Dear William, My answer is:
The moment clinical concepts as defined by groups of clinicians are proprietary it will be impossible to have any conversation. The moment clinical concepts as defined by groups of clinicians using archetypes it will be impossible to have any semantic interoperability between computer systems. Proprietary archetypes used in computer systems are the same as words for concepts used in daily life in discussions between persons. Since the EHR is about documenting by a healthcare provider in ones own words what has happened, they must be able to use all concepts and words, that express them, used in normal speech. You refer to machine computer system interfaces and that these might be proprietary. Yes they could and will. But when the holy grail is about plug-and-play interoperability then these interfaces (archetypes) must be free to use. In my mind users must pay for the use of the machine and demand completely open system interfaces. Information (entered, stored, retrieved and exchanged) must be freed from any influence by the IT industry. Information must be owned and controlled by the users. Information must never be expressed as code in software. Information must never be exchanged in proprietary ways. Without this, generic semantic interoperability between computer systems never will be possible. Gerard -- <private> -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 On 2-mei-2006, at 12:59, Williamtfgoossen at cs.com wrote: > In een bericht met de datum 8-1-2006 21:31:57 West-Europa > (standaardtijd), schrijft gfrer at luna.nl: > > >> Information is exchanged in communities.All clinical information >> belongs to the healthcare domain. >> >> >> When clinical concept models (Archetypes) are expressed using an >> Open International Standard like the CEN/tc251 Archetypes, >> both the Archetype expression and the constituting clinical >> concept models are not owned in a commercial sense. >> >> >> Gerard > > > > Sorry to be late in response, but this comment is only partly true. > After having made about 150 archetypes for use in HL7 v3 messages > (technical transition being no issue at all, clinical material is), > we have encountered several issues. > > Not all clinical information belongs to the healthcare domain. Many > instruments and scales are copyrighted and require a licencing fee. > Use in EHR or message is in that case no different from paper > versions or dedicated software. This is similar to use of vocab > which is or is not copyrighted. > > Use of CEN / ISO or OpenEHR does not solve this issue, neither does > HL7: the clinical content can be owned in commercial sense. > > It is stil questionable if the model representation of such > clinical information e.g. in a HL7 message model, or a CEN / > OpenEHR archetype format is not a breach of copyright regulations. > > Same with terminology: we bind variables and values to > terminologies: leaving the decision to the clinician which to use, > but to make sure that each element has at least one unique code > that is maintained and governed over the centuries. > > I do agree that once the source material copyrights are sorted out, > then the representation in models and storage of clinical data for > a patient, or aggregations to group level data from this can be > handled open source like, but then we have the consent issue of the > patient to exchange information, or to re-use clinical information > for managerial or policy reasons. > > > Sincerely yours, > > Dr. William T.F. Goossen > > Senior Researcher and Consultant Health and Nursing Informatics > Acquest Research, Development and Consulting, Koudekerk aan den > Rijn, the Netherlands > http://www.acquest.nl/ > & > Adjunct Associate Professor in the College of Nursing, faculty in > the Organizations, Systems and Community Health Area of Study, the > University of IOWA, Iowa City, Iowa, USA. > http://www.nursing.uiowa.edu/facstaff/adjunct.htm > & > Co-chair Patient Care Technical Commission, Health Level Seven, Ann > Arbor, MI, USA. > http://www.hl7.org > & > Country Representative for the Netherlands in the Special Interest > Group Nursing Informatics, IMIA. > http://www.infocom.cqu.edu.au/imia-ni/ > & > Member Evaluation Committee International Classification for > Nursing Practice, Geneva, ICN. > International Council of Nurses http://www.icn.ch/ and http:// > www.icn.ch/icnp.htm > & > Associate Professor, Adjunct on the faculty of the School of Nursing, > University of Colorado Health Sciences Center, Denver, USA. > http://www2.uchsc.edu/son/sonweb.asp > & > Bestuurslid Vereniging voor Medische en Biologische > Informatieverwerking > http://www.vmbi.nl/ > & > Teacher in health and nursing informatics, MBA Health Management > University of Applied Sciences, Osnabr?ck, Germany. > http://www.wiso.fh-osnabrueck.de/aktuelle-lehre.html > & > Fellow of the Centre for Health Informatics Research and > Development (CHIRAD), School of Social Sciences, Kings Alfred's, > Winchester, UK. > MailScanner has detected a possible fraud attempt from > "www.chirad.org.uk" claiming to be www.chirad.org.uk -------------- next part -------------- An HTML attachment was scrubbed... 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