mistake.

 One of the problems with weak typing is that it makes mathematically
 provable programs very hard. Not impossible, but much harder than
 statically typed languages.

I agree. This problem is commonly addressed by regression tests - which
fall into the type of mathematical proof called induction.

 It's still pretty hard in languages which take liberties with the type
 system, which is one area where C++, Java and C# are weak.

Right, I am sure this is an active area of research.
I found a paper about Aspect-Oriented Programming (AOP) that relates
to this:
  Diagnosis of Harmful Aspects Using Regression Verification
by Shmuel Katz, Computer Science The Technion Haifa Israel
  http://www.cs.iastate.edu/~leavens/FOAL/papers-2004/katz.pdf

...
   A type is-a model. What are you trying to say?
 
 A type is a really a mathematical logic construct - a template of one
 class of instances. When I said model above, I meant an entire model,
 such as a model of the EHR,

In that case, wouldn't the entire EHR model be equivalent to an EHR
class or EHR type?

...
 - you can't have an instance of ListT;  instead it is a type
 generator - the cross product of the type List with the set of types T
 gives you a set of types generated by ListT, e.g. ListString,
 ListInteger, ListEntry, and so on.

I see. What if I cross EHR with ListT ? Do we get ListEHR?

 So my point is that defining a model of say an EHR, or anything
 informational concept you like, without using types, is very hard.

I agree. My point is that any object-oriented system supports
user-definable types (=classes). These classes may or may not be known
(=determined) at design-time (many system are not even compiled)!

...
 What I am interested in is objective qualities which we could all agree
 are true of a language.

As with many qualities that relate to brain-to-X mapping (where X is a
language, etc), individual subject (=brain) impressions may contribute
significantly to the relationship. If we ignore these subjective
qualities, then we may be left with trivial residuals :-).

...
 6) With Zope, it is easy to find the piece of code associated with any
 specific user-accesible function
 
 is that because the IDE has nice browsing capabilities?

No, it is because each fragment of code has an URL.

...
 7) Easier for physicians to learn to program and debug Zope applications
(relative to other languages).
 
 Hm. I find this subjective.

But, it is subject to empirical testing :-).

 Why do you think physicians especially would find Python readable?

1) Zope DTML and Python have simple syntax.
2) No need to compile.
3) Direct mapping of code fragments to URL.
4) 100% web-browser accessible programming + runtime integrated
   interface.

...
 It's recognised by a lot of people in IT that the current situation with
 languages is pretty bad, considering what is understood theoretically.

Compared to 1983 when I wrote my first program, I would say that the
current situation is much much better. :-)

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Conflating Python with Zope and C# with .Net, was Re: Typed untyped languages

2004-04-20 Thread Andrew Ho

On Tue, 21 Apr 2004, Tim Churches wrote:
...
 Thomas asked why physicians would find Python readable, not Zope. You
 are conflating Python with Zope again, Andrew.

Tim,
  Is that the same as conflating C# with .Net? :-)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Lies about MySQL, Re: Database comparison question

2004-04-20 Thread Andrew Ho

On Tue, 20 Apr 2004, Daniel L. Johnson wrote:

 Dear List,

 I was recently sent the following table comparing SQL databases,
 comparing MySQL with SQL Server 2000.
 http://www.danlj.org/~danlj/OpenSource/Database_Comparisons.doc.html

Dan,
  Who is the author of this?

 It does not seem accurate to me, and it omits PostgreSQL.

  I am not a MySQL expert but the author may be guilty of intentional
mis-information. My guess is that the author prefers to sell Microsoft SQL
Server products.

  The statement in the Price row for MySQL is a blatant lie:
$495 per server (free if you put your source code in the GPL)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Typed untyped languages

2004-04-19 Thread Andrew Ho

On Tue, 20 Apr 2004, Thomas Beale wrote:
...
 Two comments about untyped languages:

Thomas,
  What is the definition of untyped language?

...
 - trying to define a model representing a design without types borders
 on the impossible.

  A type is-a model. What are you trying to say?

...
 Why throw away half the knowledge contained in the model when it could
 be easily used to check program correctness?

There are many good reasons why we ignore or throw away knowledge. In
fact, it could be said that the art of knowledge engineering requires it.

 I am quite interested to know why so many people use Python

1) It works in both Free and non-Free worlds.
2) Easy to read
3) Easy to learn
4) Easy to extend
5) Works with Zope

 - what's its attraction for building large software

6) With Zope, it is easy to find the piece of code associated with any
specific user-accesible function

 I'd be interested in knowing the main reasons why everyone chooses a
 certain language in health systems actually.

7) Easier for physicians to learn to program and debug Zope applications
   (relative to other languages).

 (My personal nirvana is a typed, oo/functional language, close to a
 structured mathematical logic, but with good tools, and the ability to
 write hello world without needing brain surgery.

I did a hello world programming demo last year for Zope. It took all of
3 clicks and typing 15 characters (all inclusive).

 I guess someone will write it one day, and get us all out of the
 terrible mire we're in now;-)

What terrible mire? :-)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Debian-Med

2004-03-28 Thread Andrew Ho

On Sun, 28 Mar 2004, Tim Cook wrote:
...
   I have always thought this would be a wonderful project.  Certainly a
   Knoppix distribution with the many applications listed at:
   http://www.debian.org/devel/debian-med/ would be a great tool to
   distribute at various trade shows etc.
  I would love if someone would pay me full time to build such a CD.

Tim,
  LiveOIO is a Knoppix 3.3 2004/02/16-based CD available from
http://sourceforge.net/project/showfiles.php?group_id=9295
  Zope, Plone-2.0-Final, PostgreSQL, OIO, Zwiki, and several
Zope-CMF/Plone Collector products are already included. I am sure you too
can learn to produce LiveTORCH from LiveOIO in a few hours. Alternatively,
if you like me to do it for you, I estimate that it will take 2-hours of
my time.

...
 Either way, I am not upset about TORCH not being included in Debian Med
 or as an officially blessed Debian package.

A time may come when at least one TORCH user become sufficiently upset -
and take action to package TORCH for Debian. :-)

Personally, I just have not had time to learn how to build Debian
packages. (It is probably easier than I imagine.) Once I do, I will
package OIO and all dependent packages that currently do not have Debian
package available!

Best regard,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

LiveOIO-1.0.9 released + step-by-step demo instructions

2004-03-28 Thread Andrew Ho

Dear colleagues,

  LiveOIO-1.0.9 is now available for download from
   http://sourceforge.net/project/showfiles.php?group_id=9295
  It is an iso (CD image) file suitable for burning a bootable,
650MB CD.

  Thanks to Richard Wang (American Honda) and Marcus Lopes (WRAP),
OIO-1.0.9 delivers the new Advanced Form Controls module and bug fixes
to the Import Data and reports modules.

  Advanced Form Controls provides Conditional question items (hide,
reveal) skipping, linked items (constrains), and mandatory items.
  Import data multi-step wizard provides arbitrary mapping of external
data to OIO patient identifiers and forms.

OIO-1.0.9 also supports auto-switching of IP address so that a single
OIO instance can support clients from both internal and external networks.
This is a feature long requested by Alex Chelnokov. Simply set the
internal and external base_URL and form_URL properties for the OIO
instance.

--
  The My_car form which is included in the default publicdb database
illustrates how the new Advanced Form Controls functions work. The
Advanced Form Controls are accessible through the form-change editing
screen through the function-selection Now menu.

To use OIO-1.0.9, boot up on the LiveOIO CD and then:
1) click on the LiveOIO bookmark in the Mozilla browser. The URL is
http://127.0.0.1:9673/OIO;. Username is oio, password is admin.
2) to see the new conditional item skipping feature, go to Forms -
My Forms using the dynamic menu near the top of the screen.
3) Click on Preview next to the My_car form
4) Select a Make of car which demonstrates how the answer to one
question item constrains the available answer-choices of another question
item. Selecting Honda, for example, gives only car Models that are
produced by Honda.
5) Select BMW to demonstrate question items that become visible
depending on the answer to another question. This is useful for
implementing conditional item skipping.
6) Click on All Questions to list all question items on the form.
The column Mandatory is new for OIO-1.0.9. If checked and then saved by
clicking the Set Mandatory button, the answer to the question must not
be null/empty string.
7) To change/edit the Advanced Controls for forms, select Advanced
Controls in the change-form menu and then click the Now button.
-

  To demo Plone-2.0-Final, which is a Zope-base content management system,
simply click on the LivePlone bookmark in the Mozilla browser. The URL
is http://127.0.0.1:9673/Plone;. Username is oio, password is admin.


