Hi Pablo, A very useful insight into the issues indeed. This is one topic that may end up being a quite long discussion, but I feel it is a topic that is worth laying out, not only today, but every couple of years or so, to see where we are.
I'll provide my personal views here. openEHR is not a small specification. It is not a simple one either. Considering the problem it is trying to solve, I do not expect it to be. Therefore, the complexity of implementation is significant. The nature of the problem openEHR is trying to solve inevitably creates the blind men and the elephant situation http://en.wikipedia.org/wiki/Blind_men_and_an_elephant In explaining what openEHR is, we are faced with the problem of communicating the whole picture. In my experience, partial views or decriptions of openEHR lead to confusion, even if every bit of information provided is correct. Technical people and clinicians alike have a hard time seeing the big picture, and who can blaim them? The picture is really, really big. Be warned: the kind of statements I've just started to make are usually perceived so that one gets the message "this needs to change". No. When I say openEHR is complex, openEHR is big, openEHR is not easy to implement, I don't mean openEHR is more complex than it needs to be, or openEHR is bigger than it needs to be, or openEHR is harder than it should be to implement. We are attempting to solve a huge problem, and complexity of the solution will enevitably rise in response. The instinct to simplify the solution usually cripples the solution by pruning its support for less frequently required features, but most of the time, this leads to an unsatisfactory outcome. Surprisingly, everyone seems to follow the instinct. In my opinion, tooling and education are the two most important fronts we need to make progress. The mechanics of an MRI is very complex, and yet, due to way it was implemented, it is a practical, useful clinical tool. The implementation of the very complex solution is designed so that without knowing anything about the underlying mechanics, it can be used. Clinicians and developers need tooling to take control of complex concepts, and not having enough tooling is leading to lots and lots of angels and pinheads type of discussions. The chain of problems go like this: not enough tooling -> not enough implementation -> not enough understanding & feedback -> lots and lots of hypothetical discussions. So if (at least according to me) the biggest problem is tooling, why not build the tools and solve the problem? Because no one is paying for it. Whatever we have out there in terms of actual tools and implemenation is mostly out there thanks to good intentions and hard work of people. I've opened up the code I'm writing for my PhD, Ocean, Zilics, and people Rong Chen and Tim Cook are doing the same, but with limited resources it is hard to trigger a mass adoption. We are moving forward, no doubt, but people staying up in the middle of the night are usually paying the steepest price, and the most interesting thing in all this is that the expectations are huge. Please do not get me wrong, I'm not saying this in response to your analysis, but most of the time, when people encounter openEHR, they are amazingly expecting a piece of software to install, which will deliver everything openEHR can deliver, out of the box. And of course they want it to be open source. When they can't find this, they say it is not there yet. I think this is also related to education; personally I think that we need to stop people from having unrealistic expectations, and clearly explain what the offer is, and what it takes to turn that offer into value added. Anyway, this is a big topic, and I can't put everything I have in my mind into one e-mail. Still wanted to say these bits. BTW, I've written about openEHR almost two years ago, trying to explain it to novice, though my own understanding at the time was not very clear. http://www.serefarikan.com/?p=97 may be of help, next time you're trying to describe what it is, at least some of it. Best Regards Seref 2010/11/2 pablo pazos <pazospablo at hotmail.com> > Hi Thomas, > > My opinion is the grade of adoption of a standard depend in some aspects of > goverment agencies, in some of the industry and some of the academy. > > DICOM is a good example of an open standard heavily supported by the > industry, that's the point of it success. Can't be OpenEHR a de-facto > standard for EHRs? Like DICOM is for imaging. I think yes, but the progress > of OpenEHR to solve real the problems and make it usable, is slow. > > I think OpenEHR is strong on the academy area. It has poor industry > penetration (I mean enterprises developing tools and aplying a good part of > the OpenEHR specification in their systems, and that these systems where > used in some hospitals). I don't know what's the penetration of OpenEHR on > goverment agencies. There are some open tools but there is some stillness on > making improvements on them. > > > For example, here in Latin America, almost nobody knows about OpenEHR in > the industry area, and very very few knows about it in the academy area. > > There are some ideas that may help the difusion and adoption of OpenEHR: > > - I think that regional OpenEHR communities are needed to empower the > adoption and spreading of the standard. In 2009 I send a message to the > mailing lists, but I get no answer from the community (this mail is below). > Now we have 36 members from Uruguay, Argentina, Chile, Colombia, Spain, and > more. They work on goverment agencies, big enterprises (like IBM), > developers and physicians. I think the international OpenEHR community needs > to support these regional communities, providing guidelines, general > objectives, and following their work. Here in South America, only few people > know about OpenEHR, that's a shame. People in goverment are making > decissions, without knowing that are good and open standards out there. > > - Formal training and education in OpenEHR is needed. It's very hard to the > newcomer to understand how to use OpenEHR, and people interested on the main > ideas of OpenEHR may be dissapointed when they try to use it in a real-world > software application. People in the industry must be trained, but how many > OpenEHR trainers are out there? > > In Set-2010 I've done a hands-on OpenEHR tutorial in Argentina, and people > (medics and TIC people) where amazed about building their archetypes and > having a tool that generates the EHR (this is my degree project). This was > done in the context of the "Argentine Congress of informatics and Health > 2010". Now, the organizers want to make more time to discuss OpenEHR and its > posibilities. This is just an example that great things can happen if > someone has interest. > > Regional OpenEHR communities can build courses fucused on the regional > needs, may be made some money to support