Hi All The adoption of all health standards is very slow; and it is universally so. Government eHealth programs have embraced HL7v3 or CDA or openEHR or 13606 - at great cost. Still things go slowly. The fact is that until people want a shared logical model of the actual EHR (rather than a message or a document) openEHR will not be centre stage.
Why have openEHR at the centre of a national program? There are a number of reasons that are potentially persuasive. 1. The core platform as implemented does not describe clinical information. This allows changes to clinical information to take place in the world of archetypes (the 99% of standardisation that is yet to be carried out!). The corollary is that only when there are enough high quality archetypes freely available does the argument for this separation is compelling. There are close to 300 archetypes of good quality now available and we are going to see a rush of validation coming soon. 2. Adopting an EHR service allows applications to come and go without losing/changing/adapting the health records. For patients, hospitals and major providers this is a massive benefit - you can keep your health records for a lifetime. It does, on the other hand, require enough high quality applications to be available to provide solutions for providers. There is a growing number - nursing, paediatric hospital, field hospital, infection control, cancer research - but there is still some way to go. 3. The recording model in openEHR fits with the business process of healthcare. A lot of things work out of the box from a medico-legal perspective in a distributed environment. The coherent management of workflow over a range of applications and services is the next step in this process and the one that Ocean is concentrating on. Even if the first argument is only accepted as a logical model for EHR services, the tooling available now makes it possible to produce different artefacts for different systems. On this basis people are becoming more willing to invest resources in developing archetypes through open collaboration on the internet. The second and third arguments are bringing some institutions and software vendors along. Seref is doing a wonderful job and Ocean has some experience in real implementations to which Seref is party - so he does not make the same mistakes! Where simplification is beneficial let's do it. The reality is that openEHR proposes a massive shift in emphasis - from the message to the EHR. More than 7000 vendors in the USA have invested in their own data model - which they maintain. Until it is quicker, cheaper and easier to build a system using openEHR, uptake will be slow. But I guarantee you, the alternatives will get slower and more expensive by the day. That is why we should continue: health information is highly complex AND 'you ain't seen nothing yet'. Cheers, Sam > -----Original Message----- > From: openehr-technical-bounces at openehr.org [mailto:openehr-technical- > bounces at openehr.org] On Behalf Of Erik Sundvall > Sent: Monday, 15 November 2010 11:29 PM > To: For openEHR technical discussions > Subject: Re: Why is OpenEHR adoption so slow? > > Hi! > > On Fri, Nov 5, 2010 at 10:03, Thomas Beale > <thomas.beale at oceaninformatics.com> wrote: > > there are zero paid openEHR people, full-time or part-time. > > That is not such a useful way of looking at openEHR funding. There are > a lot of people working with openEHR on paid time during working > hours. They are just not funded by the openEHR foundation. This > situation is the same for many open source projects etc. > > If you define "openEHR people" as people funded by the foundation you > are automatically excluding most of the community from being "openEHR > people". That might not be the smartest thing to do. > > Too often I hear "openEHR needs funding" with the accompanying thought > that the foundation itself needs a lot of money. Yes the foundation > might need a little money for server & maintenance costs (if we don't > want to use "free" services) and for trademark registrations etc. But > the real need is working hours, not money. > > Certain organisational behaviours make people and companies donate > working time, while other behaviours do the opposite. Some behaviours > get the time donations ending up within the original project, other > behaviours result in related projects more using and indirectly > contributing to the project via related but organisationally > independent projects. > > Many other volunteer organisations understand this difference better > than what the openEHR foundation seems to do, at least judging from > the few signals one can receive from the not-so-community-present > foundation board that has nobody to formally answer to but themselves. > In a volunteer project it can be quite OK with natural self appointed > leaders, often the founders, but it then has to be matched with other > attitudes or safeguards such as... > - being very good at communicating and willing to actively explain and > discuss decisions > - the ability for any participant to branch of and take (a copy) of > invested time (work) with them, if the leadership becomes poor > ...and so on. > > > The people who > > currently put some effort into openEHR, such as myself, are working > on > > exactly the same basis as anyone else in the community. We are just > crazy > > enough to spend more time on it;-) > > There are a lot of completely sane reasons for investing time in > openEHR. I for example believe Ocean Informatics would not at all have > been getting assignments all around the globe if it had not chosen to > invest time in open specifications. Very few would have heard of that > little Australian company. (On the other hand, it could probably have > been an even bigger company if everybody, not just a few, within that > company understood open source business models better.) > > To get back to the real issue of "slow" openEHR adoption, I believe > Seref is closest to the problem: a system trying to do everything > openEHR tries to in a well engineered way, really becomes an > "elephant". > > It takes time to properly implement an elephant from scratch, > especially including all supporting systems. > > The two organisations that could have provided a real working open > implementation of that elephant first would probably have been UCL and > Ocean Informatics. Now, instead of joining forces on that, they have > both been running their own competing commercial closed source > implementation projects (OK UCLs were probably more 13606 than > openEHR, but you get the point). They are of course both fully > entitled to do so, and it's great that the specifications themselves > are open, but I believe it has delayed the arrival of an open > demonstrator platform that people can use to try openEHR ideas on and > are willing to invest time in. On the other hand it has left the field > completely open for both competing commercial and open source efforts, > which in the long run, after this delay, might show to be beneficial > for the world at large (but probably less beneficial for Ocean and UCL > than it could have been). UCL by the help of Seref and whoever > supports him, now seem to be getting the point of an open > demonstrator, so things seem to be changing there. > > One should not deny that there might be a similar competition between > open source efforts, but I believe cross-pollination of ideas between > such projects can be pretty fruitful and efficient (look at Archetype > editors for example), and thus less effort might be wasted than in > commercial competition. (To add to the open source confusion some of > us are thinking of alternative ways (http REST) to slice the elephant > implementation and let smaller parts cooperate (or compete if you > wish) in implementations - but that should be a separate post later.) > > I hope this mail did not sound too complaining, I more aimed at > explaining (from my particular point of view). I like both UCL- and > Ocean-people, that's one reason to try and be honest with them. :-) > > Best regards, > Erik Sundvall > erik.sundvall at liu.se http://www.imt.liu.se/~erisu/? Tel: +46-13-286733 > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical
