Hi Athanassios,
I probably should let other more technically-orientated people comment but I
sense that you have not really understood the openEHR approach.
>From my perspective, openEHR is not orientated to UI requirements, that just
happens to be the way that some developers have used it.
To adapt your own premise, the openEHR approach is to isolate the clinical
complexity of an EHR, which is of a very different nature to the technical
complexity of an EHR. Furthermore, the use of templates isolates the
complexity of aligning with local requirements (including some GUI issues)
from wider semantic interoperability issues.
The reason that openEHR says nothing about the database schema, is that it
is irrelevant - all querying is done via a service layer or AQL. So there
are a variety of approaches to persistence, depending on the overall
requirement. Needless to say, implementing a enterprise-quality openEHR
persistence layer with adequate scalability, performance and an AQL
interpreter is non-trivial. This is one of the reasons why an open-source
version has not yet emerged - you are facing exactly the same problem.
Whether openEHR, RIMBAA or your own efforts, this kind of activity needs
very significant back-end engineering.
The key difference between RIMBAA and openEHR, is that we have largely
managed to isolate the clinical complexity from this technical layer, so
that the very real difficulties that we face as clinicians can be argued
between us, without requiring continual schema updates. Having now taken a
full paediatrics application, through clinical requirements to modelling in
openEHR archetypes and templates, into generated Java object models and
partial GUI generation, then rich data retrieval via AQL, I have seen this
working first hand. 70% of the archetypes came from the CKM repository with
only minimal localisation.
I think as well that you are still seeing the complexity of EHR development
from a technical developer perspective, and I sense that you are
underestimating the conflict and confusion that will arise when you try to
meet the needs of varying specialities and domains.
Interesting discussion,
Ian
Dr Ian McNicoll
office +44 (0)1536 414 994
+44 (0)2032 392 970
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll at oceaninformatics.com
Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org
On 6 May 2011 11:42, Athanassios I. Hatzis, PhD <hatzis at healis.gr> wrote:
> Hi Thomas,
>
> I will agree with you, yes there has to be a generic health information
> model but in my opinion it has to span over all three main layers of
> software architecture
>
> 1. Physical/persistence layer
>
> 2. Conceptual/Application/Object layer
>
> 3. User interface layer/Serialized representation (XML,etc....)
>
>
>
> RIMBAA technology matrix describes in the best way the different paths one
> can follow to solve parts of the generic problem.
>
>
>
> The big challenge in my opinion is that there has not been an OPEN
> IMPLEMENTATION of a generic framework to cover all these layers.
>
>
>
> I have studied a bit the underlying structure of openEHR
> archetypes/templates, where you are linking/binding user interface fields
> with clinical/admin entries of the conceptual layer in one serialized object
> (ADL). By the way I am not convinced that there has to be strong binding
> between user interface and the conceptual layer (RIM). But clearly you are
> leaving out the mapping of data captured from the forms (templates) to the
> company that is going to provide the database management system in order to
> store permanently the user data. Of course the aggregation of user data is
> also important in that case and I cannot see any open approach that is taken
> from your side to cover or support that process. Obviously I can also
> realize that there has to be a business model and profit out of that story
> and if everything is open and free then many might go out of business.
>
>
>
> Anyway, let me continue a bit on ONE GENERIC e-health FRAMEWORK. One reason
> I started the MEDILIG approach is because I realized that there has not been
> an extensive, generic, easy to follow, standalone, OPEN ER schema in
> e-health to cover the persistence layer am I wrong ? Developers do need to
> work with an open database schema because that schema is closely related to
> the conceptual/object model for programming purposes, business logic is
> shared between the two as developers do know.
>
>
>
> Question: Has anyone thought to IMPLEMENT an open conceptual framework and
> generate from there a generic ehealth database model because that is what I
> am exactly trying to implement using the programming environment of
> Microsoft Entity framework and the RIM model of HL7. In fact this way I am
> turning MEDILIG to an entity framework standardized through HL7 RIM and HL7
> vocabularies.
>
>
>
> One may realize the consequences of such an implementation. Developers can
> built user interfaces of any kind, produce serializations, do mappings from
> any forms created with other software tools, and make it easier to connect
> or redesign legacy ehealth applications and databases. Or at least that is
> the way I envisage it to happen....
>
>
>
> One idea I have is that the framework can be specialized according to each
> specialty and therefore you can make it even easier for a developer to
> approach and implement a specific solution for an individual, a clinic, a
> lab, etc....
>
>
>
> What I DO NOT have is capital, resources or even an employer interested in
> such a business plan, where I can understand it up to a point ???!!!
>
>
>
> Best luck to all
>
>
>
> Athanassios
>
>
>
> PS1: Apologies to the non-technical audience for getting a bit into
> technical details ;=)
>
>
>
> PS2: The approach I am suggesting is taking the developer at the center of
> the solution and attempts to standardize concepts, terms, properties, etc
> around him. One the other hand the user interface design should take the
> clinician/health professional at the center and try to standardize the
> software world around him. You have already achieved that at a great level I
> believe. Then the two worlds have to be linked/mapped.
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
> *From:* openehr-clinical-bounces at openehr.org [mailto:
> openehr-clinical-bounces at openehr.org] *On Behalf Of *Thomas Beale
> *Sent:* Thursday, May 05, 2011 7:21 PM
> *To:* Openehr-Technical; For openEHR clinical discussions
> *Subject:* on the possibility of 'one information model' in e-health
>
>
>
>
> this is an often debated question, and after coming across (for the 100th
> time) just such a debate recently online, I thought it might be interesting
> to try to get to the bottom of the question in some way. The basic idea
> posted here<http://wolandscat.net/2011/05/05/no-single-information-model/>.
> It is of course not scientific work, but I would be interested in the views
> of others on this concept.
>
> - thomas beale
>
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical at openehr.org
> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
>
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