Hi, Very true Mikael.
Linking archetypes to terminology is important - especially for standardised querying I believe. But in my opinion linking archetypes to terminology is not sufficient for semantic interoperability between systems. For semantic interoperability you need to have either the systems using the same (or more specialised/general) archetypes or conversion rules between these archetypes. Obviously it is best to have a set of archetypes available that can be used and specialised as needed in various systems, rather than every implementation starting from scratch with new archetypes. Also not every item in an archetype will relate 1:1 to terminology. This needs some governance processes to ensure that these archetypes: - do not have significant concept overlaps (e.g. different archetypes for nursing and for medicine for essentially the same concept - just from a different viewpoint). - are easily accessible (e.g. on an internet server) and easily locatable, i.e. organised in a way that a certain archetype can be retrieved with high recall and precision from all archetypes. - are evidence-based whenever possible and agreed to by domain experts (doctors, nurses...) - need to be maintained and systematically updated when knowledge changes. 2-level-modelling/archetypes ensure that data are _syntactically_ interoperable (i.e. structure and provenance can be understood - this is ensured by the reference model) and semantically _interpretable_ (i.e. the semantics is explicit and can be understood and analysed by domain experts - this is ensured by archetypes themselves). However, archetypes on their own do not ensure semantically interoperable systems (i.e. archetypes alone do not guarantee that different EHR systems and vendors will construct equivalent EHR extracts, and use the record hierarchy and terminology in consistent ways, etc.). In Australia for example a set of archetypes to support shared care of patients with chronic disease has been developed for Australia's General Practice Computing Group influenced by intensive discussion of a broad variety of domain experts (GPs, specialists, nurses, etc.) - see http://www.gpcg.org.au/index.php?option=com_content&task=view&id=42&Itemid=54. To support these discussions and make archetypes available, a protoype archetype repository (Archetypefinder, http://www.dualitysystems.com.au/archetypefinder) has been developed and is being expanded. Regards Sebastian Dr Sebastian Garde Faculty of Business and Informatics Central Queensland University Rockhampton Qld 4702, Australia s.garde at cqu.edu.au Ph: +61 (0)7 4930 6542 Fax: +61 (0)7 4930 9729 Skype: gardeseb http://healthinformatics.cqu.edu.au -----Original Message----- From: owner-openehr-technical at openehr.org [mailto:[email protected]] On Behalf Of Mikael Nystr?m Sent: Thursday, 9 February 2006 10:57 PM To: openehr-technical at openehr.org Cc: hakpe at imt.liu.se Subject: RE: dictionary Hi Philippe, >From my point of view is the lack of communicable structure between different >EHR systems the main problem openEHR's archetypes tries to solve. I think this is what Mattias tries to say with his letter. In general medical informatics is it of cause also a large need for medical terminology systems of good quality, but openEHR's archetypes don't try to solve this problem by themselves. Instead you are able to link your archetypes to the medical terminology systems of the flavor you prefer, like SNOMED CT, ICD-10, ICF, ICPC, NCSP or something built by yourself. (At least in Sweden there exist maybe too many "home built" medical terminology systems.) Regards, Mikael Nystr?m Mattias' and Johan's master thesis supervisor -----Original Message----- From: [email protected] [mailto:owner-openehr-technical at openehr.org] On Behalf Of Philippe AMELINE Sent: den 9 februari 2006 12:34 To: openehr-technical at openehr.org Subject: Re: dictionary Hi Mattias, The more I work on medical information systems, and the less I believe that the structure is more important than the terminology. To be a little bit more accurate, my opinion is that any health information system is there to "tell stories". I started in the domain 20 years ago with endoscopy reports : the story to tell was a 10 to 20 minutes medical act. Now, for many reasons (but it would be too long to explain it there), the "big thing" is continuity of care, and the challenge is to be able to tell someone's whole medical journey. So, how can we tell these stories (from a 10 minutes encounter to the whole life and the fighting strategies to remain as healthy as possible) ? The answer is rather simple (at least to express) : we need to make "sentences". And to make sentences requires a grammar (the discourse structure) and a vocabulary (to populate the discourse structure). Is it possible to have a discourse structure that can "host" any terminology ? My personal answer is 'no', but maybe I try to tell more complex stories than you intend, or maybe you have a more powerful technological solution. At large, I can ask you a question : do you think that you could communicate using the english grammar and let people choose any other language's vocabulary to populate it ? You can answer that natural language is more complex that formal language, but I can say that the more complex the story you intend to tell and the closer they need to be. Regards, Philippe > The important thing in openEHR archetypes is the structure of them. As > long as there is a structure that is equal for both "Weight" and > "Bodyweight", it shouldn't be a problem. The allowed information model > structures in archetypes is what really matters and the terms can > always be bound to external terminologies to create a mutual > understanding. > > Regards, > > Mattias Forss > > >