Your feedback and suggestions are sincerely invited!

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OIO API (was Re: Global PID and VISA type numbering system)

2004-03-14 Thread Andrew Ho

On Sat, 14 Mar 2004, Tim Churches wrote:

 On Sun, 2004-03-14 at 04:51, Andrew Ho wrote:

  To render an OIO form for data collection -
  http://ip_address_to_server/OIO/forms/fillout_form?skin=pink_interfacept=4973form=Prognotes_v0
 

 Two quick questions:

 Does this always create a new form

Tim,
  Yes, this particular method always creates a new form-instance.

 or will it also retreive an existing form (or more precisely, population
 the nominated form with existing values for that patient?).

  There are other methods that can be called to do that.

 How does OIO handle authentication of such requests? In other words, how
 or where are the credentials of the requestor passed to the OIO server?
 Presumably not as part of the URL since you don't list it there (and
 that's good because passing credentials in a URL is terribly insecure).

  We rely on HTTP basic authentication or cookie-based authentication,
both provided by Zope.

Best regards,

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OIO API (was Re: Global PID and VISA type numbering system)

2004-03-14 Thread Andrew Ho

On Sun, 14 Mar 2004, Elpidio Latorilla wrote:
...
 But my original query was based on my wish to have a
 behind-the-scene-app-to-app dialog.

Elpidio,
  What's the difference between an application talking to OIO vs. a human
user? :-)

...
 If I create an interface that wants to get a set of patient data stored in
 OIO, how should this interface do it?

1) query OIO's patient id module to obtain the patient's unique OIO id
2) query OIO's archived_forms table to retrieve table of contents of all
forms
2) query OIO's formname_values table(s) to retrieve data

 Does the interface need to query your database directly?

That's one way to do it. Or, you can submit a HTTP request and OIO can
return an XML document.

 If yes, how can I know the entity relationship?

The entity relationship takes only a few words to describe:

  Each form is described by 2 tables:
formname_items: contains a list of questions
formname_itemtypes: contains a list of responses
  Data collected via each form are stored in a formname_values table.

So, a progress_note form may have the following:

progress_note_items table
  name | prompt | itemtype| ...
-
  date | Visit Date | date
  history  | History| free_text
  physical | Physcial Exam  | free_text
  assessment   | Assessment | free_text
  plan | Plan   | free_text
  billable | Billable Time  | minutes

progress_note_itemtypes
  date
  text_box
  minutes

progress_note_values

 pt | date| history | physical | assessment | plan   | billable

123 |2004/3/1 | xyz | abc  | pain   | whatever   | 25
456 |2004/3/2 | zyx | cba  | flu| whatever   | 45


 Could you kindly give me a link to the ER docs that might be relevant to
 patient data?

  I hope the information above satisfies your needs. If not, please let me
know.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OIO API (was Re: Global PID and VISA type numbering system)

2004-03-14 Thread Andrew Ho

On Sun, 15 Mar 2004, Tim Churches wrote:

 On Mon, 2004-03-15 at 06:18, Andrew Ho wrote:
  On Sun, 14 Mar 2004, Elpidio Latorilla wrote:
  ...
   But my original query was based on my wish to have a
   behind-the-scene-app-to-app dialog.
 
  Elpidio,
What's the difference between an application talking to OIO vs. a human
  user? :-)

 Applications (and computers in general) are very stupid, and thus there
 needs to be a means of spelling out to them what they can and can't do.
...

Tim,
  You did not address how a human user is any different?
  I think it is similarly helpful to clearly spell out what an user can
and can't do through the user interface.

Best regards,

Andrwe
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: The rewards of contributing to the OpenSource Community

On Tue, 9 Mar 2004 [EMAIL PROTECTED] wrote:

 http://www.linuxrouter.org/

Steven,
  It is far too simplistic to attribute the demise of LRP to the open
source community.

If anyone is interested in an autopsy, the Slashdot discussion back in
June 2003 is a must-read:
  http://developers.slashdot.org/article.pl?sid=03/06/23/0336228tid=

There was a little snippet from Dave Cinege:
http://developers.slashdot.org/comments.pl?sid=68562threshold=1commentsort=0tid=106mode=threadcid=6282059

Commentary from Dave Cinege's colleagues that fills in some gaps:
http://www.mail-archive.com/[EMAIL PROTECTED]/msg06582.html

Non-free projects/companies die all the time and for multitudes of
reasons. Free projects can also cease operations - and many do.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

giving up, was RE: The rewards of contributing to the OpenSource Community

On Tue, 9 Mar 2004 [EMAIL PROTECTED] wrote:
...
 guy's code. It's ironic that millions of these devices have been sold,
 but the developer has to give up the development of software because he
 doesn't make any money at it.

Steven,
  Dave Cinege did not have to give up the development.
  He made a decision to give up on the LRP project - despite significant
achievements.

...
 His problem is that he had no mechanism to get paid for his brilliant
 Intellectual Property

There are lots of very useful Intellectual Property around that cannot
be easily/successfully exchanged for money. Unfortunately for Dave Cinege,
he is quite unhappy that LRP falls into this category.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

intellectual property, was Re: The rewards of contributing to the OpenSource Community

On Wed, 10 Mar 2004, Horst Herb wrote:
...
 1.) Intellectual property  is a dehumanizing construct

Horst,
  Dehumanizing or not, intellectual property happens to be an important
artifact for much of the Westernized societies.

...
 There is no evolution of knowledge if knowledge is not shared

ok.

 - and intellectual property is the anathema of sharing knowledge.

This part I do not agree with. People share knowledge in the form of
intellectual property all the time. Every time we read a book or watch a
movie, for example.

 Can you imagine where we would be today if Isaac Newton would not have
 openly published his ideas, but locked them away as intellectual
 property?

No no no, a way to maximize the sharing of intellectual property is to
find a publisher who is willing to put up the paper and ink to print lots
of copies of essays that describe Isaac Newton's ideas.

...
 It is a non-monetary economy of that kind which obviously suits
 increase of knowledge wealth best,

This is true sometimes. I think it is also a mistake to entirely dismiss
the usefulness of intellectual property.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

RE: The rewards of contributing to the OpenSource Community

On Tue, 9 Mar 2004, Tomlinson, Steven B wrote:

 The whole thing proves to me the utter folly of giving away your I.P.,

Steven,
  Even if the only goal in life is to die with the most gold pieces under
one's name, I would still disagree with your statement.
  Folly? Even Microsoft gives away IP from time to time!

 He should never had released the code which he developed from the sweat
 of his brow.

  It is true that Dave Cinege expressed similar sentiments at one time. He
may change his mind in the future when he realizes the true significance
of his achievements.

  Speaking for myself, I would be quite pleased if the OIO software ever
becomes as widely adopted as the LRP. :-)

 Those in a position to do so have now profited from his hard work and he
 has nothing to show for it.

  But he does have quite a bit to show for it, just not much money.

 Whilst they are laughing all the way to the bank.

  1) Isn't it wonderful that Dave Cinege made so many people happy?
  2) Why is that not a worthwhile achievement?
  3) Would Dave Cinege be considered more successful if he made people
cry and suffer?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

OpenEHR status, was Re: single model, was Re: Care2x classtree and archetypes and shared data models

2004-03-02 Thread Andrew Ho

On Tue, 2 Mar 2004, Thomas Beale wrote:
...
 There are implementations going ahead in Australia, UK, US, Germany, and
 under consideration in Netherlands. But a large part of the work is
 designing the archetypes and templates for it.

Thomas,
  What is the current situation with regards to software that
support the creation and use of OpenEHR archetypes and templates?

  On OpenEHR.Org, there is currently no software listed in the downloads
section: http://www.openehr.org/downloads.htm

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

LiveOpenEHR, was Re: single model, was Re: Care2x classtree and archetypes and shared data models

2004-03-02 Thread Andrew Ho

On Tue, 2 Mar 2004, Wayne Wilson wrote:
...
 I had a similar situation a few years ago when the OMG Health SIG was
 working on what became the COAS interface.  I could not understand the
 GEHR model that was being presented.
...
 I really do believe that this kind of thinking is only able to be
 understood once your conceptual framework has shifted a considerable
 amount (assuming you have traditional IT exposure).

Wayne,
  My experience from OIO is that showing a full, working demo is the
fastest way to shift someone's conceptual framework.
  That's why LiveOIO was a major milestone for the OIO project. That's why
I think a LiveOpenEHR will also be very helpful.