the open tool development (*). > > - Building and supporting open tools. The current tools have no regular > updates. We need developers to build new tools and improve the current > tools. We can use the money of the training courses (*) to pay developers to > do this job. If this depends only on the free time we have, tools just can > die before they are implemented. > > - In order to help any goverment adoption of OpenEHR, the decission makers > have some questions that today OpenEHR can't answer. > - What is the state of the standard? > - Is it stable? > - Wich parts are stable? > - Is there any return of investment study done on efective use of > OpenEHR? > - Or just, how much time and money I have to spend to effectively use > OpenEHR in a real world application? (I have to train people to make things > happen, not in an investigation project, but in a production project) > - What real world products are using OpenEHR? > - How these products are using OpenEHR? (they adopt the RM? the AOM? the > SM?) > > There is page on "who is using OpenEHR" in the portal, but it is outdated. > My proposal is to do regular polls on the community in order to know: who is > working on what, and how they're using OpenEHR. > > - Formal links with "formal" SDOs are needed. I think that OMG is in tune > with the way OpenEHR do things. They have the COAS standard, and OpenEHR RM > is mapped to COAS. This is a good starting point to have something in > common. > > I think there are very good posibilities in the OpenEHR adoption on the > industry adn goverment areas, but we need to build improve the lines of > action of the community to reach that. > > > Just my humble opinions. > Best regards, > - Pablo. > > -------------------------------------------- > Hi, > > We're trying to build an spanish-speakers community about openEHR , I just > create a google group: http://groups.google.com/group/openehr-es > > We want to translate some docs and presentations to generate enough > knowledge to spread the word about OpenEHR, and other EHR related concepts > between latin-american and spanish people. > > > Best regards > Pablo Pazos Gutierrez > http://pablo.swp.googlepages.com/ > > > ------------------------------ > Date: Fri, 22 Oct 2010 20:19:29 +0100 > From: thomas.beale at oceaninformatics.com > To: openehr-technical at openehr.org > Subject: Re: Articles on Healthcare, Complexity, Change, Process, IT and > the role of openEHR etc > > > Hi Derek, > > it is very simple. Not being an official standard has been a real problem > for government agencies, obsessed with official standards. > > - thomas beale > > > On 22/10/2010 17:12, Derek Meyer wrote: > > Tony, > > This is very impressive piece of work. Every since I first came across > openEHR I have intuitively felt that it is closer to the 'solution' than > more static attempts at standardization. So why is progress so slow? I've > appplied some lateral thinking to this, and come up with what many people on > this list may (at best) think contrarian - but at the risk of being > flamed.... > > The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. > > (I'll go get my hard hat now...) > > Best wishes, > > Derek. > > On 22/10/10, *"Shannon Tony (Leeds Teaching Hospitals NHS Trust)" * > <tony.shannon at nhs.net> <tony.shannon at nhs.net> wrote: > > Late last year I said I would work on some material to help explain openEHR > in the wider context of healthcare change during 2010. > > It has taken me longer that I originally planned but I've recently shared > some articles online towards that end. > http://frectal.com/book/ > > The articles explore issues such as > Healthcare under pressure, > Complexity of healthcare+management+IT, > Change and the elements within > Aligning process improvement efforts with IT > > In the final articles I explore healthcare change going forward, the need > for better IT and particularly why I believe openEHR has the potential to > tackle the complexity and diversity of healthcare.. > http://frectal.com/book/healthcare-change-the-way-forward/ > > http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%e2%80%99s-potential-to-handle-complexity-diversity/ > > In the spirit of evolutionary change, they are up in draft form for now, so > comments on any article are welcome.. > > Hope you find it of some interest/value in explaining openEHR's place in > the wider world. > Please feel free to share.. > > Kind regards > > Tony > > Dr Tony Shannon > Consultant in Emergency Medicine, Leeds Teaching Hospitals > Clinical Lead for Informatics, Leeds Teaching Hospitals > Chair, Clinical Review Board, openEHR Foundation > tony.shannon at nhs.net > +44.789.988.5068 > > > ******************************************************************************************************************** > > This message may contain confidential information. If you are not the > intended recipient please inform the > sender that you have received the message in error before deleting it. > Please do not disclose, copy or distribute information in this e-mail or > take any action in reliance on its contents: > to do so is strictly prohibited and may be unlawful. > > Thank you for your co-operation. > > NHSmail is the secure email and directory service available for all NHS > staff in England and Scotland > NHSmail is approved for exchanging patient data and other sensitive > information with NHSmail and GSI recipients > NHSmail provides an email address for your career in the NHS and can be > accessed anywhere > For more information and to find out how you can switch, visit > www.connectingforhealth.nhs.uk/nhsmail > > > ******************************************************************************************************************** > > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical > > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical > > > > -- > [image: Ocean Informatics] *Thomas Beale > Chief Technology Officer, Ocean Informatics<http://www.oceaninformatics.com/> > * > > Chair Architectural Review Board, *open*EHR > Foundation<http://www.openehr.org/> > Honorary Research Fellow, University College > London<http://www.chime.ucl.ac.uk/> > Chartered IT Professional Fellow, BCS, British Computer > Society<http://www.bcs.org.uk/> > Health IT blog <http://www.wolandscat.net/> > * > * > > _______________________________________________ openEHR-technical mailing > list openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical > _______________________________________________ openEHR-technical mailing > list openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical > > _______________________________________________ > openEHR-implementers mailing list > openEHR-implementers at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-implementers > -------------- next part -------------- An HTML attachment was scrubbed... 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