Hi Ian, you have certainly managed to isolate the clinical complexity from this technical layer up to a certain point and this is great. You offer clinicians software tools to design clinical care, administrative forms and prototypes using familiar terminology. But database schema is NOT irrelevant because it is the physical location of your data that are collected from your forms, that is the final/original destination. Moreover a framework that is handling the database schema, the mapping of conceptual schema, and the management of objects at programming level is very popular in modern software development environments.
In your case, you are storing clinical content, business logic, vocabulary terminology and user interface fields among other things in your ADL archetypes, templates in order to be standalone, in order to be transferable. I can appreciate that and the fact that there can be similar poorer approaches that other followed with tools such as Infopath to store/retrieve/exchange XML data. But as a developer/architect I am not aware and I cannot comment on the complexities you face when you need to read the structure, data content and relate them with other data collected from other sources (databases, documents, etc), or interoperate with other systems and clinical document formats that require a different serialization or store the data from multiple openEHR forms. I believe that you have to provide more examples apart from openEHR Java and Opereffa projects of simple processes (data entry, data storage, data retrieval, data reporting, data serialization (CDA,CCR), data view, etc) that are based on openEHR and implemented in popular DBMS, RAD environments and other open software tools. If you have the clinicians on your side then perhaps it is time to take more independent/freelance/company developers on your side too. Make it more popular if you can ;-) Thanks for your comments on my reply Athanassios From: [email protected] [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Ian McNicoll Sent: Friday, May 06, 2011 2:28 PM To: For openEHR clinical discussions Cc: openehr-technical at openehr.org Subject: Re: One model vs One framework in e-health ..... 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: [email protected] [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 -------------- next part -------------- An HTML attachment was scrubbed... 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