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OpenEHR status, was Re: single model, was Re: Care2x classtree and archetypes and shared data models

2004-03-02 Thread Andrew Ho

On Wed, 3 Mar 2004, Thomas Beale wrote:
...
   What is the current situation with regards to software that
 support the creation and use of OpenEHR archetypes and templates?
 
 I should point out that there is a difference between software that
 companies and other organsiations create and software funded and created
 by openEHR itself.
...

Thomas,
  What software have been produced, to your knowledge, in each category?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

alchemy of open-source projects, was Re: Interesting article: non-profit and for-profit

On Fri, 20 Feb 2004, denny adelman wrote:
...
 I found myself wondering what alchemy would bring the open source
 community into legitimate competition for such large projects.

Denny,
  This is a great question that actually has already been answered. The
answer is contained in the history of GNU/Linux, Apache, Mozilla, and
other well-described open-source projects.

 And if such a thing could happen, what reassurances could we give that
 there would not be announcements like the apparent failure of a new
 $450m Open Source application at a XYZ Hospital.?

  The reassurances are the following:
   1) it will not fail: it will succeed incrementally
   2) it will not be a $450m open source application at a XYZ hospital:
it will be a free application at increasing number of hospitals

 Oracle, Peoplesoft, Fujitsu know how to deal with that. Do we?

Of course we do. Who do you think works at Oracle, Peoplesoft, and
Fujutsu?

What makes you think that open source means we should exclude Oracle,
Peoplesoft, Fujitsu from participating? For example, both IBM and
Microsoft are already open-source software providers.

There is no permanent division between they and us. We are all trying
to solve real world problems. Alliances and relationships will change over
time. If Oracle employees know better how to deal with certain tasks, then
they should do that part of the project.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: alchemy of open-source projects, was Re: Interesting article: non-profit and for-profit

On Mon, 24 Feb 2004, Tim Churches wrote:
...
matter of pure practicality - in order to undertake really complex
projects, you need a team of people who can immerse themselves in the
project,
...

Tim,
There is no debate that people are needed. However, how the team come
together and operate are quite different between free and non-free
projects.

...
For example, both IBM and Microsoft are already open-source software
providers.

Microsoft?

Microsoft provides open-source software through Windows XP, for example:
http://support.microsoft.com/default.aspx?scid=http://support.microsoft.com:80/support/kb/articles/Q306/8/19.ASP

...
There is no permanent division between they and us. We are all trying
to solve real world problems. Alliances and relationships will change over
time. If Oracle employees know better how to deal with certain tasks, then
they should do that part of the project.

Quite so, and that's why implementations of an open source hospital
system may still costs a substantial slice of that $450 million, because
those Oracle people generally don't work on a volunteer basis.

Most of us do not work substantially on a volunteer (= not financially
compensated) basis either.

This confusion between free/open-source methodology and volunteerism is
quite misleading and counter-productive. Unfortunately, many free software
developers are reluctant to refute this error. It is rather difficult to
expend effort insisting that you are not making a donation when you
contribute code to a free software project.

Free/open-source solutions offer lower Total Cost of Ownership _NOT_
because free software developers perform work for no pay. Instead, free
(as in speech) solutions are less costly because
1) less need for lawyers
2) better communication between developers and users
3) more code re-use
4) easier to support and maintain
5) potentially larger market penetration

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

resend, Re: alchemy of open-source projects, was Re: Interesting article: non-profit and for-profit

For some reason, it appears that a support.microsoft.com URL was
censored and did not reach Tim. Here it is again (repeated 3x):

1.
http://support.microsoft.com/default.aspx?scid=http://support.microsoft.com:80/support/kb/articles/Q306/8/19.ASP

2.
http://support.microsoft.com/default.aspx?scid=http://support.microsoft.com:80/support/kb/articles/Q306/8/19.ASP

3.
http://support.microsoft.com/default.aspx?scid=http://support.microsoft.com:80/support/kb/articles/Q306/8/19.ASP

On Mon, 23 Feb 2004, Andrew Ho wrote:

On Mon, 24 Feb 2004, Tim Churches wrote:
...
matter of pure practicality - in order to undertake really complex
projects, you need a team of people who can immerse themselves in the
project,
...

Tim,
There is no debate that people are needed. However, how the team come
together and operate are quite different between free and non-free
projects.

...
For example, both IBM and Microsoft are already open-source software
providers.

Microsoft?

Microsoft provides open-source software through Windows XP, for example:
http://support.microsoft.com/default.aspx?scid=http://support.microsoft.com:80/support/kb/articles/Q306/8/19.ASP

Most of us do not work substantially on a volunteer (= not financially
compensated) basis either.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: alchemy of open-source projects, was Re: Interesting article: non-profit and for-profit

On Tue, 24 Feb 2004, Tim Churches wrote:
...
 I had a quick look at the firt of thoose URLs and it is not immediately
 apparent what its relevance is,
...
 Can you give us some hints?

Tim,
  The URL points to Microsoft's Windows XP copyright disclosure that
mentions inclusion of open-source software in Windows XP.

   Microsoft provides open-source software through Windows XP, for
  example:
  http://support.microsoft.com/default.aspx?scid=http://support.microsoft.com:80/support/kb/articles/Q306/8/19.ASP

  Thus, Microsoft is a genuine open-source software provider - unlike
the infamous AAFP (American Academy of Family Physicians) :-).

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Microsoft as open-source software provider, Re: alchemy of open-source projects, was Re: Interesting article: non-profit and for-profit

On Tue, 24 Feb 2004, Tim Churches wrote:
...
 OK, I see what you are referring to now - the licenses for BSD material
 from the Regents of the Uni of California etc at the end of the
 document. But surely that is an example of Microsoft making use of other
 party's open source code,

Tim,
  What Microsoft has done with open-source software goes far beyond just
use. They are actually re-distributing it.

 and incorporating (as permitted by the BSD licenses) into their own
 closed source code.

  That's exactly what the authors of code allowed. Microsoft has done a
good job finding the software, incorporating them into Windows, and
properly (as far as I can tell) giving credit.

 I don't see any evidence of Microsoft distributing their **own** code
 under an open source license,

  As I mentioned, there are different ways to contribute to open-source
projects. Re-distribution of open-source software is one of many useful
and important tasks.

  As a comparison, how many subscribers of OpenHealth list actually
distributed our **own** code under an open source license? In fact, how
many of us played a part in re-distributing other people's open source
code like Microsoft?

 or even their modifications to other people's code in source code form.
 Or have I missed something?

  Only that Microsoft is quietly being a real open-source software
provider while some others make lots of noise about the merits of
open-source but do the opposite. :-)

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

eStore.OIO, was Re: FOSS and cost of development, was Re: Interesting article: no n-profit and for-profit

2004-02-20 Thread Andrew Ho

On Fri, 21 Feb 2004, Tim Churches wrote:

 On Sat, 2004-02-21 at 09:58, Andrew Ho wrote:
1) show OIO used for 3 different applications (clinical, research,
eCommerce)

 What was the address of the OIO e-commerce site again? From memory it
 sold little LED light thingies.

Tim,
  It is at http://www.OptoLight.Com
  If you click on [Open an Account], you will see an OIO form.
Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: eStore.OIO, was Re: FOSS and cost of development, was Re: Interesting article: no n-profit and for-profit

2004-02-20 Thread Andrew Ho

On Fri, 21 Feb 2004, Tim Churches wrote:
...
 Thanks. Like the US Dept of Labor WorkForce Connections project, this is
 a nice (meaning innocuous) example of how FLOSS work in one domain can
 benefit entirely different domains of endeavour.

Tim,

  For software generator R+D projects like OIO, gaining opportunities to
generate software for real applications is essential. People who download
and try OIO are truly our research subjects and potential collaborators
(once they provide feedback). We don't provide monetary compensation for
their time and labor but we offer free software.

  This is also why I occasionally volunteer to produce custom
web-applications (e.g. OSHCA.Org). Of course, sometimes even free software
+ free service are not sufficient inducements. :-)

  Recently, we launched a web-based practice management system effort to
serve a network of 3 clinics; you can read about this collaboration here:
  http://www.txoutcome.org/scripts/zope/development/wrap
We started in January and should be in production by next week.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

sheep still need charter, was Re: new lists etc

2004-02-13 Thread Andrew Ho

On Sat, 14 Feb 2004, Thomas Beale wrote:
...
 (not generally known as a sheep, but happy to be treated like one in
 this instance...)

