Hi Seref and Shinji, I share your opinions. Once in a while, we need discussions like this, since we have to lead ourselves somewhere and combine efforts if we want to support the difussion and adopton of the standard.
The domain is complex, the problem is complex, the solution must be complex, but if we add the complexity of the standard to the complexity of understanding another language (the specs are english only), we have a serious problems for a worldwide adoption. I share Shinji's vision, we must support and encourage regional OpenEHR communities, specs translation, and "open source multilingual up-to-date tools" (most tools available are: or not multiligual or the translations are horrible, or not open source, or not updated recently). I think regional communities can create courses, resources, materials, etc... and share them with other communities, throught OpenEHR foundation. Guidelines to do this must be set from the OpenEHR Foundation Boards (I think they are there to lead the community, to encourage the spread and adoption of the standard, I can't remember the last time I saw an email of the OpenEHR Boards in the mailling lists). Within those guidelines, we can be coordinated, and maybe set year-based goals. And once a year or two we can make some event to share our experiences and progress from our local communities (can be local or regional events, since for most of ours it's hard to travel so far). These ideas are not new, just look at the HL7 coutry based structure. I know this words may sound hard to someone, I just want to support the success of the standard, but I think if we keep doing things the same way, we'll end with a high quality standard with no one to implement it. Kind regards, -- A/C Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ S?gueme en twitter: http://twitter.com/ppazos Date: Tue, 2 Nov 2010 22:25:17 +0900 Subject: Re: Why is OpenEHR adoption so slow? From: sk...@moss.gr.jp To: openehr-implementers at openehr.org Hi Pablo, I also think regional community is necessary for this project. I launched openEHR.jp in 2007 in Japan. This is the first regional community of the openEHR project. We have provided Japanese translation and promotion for multilevel clinical modeling technology. We have implemented on Ruby as OSS and been trying national intractable disease surveillance database by openEHR technology. Your idea, to make a guideline is interesting. We will also try to do it. Cheers, Shinji KOBAYASHI Date: Tue, 2 Nov 2010 12:32:56 +0000 Subject: Re: Why is OpenEHR adoption so slow? From: serefari...@kurumsalteknoloji.com To: openehr-implementers at openehr.org CC: openehr-implementers at chime.ucl.ac.uk; openehr-clinical at openehr.org; openehr-clinical at chime.ucl.ac.uk; openehr-technical at chime.ucl.ac.uk 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.be...@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 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101103/451d359a/attachment.html> -------------- next part -------------- An embedded and charset-unspecified text was scrubbed... Name: ATT00001 URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101103/451d359a/attachment.pl>
