Dear William,

You write:
> I believe it is very hard to accept the dogmatic approach of Gerard  
> Freriks once again :-(

My simple dictionary reads:
dogma |?d?gm?| |?d?gm?| |?d?gm?|
noun
a principle or set of principles laid down by an authority as  
incontrovertibly true : the Christian dogma of the Trinity | the  
rejection of political dogma.
ORIGIN mid 16th cent.: via late Latin from Greek dogma ?opinion,?  
from dokein ?seem good, think.?

By the way, I like the original old meaning of Dogma better.
When we can agree on  the modern meaning of Dogma, I will not object  
either:-)
You find it hard to accept that something is 'inconvertibly true', is  
the way I interpret your quoted sentence.
When you will choose to disagree with me then you must provide  
arguments and try to convert me and the readers.

My list of positions and arguments, open for debate and written or  
presented or discussed several times at various occasions, are:

Harmonisation: CEN and HL7
Harmonisation between CEN EN13606 EHRcom and HL7v2 is not taking place.
Harmonisation between CEN EN13606 plus its Archetypes and HL7v3  
message artefacts is not possible.
Harmonisation between CEN and HL7 on the level of Archetypes as  
performed by humans using the OpenEHR Archetype Editor Tool (and  
therefor EHRcom part 2) is possible. This is very much needed and  
taking place.
Harmonisation between CEN EN13606 EHRcom and HL7v3 work on the  
Clinical Statement might become possible and has to be proven. It  
depends on the way this HL7 Clinical statement is expressed; e.g.  
what Reference Model will be used.

CEN/tc251 EN13606 EHRcom and HL7v3 mappings
In general, mappings are possible, only, when both worlds share one  
or more meta-models that guide the transformation/mapping.
At the Archetype level, when archetypes are presented to humans, only  
humans are able to translate in the absence of a formal complete and  
accepted Ontology.
(This situation is what you write in your last sentence. Humans  
easily are able to translate clinical models expressed via HL7v3 to  
CEN Archetypes and vice versa)

At the level of Archetypes, as expressed by a formalism describing  
constraints on a Reference Model, transformation is possible when  
both Reference Models can be mapped.
Part 1 of the CEN/tc251 EN13606 is not the same model as the HL7v3  
RIM. A mapping between these two is not possible. They are certainly  
NOT the same.

Only a computational mapping might perhaps be possible with some  
effort between Archetypes on the basis of CEN/tc251 EN13606 part 1  
and a HL7 R-MIM expressing EN 13606 part 1. By the nature of the  
process these meta-models can be mapped, partially. Extra models are  
needed to deal with all possible mappings of structural HL7v3  
vocabularies and elements in the CEN Reference Model (part 1) and  
types of CEN archetypes (part 3)

Requirements based standards
CEN/tc251 EHRcom (and OpenEHR) is the only EHR related standard, I  
know, that is meticulously based on a well researched set of  
requirements for the EHR as published by ISO.

Proof of Concept: working software
CEN/tc251 EN13606 EHRcom is based on more than 15 years of research  
in Europe and Australia. Various Proof of Concept studies have been  
performed. The most recent one is OpenEHR, its open source   
specifications and published functional software. Plus the  
proprietary software produced by OceanInformatics from Australia  
based on CEN/tc251 EN13606 EHRcom and OpenEHR.

Scalability
Message paradigm versus the Archetype (Two Level Model Paradigm)
Any solution derived from the RIM and expressed as a message using  
the HL7v3 MDF method will NEVER scale. Since each vendor has to write  
specific software for each artefact and version of it. Each clinical  
domain will consist of many messages. There are many clinical domains.
Any solution based on the CEN/tc251 EN13606 is scalable by the fact  
that only one schema based on part 1 has to be implemented by the  
vendor, ever.
Any CEN archetype or set of archetypes assembled in a Template can be  
read, stored, retrieved, presented and exchanged without the need to  
write any software by the vendor. Therefor EN13606 and OpenEHR  
provide build-in scalability.

Decision support
Systems that are conformant to EN13606 EHRcom have as an additional  
feature that software providing decision support is able to query ALL  
the data stored since all data in conformant systems is presented  
using one uniform method without any extra programming. Plug-and-play  
decision support becomes possible.

Plug-and-play
CEN/tc251 EN13606 EHRcom makes real Plug-and-Play semantic  
interoperability possible.

Status
EN13606 EHRcom not only is becoming an European Standard and a  
National Standard in its Member States, but is on its way to become  
an International ISO standard as well.

Role of European standards
European standarisation is subject to various European Directives.
European standards play a specific role in legislation and  
procurement in all its Member States.
The European "Stand-still rule" ensures that in Europe conflicting  
standards are impossible.

Greetings,


Gerard

--  <private> --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

T: +31 252 544896
M: +31 653 108732



On 16-okt-2006, at 8:37, Williamtfgoossen at cs.com wrote:

> I believe it is very hard to accept the dogmatic approach of Gerard  
> Freriks once again :-(
>
> I thought we would have stopped, working on the implementable  
> harmonization artifacts. It has been proven to work with HL7 v3  
> messages.
>
> For clinical content it does not matter at all in which technical  
> formalism or spec it is operationalised. A clinical concept sorting  
> out takes 2 weeks, transforming from HL7 to Open EHR takes 15 minutes.
>
> William Goossen

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