Let's move on and agree to be sheep then:
1) pick 3 people who will manage the list for us
2) agree that these 3 people will decide how/who should host the mailing
list and domain name
3) agree on a way to pick these 3 people

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: List name

2004-02-13 Thread Andrew Ho

On Fri, 14 Feb 2004, Tim Churches wrote:
...
 Joseph and I both like the utter simplicity of [EMAIL PROTECTED]

 That nicely includes the concepts of discussion, announcements of new
 projects and releases, events etc

 Any other reactions, suggestions?

Tim,

  Integrating OSHCA with OpenHealth is a wonderful idea that I fully
support, except for the quagmire that currently surrounds the transfer of
OSHCA.Org domain to OSHCA's current interim board.

  With the OSHCA.Net vs. OSHCA.Org fragmentation unresolved, I think it
would be wise for us to avoid association with OSHCA.Net or OSHCA.Org. Dan
Johnson already offered to pay $10/year to register a new domain for our
new List. Please let's keep OpenHealth away from the entangled OSHCA mess.

  For the record, I suggest that the current OSHCA interim board members
(who are also OpenHealth List members) should immediately identify
themselves to the OpenHealth List community - since there may be potential
conflict of interest involved in these merger discussions.

Just my opinion,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

tolerating differences in opinion, was Re: Perspective

2004-02-12 Thread Andrew Ho

On Thu, 12 Feb 2004, Wayne Wilson wrote:
...
 You have now alerted the list many times to my supposed desire to
 hijack the list for my own ego purposes.

Wayne,
  I am sorry that you interpreted my comments in that way. For the record,
I don't know whether Wayne Wilson intents to hijack OpenHealth or not
but I don't agree with his strategy.
  As I said before, we have differences in opinion regarding _strategy_.
You have every right to your opinion as I have to mine. Both of us can use
OpenHealth to communicate our respective opinions.

...
[intimidating personal attacks deleted]

Any personal attacks deployed to silence will not work.  Furthermore, I
hope, if we ever transition to a new List, you or anyone else in power
will not be able intimidate colleagues due to differences in opinion.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

wrong solution for the wrong problem, was Re: Wikis, threads, nosy lists and the Openhealth list

2004-02-07 Thread Andrew Ho

On Sat, 8 Feb 2004, Tim Churches wrote:

 Many subscribers to the Openhealth list value it as a source of
 enlightened discussion
...
 list does not suffer from spam, nor are there endless flame wars
...
 However, some subscribers have complained, justifiably I think, that
 some of the discussion threads evolve (devolve?) into arguments between
 a few, often just two, protagonists
...

Tim,

  1) One person's enlightened discusssion may very well be
another person's devolved thread. How shall we draw the line?
  2) Enlightened discussions need not always involve more than 2 willing
participants. If anyone feels left out, they are free to contribute to the
discussion.

...
 I think that the establishment of an OpenHealth Wiki to complement the
 OpenHealth list (or whatever the replacement for the current Openhealth
 list ends up being called) offers a solution to this problem. As soon as
 a discussion thread starts to devolve into a duologue,

You mean dialog?

 or becomes of increasingly narrow interest, then it can be transferred
 to the Wiki, and any protagonists still interested can thrash it out on
 the Wiki.

1) I suppose you will be the one monitoring the List to help us decide
what constitutes narrow interest?

2) How shall we deal with any discussant who disagrees with you/our wise
judgements? Shall we bar them from posting to OpenHealth?

3) If we adopt your proposal, how confident are you that we will reduce
the number of complaints regarding our enlightened discussions?

...

My view is that we should avoid any form of censorship. Furthermore,
Narrowness is often highly desirable to clarify the subject matter. Our
ability to access each other's expertise depends on our willingness to
give detailed, well-reasoned, and sufficiently narrow communications
through this List.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Zwiki vs. LinuxMedNews, was Re: Mail-in and Mail-out from Zwiki, Re: [boring admin] Using other mediums than discussion groups

2004-02-06 Thread Andrew Ho

On Fri, 6 Feb 2004, Ignacio Valdes wrote:

 On Thu, 5 Feb 2004 15:22:47 -0800 (PST)
   Andrew Ho [EMAIL PROTECTED] wrote:
 On Thu, 5 Feb 2004, Tim Cook wrote:
 . LinuxMedNews does not support mail-in articles and
 feedback/discussion. Zwiki does.
 LMN supports all of the above. -- IV
Through Zwiki? -- AH

Mail-in and Mail-out from Zwiki, Re: [boring admin] Using other mediums than discussion groups

2004-02-05 Thread Andrew Ho

On Thu, 5 Feb 2004, Karsten Hilbert wrote:

  I'm talking about a Wiki Wiki.
 A Wiki does not allow for offline answering/use. It makes me
 go places. However, I want the information come to me.

Karsten,
  I don't know about other Wiki's but Simon Michael et al's Zwiki does not
suffer from this limitation.

- quote from http://www.Zwiki.Org
   You can receive and send comments via email by subscribing to
individual pages or the whole-wiki mail list.
 end quote

So, I can elect to get an email message from the Zwiki whenever someone
posts a comment via Web or via Email. I can reply to that email and my
response gets posted to the correct Zwiki page.

I belong to the Los Angeles Zope Users Group and we have been using Zwiki
as a combination of mailing list and Web-based collaboration tool for
several years now:
  http://www.lazug.org/lazugsite/laZugWiki/GeneralDiscussion#bottom

I think it is a fantastic tool!

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Zwiki vs. LinuxMedNews, was Re: Mail-in and Mail-out from Zwiki, Re: [boring admin] Using other mediums than discussion groups

2004-02-05 Thread Andrew Ho

On Thu, 5 Feb 2004, Tim Cook wrote:

 On Thu, 2004-02-05 at 12:49, Tim Cook wrote:

  I agree. This is the best of all worlds so that content can be
  maintained and linked/cross-linked, yet it is sent to those that
  subscribe with them having to go look for updates.

 OOOPS!!! Pushed send too soon.

 ...but then Linuxmednews does the same thing and it already gets 1000's
 of eyeballs a week.

Tim,
   LinuxMedNews is a news site. Zwiki is a software tool.
   LinuxMedNews does not use wiki technology - news articles are reviewed
by human editor(s) before they are published. Zwiki allows anyone to edit
the pages. LinuxMedNews does not support mail-in articles and
feedback/discussion. Zwiki does.
   You are/were a LinuxMedNews editor. I am a happy Zwiki users (and goes
to the same Zope users group (www.LaZug.Org) as Simon Michael :-).

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

LiveOIO-1.0.8 released: with R integration, Italian + German translations, Live Reports

2004-02-05 Thread Andrew Ho

Dear colleagues,

  LiveOIO-1.0.8 is now available through Sourceforge:
 http://sourceforge.net/project/showfiles.php?group_id=9295

  It is a 640MB iso suitable for producing a bootable CD. LiveOIO is a
remastered Knoppix 3.3 2003/11/19 (www.Knoppix.Net) that contains all
software needed to run OIO server + client. From boot-up, it now takes
only a single mouse-click to access a fully-configured, functional OIO
server system (KDE + Mozilla are the default client software).

  Contents include:
* OIO-1.0.8
 - with psychiatry/research forms, schedules, workflows, reports
 - with English, German, Italian switchable menu
  (provided by Anton Auer)
 - integrated with R (via Gregory Warnes's RSessionDA)
  for advanced statistical analysis
  (ANOVA and scatter plot w/regression line in this release)
  screenshots:
http://www.txoutcome.org/screenshots/livereport/anova.png
http://www.txoutcome.org/screenshots/livereport/scatter.png
 - new Live Reports module, for customizable reports aggregating
  data from multiple OIO forms
   screenshot:
http://www.txoutcome.org/screenshots/livereport/live_report1.png
* R-1.7.1 (www.R-Project.Org) - and components needed to link
   to Zope (RSessionDA, RPy, RSOAP, SOAPPy, PyXML)
* Plone-2.0-rc5 (www.Plone.Org)
- general-purpose content management system
- includes CMFBoard and SimpleBlog add-on products
screenshot:
http://www.txoutcome.org/screenshots/plone.png
* Zwiki-0.27.0 (www.Zwiki.Org)
- wiki implemented in Zope and integrated with Plone
- includes Epoz WYSIWYG editor 
(http://www.zope.org/Members/mjablonski/Epoz)
screenshot:
http://www.txoutcome.org/screenshots/zwiki.png
   * Zope-2.6.2 (www.Zope.Org)
   * PostgreSQL-7.3.4 (www.PostgreSQL.Org)

As always, feedback and comments are sincerely invited.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Administrative - mail list changes ahead

On Sat, 31 Jan 2004, Christian Heller wrote:

  Another option is Linuxmednews...Ignacio has kindly hosted OSHCA for

Christian,

Since Ignacio has not volunteered, I don't think it is fair to single him
out. If the man wishes to volunteer, let him tell us directly.

