Dear Gerard, Thank you very much for bringing up the point of religious fanatism in relation to standards development and application.
It is a word from my hearth in this ongoing debate with you. :-) I want to analyse both standards (13606/OpenEHR and HL7 v3), look at each strenght and weakness and make sure that we achieve semantic interoperability in an intelligent way, by applying scientifically derived methods, evaluating approaches and results, and harmonize the work on standards. Work that I have been supporting and carrying out for quite some time now. Nice that you point to my PhD, if you have read my about 40 papers that appear in Medline and the more than 100 that do not appear in Medline, you would have known that I take the scientific approach where possible and where methods are available, or when it is a position statement paper, that I analyse the raw material in a way that allows scientific debate and discussion. As you will be aware I am the last person to accept dogmatic positions, especially in the world of standards, see the ongoing discussion on terminologies in the Netherlands where I analyse and test them for purpose. I would like to point at the evaluation of three terminologies relevant for the Netherlands applying the CEN Nursys (now ISO standard 18104), which has been reported to CEN and ISO. Similarly, I appreciate your valuable contributions at the medical informatics conferences of this decade. In this respect I see valuable work ongoing in both the OpenEHR and CEN 13606 environment and in the HL7 v3 environment. Despite the work on 13606 / OpenEHR, the first feasible method to express clinical content in a consistent and machine operable manner proved for us the HL7 v3 approach, following the USAM work underpinning it. You cannot deny this, we have been working together on trying to get this working with OpenEHR tools in this period and failed at that time, also because there was no funding available. Thus, in 2002 when the Dutch projects started (see: Goossen WTF, Jonker M, Kabbes BL (2002). Electronic Patient Records: Dutch Domain Information Model Perinatology. In Surj?n G, Engelbrecht R, McNair P (Eds.) Health Data in the Information Society. Proceedings of Medical Informatics Europe 2002. Amsterdam (etc.) IOS Press, 366-370.), there was no other option available. Since then many things go easier, better, the specifics have been modeled out in favour of a less clinical specific domain model towards one that is reusable in other domains (see: Goossen WTF. (2004). Model once, use multiple times: reusing HL7 domain models from one domain to the other. In: Fieschi M, Coiera E & Jack Li, YC: (Eds). Proceedings of the 11th World Congress on Medical Informatics Medinfo 2004. Amsterdam etc. IOS Press, 366-370.). Ongoing work in patient care is moving even further this direction and is a perfect host for archetypes if you can see through the current method of expressing them in R-MIM format, which has been and still is the only way to get the clinical content rightly in HL7 v3 XML message, waiting for tooling to help us out (see later). You rightly point at the negative vote from the Netherlands towards the 13606. You define this as stupid. Fine. However, you did not mention the main reason for the Dutch "no". In addition, you did not mention that it is only referring to the 13606-1 part. This Dutch no is a no because the 13606-1 does not refer at all to existing related standards, in particular it ignores the HL7 v3. In no way the 13606 explains to any European country how ongoing work with a national health ICT strategy (indeed based on HL7 v3) could work with both standards and align the multi million investments. If the debate - on your behalf - then takes place on a either - or basis, and then you declare publicly that only 13606 is good, yes then the problems of fanatism come into being. If you then only apply political argumentations, such as that the 13606 will be voted positive by all other European countries and then automatically will become the law in the Netherlands, and everybody should only listen to you, yes then we are in the fanatics area. Perhaps the Dutch are not stupid, but might have enough of your quarrels, and perhaps the stupid Dutch could need a solution to work with both standards? And maybe we are brave to deal with both worlds, since I do know that there are several HL7 European affiliates working in similar space. Also of interest is the Swedish work with HL7 which started recently because the existing standards work did not bring all solutions. Back to the science of standards (I assume it is academic work after all). We are moving very far in harmonizing 13606/OpenEHR and HL7 v3, e.g. the work that Heath Frankel has carried out based on the development of the HL7 v3 Care Provision model. The current 13606 R-MIM is based on this model to a large extend, and includes the particularities of the 13606, ensuring eventually, after careful and scientificall sound testing, that those who apply 13606 / OpenEHR in their record system can realise semantic interoperability with those that build their systems on HL7 v3 / Care Provision or similar approaches. Of course doing things directly is easier, and of course this will still cause a lot of troubles, and there comes the scientific debate on how to solve them. Now to my knowledge four systems based on HL7 v3 design are working in the practice arena, and to my knowledge three are in a far stage of development. Here I do not refer to the around fifty systems currently able to do the v3 messaging, but systems able to develop a record based on these principles. Another very harmonized approach is the work to develop care information models / clinical templates / archetypes / HL7 v3 templates/ OpenEHR templates / GPIC content / detailed clinical models. There is general agreement among CEN 13606 / Open EHR and HL7 v3 developers that the difficulty lies in the clinical detail, that vocabularies play a role here, that this can be sorted out and synthesised, that a more or less agnostic from technology model can be determined, and that the implementation into any technology is more difficult than implementing or transforming from one technology to another. A third area of harmonization is in the tooling. Where the agnostic modelling approach is far underway. One example is using the OpenEHR archetype editor to express the clinical content agnostically. Then I could make my care information models in such a way that they automatically transform to HL7 v3 message content. Of course the same clinical material would transform to an OpenEHR archetype, thus making the hard effort of sorting out the clinical stuff more cost effective and more worthwile. This can simply be achieve via adding / adjusting existing features of the archetype editor. The template editor could help us combining archetypes / R-MIM structures into larger components for EHR or message. E.g. from temperature, heartrate etc to vital signs panel, and combining this with other physical measures to a full physical exam / assessment. Then the next work underway is the transformations between technology a versus b versus c. I have not understood all details of the discussion between Grahame and Thomas, but I am sure that we are addressing real world problems with this work of making health information available to those with a need to know, and not some fanatisms belief. This might be not scientific, but at a certain point science tells me I have to stop being an expert because of limitations in knowledge and let the real experts in an area sort it out. For me the real techy stuff is the limit of doing science, and more the area of applying science that others develop. I see useful science going on on both sides. I fourth area of harmonisation is on the datatypes. I understood from a recent report of the ISO chair prof Kwak that this work is progressing. This means harmonization of CEN / HL7 / ISO work, allowing the science of medicine to express its data in different types necessary for practice and research, to store it and to exchange it independend of technology approach. Yes, there is work to be done, it is difficult, it is not finished, it is not a religion. In my opinion discussions on such harmonisation matters, with all pro's and con's, are useful and indeed a scientific debate. In my opinion shouting at everybody that "some standard 13XXX is the best" might relate to fanatism. I have never told anyone that there is one best standard, in contrary, I take a very eclectic approach, see for example: Goossen W (2006). Representing clinical information in EHR and message standards: analyzing, modelling, implementing. HINZ Primary Care and Beyond: Building the e-Bridge to Integrated Care. Eds: Christopher Peck & Jim Warren. Publisher: Health Informatics New Zealand (HINZ) & Health Informatics Society of Australia Ltd (HISA)/ISBN 0 9751013 7 4// ? The author(s) & HINZ All rights reserved. Thus, I would declare your mission to throw away HL7 as religious fanatism. :-) So again, thank you very much for pointing this out. William PS, on my behalf with defending my position here the debate on fanatism is closed, I will only reply to real harmonization work. -------------- next part -------------- An HTML attachment was scrubbed... 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