Sam, I agree that a certain degree of convegence is desirable and inevitable and will evolve over time based on implementation experience, but what is the reference to smoke filled rooms about?
Liora At 09:37 AM 6/11/02 +0930, Sam Heard wrote: >Dear All > >There is no doubht that the solution will have a degree of complexity - just >look at HL7 v3 which is aimed at messaging. I believe that the HL7 and CEN >EHR approaches will align - and will include the level 3 CDA demands - >though it will take some time and must arise through implementation >experience. The time for smoked filled rooms and EHR standards is over for >us at openEHR and Ocean Infomatics. It is very helpful to have lots of >ideas, but unless people are working on an implementation it is almost >impossible to contribute in a major way. > >I have put the challenge to CEN to have some pilot implementations of >Clinical Applications to GEHR (using our current trial implementations) and >see what the implications are of our current approach. At least 2 European >companies are interested. > >I also believe that the EHR demands an information model designed >specifically for that purpose - the interoperability of EHRs. The fantacy >that sharing information based on different information models will be >straight forward is evolving - one only has to look at the difficulty of >sharing a word document amongst different software - it is often close. The >order of magnitude of complexity with health information is far greater. > >So let us address the difficulties of information models, of clinical models >in a two level approach and work to create an EHR that is genuinely >interoperable. It will take resources - but to have it working as a sharable >component will take 0.1% of about 3 countries health IT development budget >and 10 good minds. > >I think it is really starting to happen! > >Cheers, Sam >____________________________________________ >Dr Sam Heard >The Good Electronic Health Record >Ocean Informatics, openEHR >105 Rapid Creek Rd >Rapid Creek NT 0810 >Ph: +61 417 838 808 >sam.heard at flinders.edu.au >www.gehr.org >www.openEHR.org >__________________________________________ > > > > > > >Why the focus on HL7 only? CEN/TC251 has started work on the EN 13606 and > > is precisely what you want. HL7 version 3 and >CDA will be to unstable for > > some time to come. HL7 doesn't adopt the GEHR (CEN) two model approach. > > >Artifacts based on the present HL7 version 3 RIM will prove to be > > unimplementable as a system or object. > > > > We can be very encouraged that you may get together with HL7 on this. > > However you (or was it Gunnar Klein) did say in your ?Berlin CEN meeting > > 2002 presentation (the presentation has disappeared from the > > www.openehr.org. site) that EN 13606 had limited uptake because it was: > > > > a) incomplete or have offered only partial coverage of the healthcare > > domain; > > b) unnecessarily complex; > > c) too generic, leaving the various implementations too much > > variability in > > how the models are applied to a given domain; > > d) flawed, with some classes and attributes not implementable as > > published; > > e) requiring expensive re-engineering of systems; > > f) containing features not required by the > > purchasers of clinical systems. > > > > The time is evidently ripe for a synthesis. I agree about the > > importance of > > narrative: > > You said: > > > > >It is a narrative for personal usage. > > >When information is to be shared the author will select and rewrite parts > > >of his notes in order to meet a specific request by an other healthcare > > provider. > > >This is the way people work. This is the way healthcare > > providers know how > > > to work with using paper systems. > > > > Perhaps the record is a resource to make stories out of? The original > > 'syntagm' is just the first, and even that was an > > interpretation.The 'true' > > story is unknowable. > > > > > I can see that objective information (orders, test results) can > > be shared > > by > > > all without real problems. But people (good healthcare) will need > > subjective > > > narrative as recorded in their personal Medical Records. > > > > Free text remains indispensable, structured data is just the debris left > > behind - it's a point of view... > > > > Regards > > > > Mike Mair > > > > > > > > > > > > - > > If you have any questions about using this list, > > please send a message to d.lloyd at openehr.org > > > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