...
 I vote for this option and would like to see Andrew's list charter applied.

The applicability of my proposed List Charter remains unknown. It remains
to be seen whether:
  1) enough people feel that we need something like that
  2) enough people will migrate to a mailing list based on that
  3) five willing and able bodies will volunteer to fill the positions

As I said, we still have [EMAIL PROTECTED] in the meantime. When enough of
us feel sufficiently moved to take concrete action, then we shall have a
new list.

 (Thanks to Denny for his offer, but I think it is not a good idea to
 again leave administration of the new list to a commercial company.)

In my humble opinion, we need not discriminate against commercial entities
as long as we have a strong Charter and enforceable contracts with the
volunteers. Without such agreements in place, I fear that even the most
up-standing members of our community are human and thus vulnerable to
corruption. This is not an issue of trust, but immunizing well-intentioned
people so that they may do good with maximal efficiency. Present company
included :-).

According to my proposed charter, the list managers will be responsible
for choosing a Host and a Domain Name Manager. After a few more days of
deliberation and discussion, maybe people will begin self-nominating for
the list manager positions. We just have to wait and see.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

balance of power, was Re: Administrative - mail list changes ahead

On Sat, 31 Jan 2004, Joseph Dal Molin wrote:

 On Sat, 2004-01-31 at 10:13, Tim Cook wrote:

  I think in both cases they offered to provide the infrastructure but
  neither of them want to administer the list.

 Providing the infrastructure and not administering is essential...it in
 effect deals with the root cause of the problemsi.e.

Joseph,
  In that context, what do you think of my proposed Charter? Do you think
dividing up the responsibilities 5 ways (3 list managers, 1 Host, 1 Domain
name manager) is excessive?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

OpenHealth archive, was Re: Administrative - mail list changes ahead

On Sun, 1 Feb 2004, Christian Heller wrote:
...
 My main sorrow is the precious list archive. I am not sure if we can
 rescue it somehow from Minoru.

Christian,
  The OpenHealth archive appears to be hosted by mail-archive.com. I do
not believe deletion is possible according to their FAQ:
  http://www.mail-archive.com/faq.html#delete

  I would propose that we continue to use mail-archive.com to host at
least 1 copy of our new list archive. It may be a bit more inconvenient to
do a search across the two archives but Google should be able to span them
nicely.

...
 charter, at least two admins

  I thought three admins makes it harder to deadlock on decisions :-).

 and perhaps some export functionality for the archive,

  I believe mail-archive.com could burn a CD, upon request.

 it shouldn't matter who is hosting the list.

  Why not elect three list admins first and then trust them to pick the
best Host and Domain Name Manager?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Charter + List rules, Re: Administrative - mail list changes ahead

On Sun, 1 Feb 2004, Tim Churches wrote:
...
 What we need are administrators who a) approve the membership of list
 applicants and b)  counsel or ultimately disable the member of those who
 abuse the list of fail repeatedly to observe its rules.

Tim,
  I agree. I am against list moderation as well.
  In my Charter proposal, I said the Lead list manager will make
decisions - which day-to-day will basically be what you outlined above.

 Thus we need rules - a charter if you like

  Charter and List rules are entirely different animals. We need both.
  I would propose that we simply copy OpenHealth's List rules verbatim
(excepting the Minoru disclaimer, of course), see:
http://www.mail-archive.com/[EMAIL PROTECTED]/msg07122.html

What do you think?

...
 Perhaps some (simple) rules for deciding such matters (because they are
 necessarily subjective) can be proposed - like Andrew Ho's charter, but
 a bit less complex.

I am all ears. Please spell out what you have in mind.

 An elected triumvirate might suffice, with an interim triumvirate by
 popular acclaim until the membership of the list is re-established,
 perhaps with a rotating duty-roster to be first line admin/moderator.

1) How do you determine popular acclaim vs. elected?
2) How is this any different from what I proposed?
[
see
http://www.mail-archive.com/[EMAIL PROTECTED]/msg10345.html]


Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OIO pickone_from_form, Re: cancer registry example, Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS w

2003-12-29 Thread Andrew Ho

On Mon, 29 Dec 2003, Tim Churches wrote:

 On Mon, 2003-12-29 at 20:56, Andrew Ho wrote:

  Right - as I said at the start - this is an example for the purpose of
  illustrating how the OIO system works. If you are interested, I can
  probably setup a demo system with 3-4 forms that we have been discussing.
  Then, you can take a look, try it, and decide for yourself.

 Yes please. I am sure I am not the only one who would be interested in
 seeing exactly what you mean.

Tim,

ok, I will post URL when it is ready.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: cancer registry example, Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

2003-12-29 Thread Andrew Ho

On Mon, 29 Dec 2003, David Forslund wrote:
...
Correct, each form-instance is linked to a patient. Forms (blank forms /
 metadata / in the abstract) aren't linked to any patient.
 
   But there still needs to be relationships and contexts for forms.
 
 Right.

 Aren't there linkages between forms in the abstract, too?

Dave,
  Yes, since Form A can contain a quetion item that uses a
pickone_from_form response that depends on a question item on Form B, Form
A and Form B can be linked via this question item:
  Form A  Form B
 Cancer Case Number --- Cancer Case Number
 Histology   Date discovered
 Staging Cancer name


 In other words, can't I have a complex form?

  We don't have simple vs. complex forms. OIO forms are rather flat and
quite simple. However, this issue has been raised quite a few times by
Alex Chelnokov.
  OpenEHR's organizer archetype provides an useful mechanism to model
hierarchical relationships between attributes within each archetype. If we
add complex forms to OIO, we will probably copy OpenEHR's archetype
organizer design
(page 30, http://www.openehr.org/downloads/archetypes/archetypes.pdf).

  What do you think?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sat, 27 Dec 2003, David Forslund wrote:

 How do I use OIO forms in a non-OIO application?

Dave,
  You can't. If an application uses OIO forms, then it is an OIO
application. :-)

 In other words, I don't want to have to run Zope to use and manage
 forms, and I don't want to rely on having to get to a remote OIO server
 to get a form, since I might be blocked by my firewall (as in the case
 of the entire VA).

Try LiveOIO, the Knoppix-based boot disk that runs and installs OIO.

 What is the platform and language independent description of an OIO
 form?

form
  item
name
description
item_number
prompt
itemtype
  /item

  itemtype
name
description
action
choice
code
  /itemtype
/form

 Couldn't that be an OpenEHR archetype or an XML schema, or an HL7 CDA?

Yes, that's the idea.

 In this case OIO might be used only has a way to author an archetype,

OIO can be a web-based tool for authoring OpenEHR archetypes / OIO forms
and also render/collect data via these archetypes(+templates) and forms.

 although there needs to be a place which maintains the official
 structure of a form, such as HL7 or some other body.

Maybe - or end-users can simply upload forms into the OIO Library to be
index and shared.

 Can you send me an example OIO form that I could simply use in my JSP web
 application?


form
  item
nameGender/name
descriptionself-reported gender/description
item_number10/item_number
promptGender?/prompt
itemtypegenders/itemtype
  /item

  itemtype
namegenders/name
descriptionphenotype gender/description
actionpickone/action
choicefemale,male,unknown/choice
code2,1,0/code
  /itemtype
/form

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: hub, spoke, new Esperanto for healthcare, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sat, 28 Dec 2003, Tim Churches wrote:
...
 Converters are necessary evils. But having spent far too much time
 writing converters (80-90% of any epidemiological or statistical study
 is spent in data management and data preparation, which usually means
 writing custom converters), I am **very** interested in any means of
 having to write fewer of them in the future, not more.

Perhaps more re-use and more automative generation will lead to less need
for custom, hand-built converters that you are familiar with?

...
  This like saying if we standardize English then we won't have to
  worry about learning new words and slangs.
...
 People with strong individualistic traits tend to be suspicious of
 standards.

This is quite characteristic of many physicians and scientists.

...
  These may be useful - but they are not replacements for converters.
  Thus, they must not prevent development of an adequate converters
  infrastructure.

 I have never seen any data dictionary, minimum dataset, terminology or
 other data harmonisation effort which has said Thou shall not develop
 data converters or converter infrastructure. Never, not once, ever.

Promoters of restrictive terminology tend to suggest converters are needed
only for exceptional cases and ought not be used regularly.  Instead of
recognizing converters as a desirable part of the semantic network, they
tend to see them as necessary evil :-).

