I would like to congratulate the authors for the amount of effort they’ve put into this paper. It is rarely the case that someone looks at such an important aspect of implementing openEHR with such a level of commitment.
That being said, I think this study lacks a major aspect and it is probably going to become the “archetypes don’t work paper” for the sceptics quite soon even though the authors do not say that. The missing aspect of this paper is the overall context of model driven development in healthcare and how much openEHR improves on previous and current attempts to apply MDD to healthcare. If you did not know who Bill Gates is, and if you’d have seen him crying his eyes out on the street saying “I’ve just lost 99% of everything I have”, you’d surely feel sorry for a 60 year old who must be looking at a horrible fate ahead of him. Given the full context, in which his net worth is ~80 billion dollars, you’d hardly be likely to reach to your pockets for some change for a man who is left with only 800 million dollars of wealth. Without context, local minima becomes global minima, any failure becomes total failure. This study takes openEHR as the representative of MDD in healthcare and provides its observations, but it does not mention how, if any improvements are provided by openEHR over the alternatives. Sure, the authors can’t perform the same study and observe outcomes for all the other alternatives and they’re doing a study on openEHR, but I would expect at least a research question being raised as to whether other methods are subject to same issues or how they compare to archetype driven methodology. (very happy to be corrected if I missed this bit) I’ve been developing software for a living for 19 years now and I have seen my share of MDD applied to many problems. If you put the alternative, rather generic MDD approaches say, driven by UML, to use in this scenario, what would the results be? I’m going to dare suggest that the clinicians would have a much harder time figuring out how to express their requirements with UML notation. The paper also seems to assert that a claim of openEHR modelling being usable by every clinician is wrong or partially incorrect but I don’t think openEHR makes such a claim. You could replace all instances of openEHR in this paper and many sentences would read the same for SNOMED CT or HL7 CDA : clinicians and nurses would find developing snomed ct local extensions or ref sets hard, which is expressing clinical concepts using a domain specific language . I also find the repeated use of the same comment from Dips developer 2 as proof of blurred boundaries between clinical and technical aspects insufficient to make such a claim (sorry dear Dips developer 2 I hope I’m not causing you any trouble here) since the comment is brief and lacking depth. Despite its findings, the paper actually (ironically) proves that openEHR indeed puts the clinicians in the driver seat, but they just don’t know how to drive, because the technical implementation is good to go as soon as you come up with the models. Very few, if any other alternatives to openEHR can make that claim. A claim of separation of technical and domain concepts does not imply zero effort for expressing domain concepts . But the paper presents the learning curve and difficulty as proof of MDD in healthcare failing to deliver its promise. openEHR offers a lot of advantages in exchange for investing into clinicians. The idea that clinicians can and should learn how to express their requirements via methods and tools defined for them is the basis of all the great things one can do with computable health. This unusual investment compared to other approaches offers so much value down the line but it is usually trivialized or downright neglected which leads to issues outlined in this paper. At this point, one can see why Koray is pointing at the importance of having more clinical modellers around. Finally, I don’t understand the pains associated to reaching out to international community as described by the paper, simply because you can get help but you’re not forced to make use of it. I think this paper just shows that how important it is that governments and healthcare institutions should invest into educating clinical modellers. If the role and its key position for computable health is not recognized and supported as a speciality within the clinical practice, all benefits of openEHR and similar approaches will remain extremely underutilized. (The paper makes the statement that archetype development should be included as part of the effort) So I would like to conclude by saying that this paper asks the difficult question : “does this really work?” and it provides vital observations for which I’d like to congratulate the authors again. Just providing a bit of a context would make it a lot less amenable to misinterpration, but hopefully we’ll see more research in the future, giving us all a better view of where we are and where we are headed. Best regards Seref On Thu, Mar 10, 2016 at 6:58 AM, Bakke, Silje Ljosland < silje.ljosland.ba...@nasjonalikt.no> wrote: > Hi everyone! > > > > As some of you may have noticed, a paper called “Evaluating Model-Driven > Development for large-scale EHRs through the openEHR approach” ( > http://www.sciencedirect.com/science/article/pii/S1386505616300247) was > recently published by a PhD student at the University of Tromsø. The paper > has some pretty direct criticism of the ideal of wide clinical engagement > in widely reusable information models, as well as the clear division > between the clinical and the technical domain inherent in the openEHR > model. I think a lot of the observations detailed in the paper are probably > correct, for its limited scope (one Norwegian region and 4 years of > observation, half of which was done before the national governance was > established). We’ll probably use the paper as a learning point to improve > our national governance model, and I’d like to hear any international (and > domestic Norwegian for that matter) takes on the implications of the paper. > > > > Kind regards, > *Silje Ljosland Bakke* > > > > Information Architect, RN > > Coordinator, National Editorial Board for Archetypes > National ICT Norway > > Co-lead, Clinical Models Program > openEHR Foundation > > Tel. +47 40203298 > > Web: http://arketyper.no / Twitter: @arketyper_no > <https://twitter.com/arketyper_no> > > > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical@lists.openehr.org > > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org >
_______________________________________________ openEHR-clinical mailing list openEHR-clinical@lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
