The best way to look at this, following Tom's example of 1 RIM => N archetypes and M templates in OpenEHR is to look at HL7 v3 Care Provision (CP) or CDA or Clinical statement.
Here I agree fully with Rik's comments. v3 Care Provision, CDA and Clinical Statement have a Domain Message Information Model that serve exactly the same purpose as the RIM in OpenEHR: the basic and unchanged model against which all detailed clinical content is modeled. Several R-MIMs are produced from this to cover the dynamics of continuity of care (referrral, acceptance, query, record exchange). There is a fixed set of XML schema's for each of these R-MIMs. As Rik explaines: within the R-MIMs there is an option for nested R-MIMs. Each of these smaller R-MIMs are clinically a 100% match to an archetype in OpenEHR (variations are clinically necessary variations e.g. to population or age groups). Technically it does work a little different. These small R-MIMs go into the choice box, that allows clinicians 100% freedom about what to include in the message. The full XML remains the same, but at the start of choicebox XML until the end of choicebox XML one can enter 1 - N small R-MIMs, each of which adheres to a pattern, e.g. the vital sign pattern, a common observation pattern, an assessment scale pattern. This pattern leads to XML small blobs, similar to archetype XML, and can be insterted in the specific message XML. At this stage we have been testing the Care Provision model for perinatology continuity of care and national statistics: no limits for > 300 data items and constructs juvenile care, youth at risk: no limits for > 1000 data items stroke care, . 1200 items, no limits in message diabetes care, work in progress, no limits found at this stage elderly care in 2 projects, > 1500 items, no limits To a large number the items are composite data items, e.g. representing assessment scales like Apgar, Barthel, MMSE and such. Others are very complex growth and development measures, not summated, but a complex overview of motor, physical, psychosocial growth and development, measured from age 1 week until age 18 years. All match the pattern and can be developed in user interfaces and included in the CP message. mental health by GP and social worker > 50 items, no limits, however consent needed to be included explicitly. So I think the only points that are valid are that the technical implementation is different, and that the archetype build up is mostly done top down. relationship between small R-MIMs are done via the Organizer class in HL7, allowing any linkage to each other, exactly as is done with archetypes and templates in OpenEHR. These many similarities make me move to a technology independed way of modeling with the detailed clinical model approach. Sincerely yours, dr. William TF Goossen director Results 4 Care b.v. De Stinse 15 3823 VM Amersfoort email: Results4Care at cs.com phone + 31654614458 fax +3133 2570169 Dutch Chamber of Commerce number: 32121206 </HTML> -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20071212/85ad0f91/attachment.html>