...
  As I pointed out repeately, a constraint language is not sufficient. We
  also need a translation infrastructure. This is exactly why OpenEHR, in
  its current form, is inadequate.

 I agree with you here - that a translation infrastructure is needed -
 one that can take data collected in accordance with given metadata, and
 automatically convert the data into another form as defined by different
 metadata. AFAIK, openEHR does not currently provide that. But I have a
 hunch that openEHR may provide an excellent, principled basis on which
 to build such converter infrastructure.

Maybe you would be willing to help in this effort?

...
  The tricky part is avoiding falling into the same trap our predecessors
  fell into. OpenEHR's emphasis on creating common archetypes suggest it
  may fall into that exact same trap.

 Which trap was that?

Focusing on forming political structures to build and promote common
archetypes/terminology rather than constructing translator/converter
tools.

...
  To the extent that OpenEHR does not provide a translation facility, it
  will be rather hard for humans to create their own unique archetypes and
  make full use of them.

 Sorry, you've lost me there - what does a translation have to do with
 the ability to create archetypes?

Lack of translation tools leads to significant *disincentives* of
organized medicine to permit individual physicians the option of creating
their own archetypes.

...
 do you mean that everyone should have their own definitions of data
 items?

Not that they should - but that they can.

 With translators between them? Instead of shared definitions?

Yes. Without a translator infrastructure in place, shared definitions
(=restrictive terminiology) will be the only remaining option.

   Pretty soon, some will argue (effectively) that the
  solution to mutually incompatible OpenEHR archetypes will be to agree on a
  standard set of archetypes to use.

 I think the idea is to try to avoid the stage of mutually incompatible
 archetypes as far as possible, and skip straight to agreeing on a
 standard set of archetypes.

Such thinking leads us straight back to SNOMED, HL7, etc. Note that
mutually incompatible archetypes need not come from human error -
instead, they can also be caused by lack of translators! :-)

...
 Information system standards reflect existing constraints, not cause
 them.

By not providing an infrastructure to support translators, information
systems such as the one proposed by OpenEHR will be far more restrictive
and less semantically descriptive than free text. Organizations that
choose to adopt such systems will likely place new restrictions on their
physicians' ability to communicate.

...
  The question is _who_ should be allowed to describe medicine to
  computers? Should it be the priesthood of software engineers? The
  priesthood of elitist medical experts? Or any willing physician?

 That's a good question, and no-one is sure of the answer yet.

That is not so. Through design-decisions that we make when we construct,
test, and deply these information systems, we give clear answers to this
set of questions.

 Certainly the priesthood model has often failed, or often been rather
 unsatisfactory.

Surprisingly, we often do not act like we learned anything from these
lessons.

...
   It is only possible to standardise those areas in which there is
   consensus or shared knowledge (or sometime shared belief). That's a lot
   of medicine, but not all of it.
 
  And who shall decide which fragment of knowledge to carve into stone?

cancer registry example, Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sat, 28 Dec 2003, Tim Churches wrote:
...
  For example, the Philippines national cancer registry can create a set
  of OIO forms - each form describes the initial presentation of a
  cancer case at the time of first diagnosis.
 
  In this example, the top level clinical concept is cancer case at the
  time of first diagnosis - which is modeled via an OIO form. For example,
  the Prostate Cancer Detected form, the Ovarian Cancer Detected form,
  etc.
 
  Within each OIO form, there will be multiple concepts (=Question Items)
  that serve to describe each reported cancer case.

 Cancer registries are something I know a bit about, having worked in one
 for a while. So how would OIO handle a cancer registration system?

 The basic model for a population-based cancer registry is as follows:
 Each person in the (usually geographically-defined) target population
 may have zero or more cases of cancer. A person is defined by their
 demographic details, (name, DOB, sex, address etc) and some of these
 details may change over time, and these changes need to be recorded.

Tim,

OIO's patient ID module maintains identifiers that uniquely identify each
person. Additional demographic attributes (e.g. sex, address) can be
recorded in a Demographics form.

 A case of cancer is distinguished by time of diagnosis, tissue of origin
 (topology) and histology (morphology).

If these attributes are the same across all cancer types under study, then
it may be reasonable to record them on the same form (and apply that one
form to all cases being reported).

 There are some additional rules relating to metachronous tumours in
 paired organs or the same organ (cancer of the left kidney in 1982, and
 of the right kidney in 1989, or multiple colon cancers appearing over
 tyhe course of a decade).

For attributes that are unique to some cancer types, these should appear
on specific forms that only apply to the reporting of those particular
cancers.

 For each case of cancer, there are zero or more of each of the
 following: histology reports, treatments, hospital admissions, and
 various other details, and zero or one date and cause of death.

Each of these should be a form: for example, a form for recording
histology results, treatment (perhaps a form for each treatment type -
radiation, chemotherapy, surgery, etc), hospital admission, and death.

 Andrew, perhaps you could sketch out a word picture of how that would be
 handled in OIO, for our education? Or even a rough sketch of an
 implementation in OIO?

As above, please let me know if you like clarification for any of these.

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: hub, spoke, new Esperanto for healthcare, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sun, 28 Dec 2003, Thomas Beale wrote:
...
 Those who paint converters as evil are likely responsible for
 standardization failures of our past. Any information system that does
 not fully support converters cannot provide extensible semantics
 support.
 
 well, I don't think that's true - consider the 'information system'
 represented by a set of class texts in some library; for these to
 interoperate with the class texts of another programmer, there are
 various possibilities:
 - programmers A and B can collaborate to produce new or changed classes
 which work for both of them

Thomas,

In this context, collaborate is a out-of-band translation effort.

 - programmer B can inherit from a class of programmer A

Inherit is a special form of A-to-B translator.

 - programmer B can use a class of programmer A (i.e. use its interface)

This is re-use, not extension. Also, programmer B's ability to locate and
retrieve A's class also requires translation (of B's intention mapping to
A's published description).

 - the  system built by programmer B, having no prior knowledge of the
 system built by programmer A, might try to talk to it and use a dynamic
 invocation interface to ask it what its operations are and then try and
 make sense of them and call them

 I suggest that converters are analogous to the last category here; the
 first three categories represent some kind of a priori collaboration.

If you insist, you can call them a priori collaboration but they should
be modeled as translators if we wish to eventually automate much of it
in-the-band.

...
 As I pointed out repeately, a constraint language is not sufficient. We
 also need a translation infrastructure. This is exactly why OpenEHR, in
 its current form, is inadequate.
 
 
 as I have pointed out a number of times in the past, there is room for
 'translation' of data via archetypes; all I have said is that it is not
 the front line approach in achieving interoperability.

I differ in this assessment. Interoperability through re-use of OIO forms
or OpenEHR archetypes is trivial. Our research and development focus will
be on translation services.

 it would be interesting to see:
 - the constraint language definition that you propose

This is the forms-metamodel, for example.

 - a description of the translation tools

1) Pick 2 forms, 2) define mapping between question items, 3) define
re-coding/transform functions, if any.

 - the OIO equivalent of a systemic arterial blood pressure
 measurement, an Apgar result, a glucse tolerance test result, a
 psychiatric note, 

These are all single data items. They will just be Question items on
OIO forms. For example (blood pressure),

form
item
  namesBP/name
  descriptionsystemic arterial blood pressure, supine/description
  promptsBP?/prompt
  itemtypepressure/itemtype
/item
itemtype
  namepressure/name
  descriptionmmHg/description
  actionnumber/action
  choice/choice
/itemtype

/form

...
 A classic case of blaming human users for inadequate information
 systems!!!  Now, let's whip the human end-users into submission so that
 they won't dare question the wisedom of the perfect machines :-).
 
 
 Getting out of the sea of incompatible data means some kind of
 cooperation.

Cooperation is one thing. Having no other option (to agree to disagree and
then use translators) is quite another thing.

...
 Sure it does. What if computer software can create these data converters
 without human intervention?
 
 if that's true, then you in fact have some kind of systematically
 computable compatibility between forms, and they are not in fact
 completely independently created.

Appearance of intelligence comes from the ability to discover non-obivous
relationships between concepts :-).

Completely independently created does not necessarily mean zero
computable compatibility.

...
 Can you show how you came to these conclusions?

  1) OpenEHR lacks a fully functional, open-source implementation
  -- No code to download.

