Subject: Re: single model, was Re: Care2x classtree and archetypes and shared data models
Date: Fri, 27 Feb 2004 17:13:17 -0800 (PST)
From: Andrew Ho <[EMAIL PROTECTED]>
To: J Antas <[EMAIL PROTECTED]>
Andrew Ho wrote:
> Having a single model will certainly solve the inter-operability > problem. However, countless smart people and many millions of dollars > before us have not been able to achieve this solution.
Well, either it has no solution, or no single model has emerged yet that fits the medical data models in a satisfactory way.
J,
There are other possibilities, for example, maybe the solution requires more than one model.
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1.1. A HIS is a living organism. Some of us see it much like a symbiont,
Nice analogy. Most of currently available HIS do not behave like successful living organisms. Major "dead" attributes include 1) hard to adapt to change 2) hard to reproduce / disseminate ...
1.2. HIS do not diagnose, HIS do not treat people, HIS only produce information.
This view is too limiting. For example, many physicians already rely on software to tell them whether an EKG is normal.
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1.4.3. What we tend to forget to talk about, or fail to see as much enthusiasm about, is the fitness or well being of the living part of the HIS "animal", i.e., the healthcare institution people.
This is because most software systems are difficult or impossible to "fit" to the actual needs of the healthcare providers. This is the major motivation behind the OIO project - which attempts to bring "easy fitting" as the main feature of the software.
1.5 Some of us see these as fundamental reasons to the failure of more than 80% of all health IT projects. Could it be because they are not "plu&play" things? Could it be because they are living organisms that must strugle to adapt to new environments?
I agree completely. What I like to know is how Care2x addresses this problem?
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2.2. But, as I do not know better, I am involved in the research and making of the software part of the HIS organism. And in my "caveman" I see the software part of a HIS as simple thing, having 3 simple components: a. Clinical, b. Administrative & Operational c. Financial
ok, in OIO, we use a. patients b. forms c. schedules d. workflows e. reports
We build clinical, financial, and administrative functions using these components.
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3.1. So, at this time I only aim at giving those people the most adequate and robust tools that I can find. As a caveman I am not yet worried about good information models or knowledge theory vanguardist solutions.
"Worried" is the wrong concept. I think it is worthwhile comparing notes with other people's information models. Caveman becomes a more effective caveman when he learns how to build fire from another caveman.
I am just seeking simple, fast, reliable, secure and sheer user friendly tools to help people that work at the HIS organism.
I agree, and Care2x has more-or-less achieved this for many hospitals. What's next? How will Care2x fit into other hospitals? What about clinics?
3.2 As I do not know any better method to improve knowledge, I do trust the scientific method to produce these tools, i.e., the software part of this HIS organism. That's why I favor the open source approach as to me it is simply the scientific methodology applied to the making of software.
I agree, that's why we are having this conversation. :-)
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5. Now enter Care2x, the "web based", "standards based", all open source, "everybody-knows-how-to-contribute-to-it" approach.
How will Care2x handle local variations / customizations? When those data model changes are sent back to the Care2x Team, how will you decide what to keep in the official distribution and what to reject?
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Has it a good conceptual model?
J, I think it has an excellent data model. That is not the criticism. Instead, the issue is how can a single data model be excellent for every hospital and every living, breathing group of healthcare workers?
Well, here we diverge. It certainly does not have the most accurate medical data representation model.
Accuracy is never the issue. The biggest issue, when it comes to living, breathing, symbiotic software (from my biased perspective), is change management / adaptability.
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6. And, most important... Care2x code works, or should I say... it lives.
It lives but how easy can it grow, learn, and change?
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Is there anything wrong to be willing to try someone else clever ideas, which I am sure that we all agree to exist in approaches like GNUMed, OIO or Care2x?
I think that's why it is so wonderful to have you join us on the OpenHealth List! Now, we can have conversations and debate ideas. :-)
Isn�t that what we all do at our hospitals when we try some clever new aproach that we found in the newest literature?
Exactly - only this is even better: 1) We don't have wait a whole month or longer to get the next issue. It is near-instant publication. 2) We can review the entire work (via fully functional source code), instead of just a description of it. 3) We have many experts who are willing to peer-review our writing and software products. 4) Full-text searching of List archives via Google!
Best regards,
Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
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