Hi, I have been reading architecture overview of openEHR, and I would like to make some comments, questions with respect to the ontological separation:
a) There has not been an international agreement on the Reference model, that is supposed to be stable, (openEHR RM vs HL7 RIM vs .....) I am not surprised as it is usually this level (RM) that is implemented in software according to the openehr architecture overview. But I would like to make clear for those that were reading the posts of "one model vs one framework in e-health" that I was not referring to that level of modeling. My interpretation on this issue is that we have many health standards at that level ;-) b) There has not been an international agreement on the "Domain Base Concept Model", level 2 invariant domain concepts according to openEHR ontological layering, where the archetypes are based on (clinical care entries - instructions, evaluations, observations, actions, etc), administration entries (admission, registration, accounting, etc) My interpretation on that issue is that we have many health standards at that level too ;-) DO NOTE also the comment on the presentation of Ocean Informatics at UCL in the year 2005: This level must be standardised and agreed for archetypes to be sharable. So what has been the progress on that ? c) There has not been an international agreement on the variant re-usable domain concepts, openEHR level 3, openEHR ARCHETYPES (e.g. medication, symptoms, imaging, diagnosis, procedure, etc....). My interpretation on this issue is that we have many health standards at that level too ;-) OK that is perhaps the reason that many presentations end up with the tower of BABEL ;-) Therefore domain concepts are defined differently in HL7 and openEHR and the same is true for any other organization that attempted to write specifications for that level. But It is common sense I believe for any architect/developer/analyst that worked in industry, or even an IT database course student, to attempt solutions at a business domain and to define, to model entities at semantic level as a starting point. In fact if you study many of the commercial ehealth systems and open source ehealth software you will do of course find classes (objects) and tables that represent such entities. So why is not there ONE information model at that level for many if not all to agree on ? Because I suppose many will answer there is great variability and here it comes the solution of many organizations including openEHR to specify FIRST persistence level (see also comments and discussion on one information model vs one framework in e-health), meaning to deal with data types and then start building the other layers. Invariant parts come first no matter how close they are to the health domain ! OK let us focus on the clinical content for a moment and suppose we start modeling this FIRST as it has already happened. Think also about the conversion issue of legacy, old systems. For this argument I will choose existing clinical models, archetypes defined at the clinical knowledge manager: Medication description (Dose Unit, Dose instruction, indications, etc......) Symptom Features (Locations, Variation, Severity, etc.....) Imaging Data (Imaging procedure, anatomical site, location, etc....) You noticed of course that I have taken content from different sections of a typical EHR. Questions ------------ 1) What about if there is an agreement for a minimal set of features to describe all BASIC content sections that are typically present at EHR (i.e. something close to a CCR). Or else describe the specifications of a clinical model for a GP or general medicine. 2) Then attempt to specialize, i.e. specify a minimal set of archetypes with the most common present features in cardiology, neurology, etc... What clinicians PROBABLY SHOULD DO is to define the levels of ontology for their domain (i.e. general medical practice, specialties, sub-specialties, etc...) based on archetypes. Of course I do strongly agree with openEHR approach, that at the atomic level you have to deal with a standardized archetype (re-usable domain concept, unit of ehealth information sharing). But I think there has to be an assessment for those archetypes that are most common, for those features that are met in those archetypes most often, etc. 3) If that is what is going to happen, why not implementing these standard archetypes with classes-objects at programming level, if we agree the names of the attributes (features) ? So far what has been over-emphasized I think is the data types for describing archetypes. Maybe there has to be some freedom here for the developers or the DBMS. Yes we can have hundreds of relationship diagrams, hundreds of database schemas, but if we agree on the classes (archetypes) then work for developers will become much easier and we will have to focus on the analysis, workflow, problems, plus that there is going to be higher coherence between developers and clinicians. And here I rest my case dear distant colleagues, and fellow humans ;-) Athanassios Four quick suggestions for your developers, clinicians PS1 : You may create any kind of artifacts around archetypes (i.e. templates, entries, actions, etc.....) for structuring organizing them, but again these should not be strictly imposed on the community. PS2 : The easier one can build a basic EHR system and USE it based on archetypes the faster they will be spread around the world.... PS3 : What about terminology and translations, you simply use term binding, language binding on the features but not strongly connected to the archetype. Let anyone decide by simply specifying the vocabulary set.... PS4 : What about the user interface, same thing, we are simply interested in the data fields, bind them anywhere you like. Avoid to specify these on the archetype definition language From: [email protected] [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Thomas Beale Sent: Monday, May 09, 2011 4:11 PM To: openehr-clinical at openehr.org Cc: Openehr-Technical Subject: Re: on the possibility of 'one information model' in e-health On 09/05/2011 13:51, pablo pazos wrote: Hi Thomas, I've left a comment in your blog but is not appearing, so I comment your idea here. I don't think today it can be possible to have one information model agreed by all the medical informatics community, but I think if we can agree in a common metamodel like an ontology that represent the more generic concepts in medicine, like people, processes, resources, records, etc, we will be one step closer to a common IM. yes, that's pretty much what I was suggesting. Because if we can agree on that ontology, all the information models in healthcare MUST follow the ontology, so, different information models can live together, but they model the same concepts (semantically speaking). With different models, but semantically equivalent, the point of convergency will be closer. information models, at least abstract ones are in effect an ontology in themselves: they are a description of information that either exists, or we want to exist. So it seems reasonable that a pragmatic UML model, with an appropriate level of abstraction can be used for just this purpose - to describe and agree on key patterns. If this were true, it would mean that the challenges for agreement are: * agree on the list of patterns; I have proposed some basic ones; your list above implies another set of candidates * to help agreement, some kind of rating system would probably be needed so that at least some 'core' patterns could be agreed, even if some patterns / concepts remained beyond agreement * for each pattern, agree its abstract definition. * this means defining as much of the pattern in the IM as can be agreed, and not more. An example of one of the patterns, modelled in UML is the 'history of events' one here <http://www.openehr.org/uml/release-1.0.1/Browsable/_9_0_76d0249_1109157527311_7 29550_7234Report.html> . Could this or something like it be agreed across e-health for interoperably representing the common concept of a history of events? If sufficient patterns could be agreed, then an 'information model' consisting of these would in effect be a 'common information model' for the medical informatics community - whose scope is interoperable representation of the patterns contained within. It seems to me that this would be a great step forward. - thomas -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20110509/01ae944b/attachment.html>