  2) OpenEHR has no translation facility (and no recognition that a
 translation infrastructure is central to its professed future-proof
 goal)
  -- Per OpenEHR design documents and recent discussion

  3) Target audience is not any willing physician - thus it is not capable
 of supporting a grass-roots build-out.
  -- No end-user tools that support deployable archetypes/templates for
  data collection and reporting

  4) Overly complex archetype model - unnecessarily hard to understand,
 needlessly difficult to implement
  -- why archetype model cannot be simpler is unclear
  -- archetype model did not come from incremental development based on
  real implementation experiences (that drove incrementally
  complex model)
  -- use of much jargon in documents that describe OpenEHR archetype
  model. If it is easier to understand, it may be easier to
  implement.


 Perhaps we should publish a comparative analysis of a very simple

Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sun, 28 Dec 2003, Thomas Beale wrote:
...
 Within each OIO form, there will be multiple concepts (=Question Items)
 that serve to describe each reported cancer case.
 
 I'd like to see examples of these forms - can you provide a URL?

Thomas,

The cancer forms are just examples for this discussion. They have not been
made yet. However, you can see example forms at:
  http://www.txoutcome.org/scripts/zope/newuser/signup/forms_gallery
In particular, the University of Pacific Health History form (and
translations) were made by Mark Preston and myself using OIO, based on
http://www.dental.uop.edu/DentalPro/Health_History_Forms/default.htm

...
 Contextual information on forms include
 1) the fact that the data items appear on the same form
 2) proximity of data items to each other on the form
 3) sequence of appearance
 4) inter-item dependency, if any
...
 I think all the items you point to are important - to gui design;
...

Also important for semantic interchange - which I guess you don't agree
with ?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sat, 28 Dec 2003, Tim Churches wrote:
...
  the Prostate Cancer Detected form, the Ovarian Cancer Detected form,
  etc.
  
  Within each OIO form, there will be multiple concepts (=Question Items)
  that serve to describe each reported cancer case.

 Hold on... Andrew, you are suggesting that there should be a separate
 form for each type of cancer?

Tim,
  If you wish to describe each type of cancer by different set of question
items, then yes - you should have separate/distinct forms for each.

 So in OIO data for each type of cancer is stored in a separate table?

  Could be - if that's what you want. On the other hand, maybe you can get
away with describing all possible cancer case using the same form? Or, you
can have a first form that contains common questions (across all cancer
types). Then, a special form for each cancer that contains all the
cancer-type-specific questions.

 Say there are 50 types of cancer of interest (that's an underestimate).
 So to create a frequency distribution of type of cancer, I need to write
 a query which visits 50 tables?

  Not at all, OIO's reporting module can do that for you.

 Sure it would be better to record type of cancer as an attribute on a
 single cancer Case form,

Yes, you can do that too. It all depends on your particular clinical
or research needs.

 and then record the particularities of each case on separate,
 specialised forms for prostate cancer, ovarian cancer etc.

Yes, that's probably how I would do it too.

 It is just that I can't see how one would do that using OIO.

1) Just select a patient, select a form, and fill it out.

Or

2) define a workflow that contains fillout first form,
branch-on-condition, then fillout second form (selected based on answer to
cancer-type question on the first form). There is a screeshot with example
of this type of workflow here:
http://www.zope.org/Members/aho/Open_Infrastructure_for_Outcomes/OIO-1.0.0%20released

There is actually a demo workflow on the LiveOIO CD that does this.
Download from http://sourceforge.net/project/showfiles.php?group_id=9295

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sun, 28 Dec 2003, Thomas Beale wrote:
...
 exactly - this is the problem of N^2 translation that HL7v2 has. I was
 just saying that Andrew's statement that HL7 has failed is not totally
 correct;

Thomas,
  Rather than arguing whether or not HL7 failed completely or partially,
I think it is much more useful to discuss what lessons were learned. The
fact that we may have learned different lessons has serious implications
regarding our plans for OpenEHR and OIO.
  If I understand you correctly, you learned that reducing the reliance on
translators is the key to success - and you hope to achieve that through
a robust archetype authoring and standardization infrastructure.
  For me, I learned that developing a robust infrastructure for the
production and re-use of translators is essential - since re-use of OIO
forms is already a no-brainer.

 and regardless of the shortcomings (of which I can be as critical as
 anyone else), there are quite a lot of implementations, and there is a
 measure of success. It's been a step on the path, and a lot of things
 were learned.

Is the new HL7 going to offer a translation infrastructure?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Lessons from HL7, was Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Sun, 28 Dec 2003, Horst Herb wrote:
...
 A lot has been learned, yes. But Andrew's statement - if we only look at
 what is actually available AND in use today - is correct: HL7 has been
 en exteremly expensive failure so far. A failure for more than a decade,
 that is.

Horst,

The questions are :

1) How will the new HL7 differ from the old HL7?
2) How will OpenEHR and OIO be different from the old and new HL7?

...
 - but in one aspect they haven't learned from their past errors, and I
 consider this non-learning a gloomy sign: that is, they don't publish
 their work freely.

I suspect the new HL7 does not consider non-free to be the cause of
previous HL7 failure(s). Based on the focus of their new work, it appears
they must have concluded that their failure(s) came from an insufficiently
comprehensive reference model. :-)

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: OpenEHR vs. OIO semantics infrastructure, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

2003-12-23 Thread Andrew Ho

On Wed, 24 Dec 2003, Thomas Beale wrote:
...
   1) Are archetypes versioned?
  How does OpenEHR support old data when achetype is changed?
 
 yes, they are versioned.
 There is a formal definition of the various flavours of changes to
 archetypes you can make - here is a rough version:

 - versions - fix an error in an existing archetype; this implies the
 data created via a previous versions is slightly wrong, and a new
 version always have to suply a conversion algorithm to deal with it.

This is how you manage addition, changes, and deletions of attributes,
correct?

Can OpenEHR Templates, for example, continue to use the older version?
Meaning, can multiple archetype versions co-exist at a given point in
time?

 - specialisations - further specialise an existing archetype; only
 narrower constraints are allowed, guaranteeing that the parent archetype
 can deal with data created by the new specialised version

Do you mean the addition of an attribute?
With specialization, the parent archetype is retained, correct?

 - revisions - make changes which do not have any effect on existing
 data, e.g. add a new language translation of all the terms

ok, but adding an attribute falls under specialization, not revision?

...
 the workflow to do with a PAP or vaccication recall is qualitatively
 different from the workflow to do with discharge referral and other
 events where the patient gets sent around the health system to other
 providers (and usually back as well).

How so? I think they can be all be modeled using the same workflows
metamodel.

...
 When I say that archetypes are globally defined, I mean that they are a
 priori designed as globally, or widely (maybe nationally, or across an
 entire specialty or disease category) usable,

Same as OIO forms.

 and carry a conceptual definition that can be widely agreed to,

Same as OIO forms.

 even though the concrete screen and data realisations in particular
 systems will be quite different.

Same as OIO forms.

 What if you use different archetypes across these exams to represent
 blood pressure?
...
 If two parties want to use different archetypes for Systemic arterial
 blood pressure measurement but still share data, then there will
 clearly be some conversion /translation to do on the data - that can't
 be avoided.

Right, that's what I tried to convey.

...
 A few _classic semantic representation problems_ come to mind:
 1) What if I add 4th sound and another end-user independently also adds
 4th sound - and we describe 4th sound differently?
 
 if they both map it to a relevant UMLS, snomed or Loinc term - they will
 more or less be obliged to choose the same term from these
 terminologies.

Does OpenEHR require the use of terms the come from one of those
terminologies?

 2) What if I add 4th sound and another end-user independently adds
 extra sound to describe the same observation?
 
 It depends on whether you are talking about independent modifiers in
 different countries, or two clinicians in the same provider
 organisation. The key thing to remember is that the lifecycle of an
 archetype is not simply - modify and start using in the production
 system - there has to be plannnig, review, approval before it can be
 injected into the system;

Why not shorten the cycle and just inject it into the system. Then, later
build translators if they are needed?

...
 *With flexibility to create new terms (=OpenEHR archetypes/OIO forms)
 comes need for translation between terms.* Do you disagree?
 
 
 do you mean terms as in Snomed terms or the like?

Kind of, I mean the creation of OpenEHR archetypes or OIO forms is
basically creation of terms. A form-to-form translator is equivalent to
defining relationships between terms.

...
 not so they can then go and invent unrelated ones to do the same job.
 
 Perhaps this is a fundamental difference between OpenEHR and OIO:
 
 I am of the opinion that end-users *can* and *must be allowed to* go and
 invent whatever forms/archetypes they wish even if you or any so-called
 experts believe we already have forms that do exactly the same job.
 
 This freedom of expression is a core aspect of OIO.
 
 well, I'd say it is a core aspect of a pluralist society. OpenEHR works
 within such a framework, its just that it is trying to find ways to make
 collaboration easier and minimse replication of work.

How does OpenEHR make collaboration easier and minimize replication of
work?

 OpenEHR is certainly not going to stop anyone from using all the
 software and creating an entire mountain of unrelated incompatible
 archetypes to use in their institution. Good luck to them I say;-).

I think we can and should do more than wishing them good luck! This is
because that's how people work - we know that, there is no doubt humans
will build a tower of Babel yet again. :-) We need to fit the tool to the
people and not the other way around.

Thus, I think *supporting interchange* of data between different OpenEHR
archetypes and OIO

Re: OpenEHR implementation, Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

2003-12-23 Thread Andrew Ho

On Wed, 24 Dec 2003, Thomas Beale wrote:
...
 I don't think so - they're a normal commercial enterprise; as far as I
 know they aren't going to do any OS yet, although they do know what it
 is. See http://www.systematic.dk/uk/welcome. They created something like
 an archetype system independently of our work and then read about
 openEHR 2 years into their development.

Thomas,
  I cannot find anything except a very brief overview at
http://www.systematic.dk/UK/Products/Columna+-+EPR/Columna+Open+Architecture/

...
 You mean it is not going to be a full system that we can use to collect
 and manage data?
 
 no, not tomorrow, I don't quite have the spare $5m resources to do that
 and give it away, sorry, but it might be the following month;-).

We can always implement a full OpenEHR via OIO. I won't charge you $5m and
it might even be ready by the following month. :-)

(And I will even help you give it away.)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: hub, spoke, new Esperanto for healthcare, was Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

2003-12-23 Thread Andrew Ho

On Wed, 24 Dec 2003, Horst Herb wrote:

 On Wed, 24 Dec 2003 12:32, Andrew Ho wrote:
  3) My proposal is to build hubs from the bottom-up - based on OIO forms
     that are in-use. Analagous to building a dictionary - opposite from
     building an universal language. Let's learn something from
     the failure of Esperanto,

 A MAJOR point, and I see this failure happening all over again and again, be
 it in the domain of coding (where countless professionals have been mucking
 around for decades in the quest for the ultimate coding system instead of
 settling for a thesaurus like growing dictionary of terms) or in the domain
 of health record architectures

Horst,

Well said :-).

 I'd wish we would settle for small independent modules all communicating via
 *simple* protocols (like XML-RPC via HTTPS or Jabber), using self-growing
 terminology dictionaries.

DrugRef.Org, FreeB, and ZSVG_Graph have already started this process. We
don't need to settle anything - just keep building these modules.

If they are easy to connect to, many systems will connect to them.

 I don't believe we need a monolithic architecture. All we need is well
 defined APIs to extract and submit data.

Again, I am opposed to wasting time discussing what is or is not a
well-defined API. Put forth a proposal via OpenHealth if you like, build
it, and maybe your colleagues will eventually try it and give feedback.
(Or just use it quietly).

By the way, I have been able to communicate with DrugRef.Org via XML-RPC
in Zope without issue. Great work! Look for it in a future release of OIO
:-).

...

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

VistA.OIO, was Re: How VistA inspired OIO, RE: Vista on the BBC News Web-site

On Mon, 22 Dec 2003, Jim Self wrote:
...
 People who are familiar with MUMPS and VistA and also familiar with web
 technologies are in very short supply.

Jim,
  Thanks to the OpenHealth List, we found you :-).

...
   1) 100% reverse-engineer VistA in OIO:
 look at VistA, re-implement forms and workflows in OIO
 package LiveVistA.OIO on a single CD
   2) parallel systems with gateway-software:
 single CD (or DVD :-) that installs both VistA and OIO
 OIO's reports module can pull data over from VistA
 OIO forms can map to VistA data (both input and output)
 VistA can retrieve OIO data
 OIO's workflows can activate VistA modules/screens
   3) implement OIO in VistA
 VistA can create/use OIO forms, workflows, etc
 VistA can output OIO forms, workflows, etc
 VistA's new OIO module integrates with existing VistA modules
...
 I do not consider myself a VistA expert.

We will learn together.

...
 At one time I was expert in the internals of Fileman (a central
 component of the VistA kernal).

Perfect.

...
 I have made a start on exposing Fileman defined data to the web that
 could help with both #1 and #2 above included in the VistA distribution.

Jim, could you set up a test/demo/development server that is open to the
web? That might get us started fastest since VistA install remains
non-trivial (=scares me).

I can provide a dedicated server + Internet connection if that will help
you (you can remote-administer it, I will poke-around and try to figure
out how to package it via Knoppix) ? I will install OIO on it too.

I can also setup a new mailing list to track this effort - maybe
[EMAIL PROTECTED] ?

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Worldvista installation.

On Mon, 22 Dec 2003, Richard D Piper wrote:
...
 Has anyone installed the opensource version of Vista
 (http://sourceforge.net/projects/worldvista/). I guess this would be the
 best way to become familiar with it.

Try:
  A HowTo written by Todd Smith in April 2002 -
  http://www.linuxmednews.com/linuxmednews/1018974735/index_html
  The is the best step-by-step install guide for VistA that I have seen.

In January 2003, Tim Churches said he did it in 1 hour following these
steps and he got a nice M command prompt after he was done:
 http://www.mail-archive.com/[EMAIL PROTECTED]/msg07411.html

Definitely not web-enabled yet.

I'll be very interested to know if you find better install documentation
for VistA than these (especially describing steps after reaching the M
command prompt).

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: form-to-form translator, was Re: Solving the data type problem, was: ODB vs. RDMBS was: OIO-0.9.1 released

On Mon, 22 Dec 2003, Thomas Beale wrote:
...
 In an openEHR system, BPs are captured as Observations, which are a
...
 described by the archetype for BP measurement, which I have reproduced
 below

Thomas,
  As we previously discussed in February 2003:
http://www.mail-archive.com/[EMAIL PROTECTED]/msg07983.html
like OIO, OpenEHR also allows ad hoc definition of new archetypes.

Therefore, I believe OpenEHR will still require archetype-to-archetype
translators - despite the much more complex structure for describing
archetypes (compared to OIO forms).

 And yet - this still can be treated as quite simple data in the EHR, and
 it can be queried in the same way, regardless of whether it was part of
 a neonatal exam, general exam, or whatever else.

This is the same as saying if you use the _same OIO form_ to record a
neotatal exam, general exam, etc, your reporting application will be able
to understand the semantic content without an additional translation
step.

If you use the same archetype across all these exams, that is.

What if you use different archetypes across these exams to represent
blood pressure?

Now, maybe OpenEHR says no, end-users cannot be allowed to use the wrong
archetype to represent the same/similar/related semantic content. Well,
then how do you propose to detect/enforce/prevent that? (I don't think you
can without entirely eliminating ad hoc archetype authorship.)

So, in the end, the more complex archetype description language developed
by OpenEHR does not eliminate the need for archetype-to-archetype
translators, which is what I explained on Feb 10, 2003 during a discussion
with Helma van der Linden:
 http://www.mail-archive.com/[EMAIL PROTECTED]/msg07879.html

Consequently, maybe a minimalistic metamodel for forms (=archetypes) + a
robust translation facility will be adequate (and much simpler). That's
what we hope to find out via OIO's new translator module (thanks to
Horst's help, it should become part of OIO-1.0.8 to be released in the
next few weeks.)

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Use of public key fingerprint, was Re: Alternatives to PKI for the transmission of health information over the Internet.

On Mon, 22 Dec 2003, Wayne Wilson wrote:
...
 :) How many of you have noted the pgp signature aspect of my messages
 and my information note below and been able to do anything with it?
 --
 Wayne Wilson
 An attachment containing my pgp-signature is included.
 My public key fingerprint is:
 9325 05AD 866B BCCB 45BF  E86A 63E1 C6ED 4130 5461
 My public key can be downloaded from wwwkeys.us.pgp.net

Wayne,

I used your public key fingerprint as search string for Google. Google
retrieved a list of your messages posted to the OpenHealth List. (No
false positive hit.)

From this, I can track your publication history at various publicly
archived mailing lists (did not find anything outside OpenHealth List).

Best regards,

Andrew
---
Andrew P. Ho, M.D.
OIO: Open Infrastructure for Outcomes
www.TxOutcome.Org

Re: Use of public key fingerprint, was Re: Alternatives to PKI for the transmission of health information over the Internet.