If I might add to the debate about supporting clinical processes in e Health standards..
I've written about the complexity of healthcare, the need to support healthcare people (ie frontline clinical staff) and their processes with information technology, which requires standards and better value for money. While I think its impossible to get complete agreement on the right standard/information model required, right now I believe openEHR is a very good fit with whats needed. http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%e2%80%99s-potential-to-handle-complexity-diversity/ I don't suggest its the only way of doing it, but rather than debate this ad infinitum believe that tackling healthcare process improvements with information technology trialing these standards is the way to progress the science. I've suggesed greater open source collaboration between standards groups and those at frontline should help. Hence my push for Opereffa and recently locally in my hospital an open source portal project.. http://frectal.com/book/healthcare-change-the-way-forward/healthcare-change-why-%e2%80%9copen-source%e2%80%9d-is-part-of-the-recipe/ Thanks to others in this field who are also sharing their work publicly. As to the way from where we are to where we need to be may I offer a slide/picture that I find can help explain one way.. http://frectal.files.wordpress.com/2011/05/architecturemovetoopenplatformv2.png FYI, It is deliberately imperfect.. so no points for spotting problems with it. It explores 3 options A B C which I beleive are universally applicable. Option A is the current mess of >200 legacy systems I have in my hospital(s) that dont connect well and pose a large cognitive load on clinicians, .. for some this is the status quo option. Option B is move towards "best of breed" ie integration via whatever means are available, eg integration engines. Option C offer Ci) Rip and Replace with vendor X- (anyone keen on that dependency?) Cii) Open Platform - with key open source components (inc archetypes etc), to my mind the way forward The jump from A to C is huge for many people, too big for one leap. Locally here we are purusing Option B for now, ie integration with a web UI/portal layer facing the clinicians. I hope to be able to introduce a single archetype into that mix (eg Allergy) as the organisation realises we need agreement around core concepts.. Others from the "top 10", ie Problem/Diagnosis, Medication etc would be likely to be next likely contendors. Over time I see that an evolving standards based (eg archetype) could replace the current architecture in a move towards an open platform.. this would/will take years to achieve, but is the best current fit the with organic movement of the ecosystem I work within here. I'm guessing that most folk on the list are struggling with how to move from A to B towards Cii.. so I see that rather than waiting for national/international agreement on the ideal reference model, that most/all of those of us are tackling similar challenges at the frontline will leverage standards where they help (not hinder). Anything that offers help in sustainability, maintainability and ease of collaboration appeals here+... openEHR and related tooling appear to offer that potential...however I still dont have the openEHR tooling environment I need, as Toms says tooling costs money and as Seref notes the range of requirements are the size of an elephant.. So for a starter.. from a common clinical process perspective, who can offer a web-based (openEHR or other standard) widget/service to add clinical value in supporting documentation of adverse reactions/allergies at the frontline? If other approaches (i.e. via related tooling, not just debate/academic discussion/paper based standards) add value to support such common clinical processes then the complex ecosystem of healthcare will start to leverage.. Regards Tony Dr. Tony Shannon Consultant in Emergency Medicine, Leeds Teaching Hospitals Clinical Lead for Informatics, Leeds Teaching Hospitals Chair, Clinical Review Board, openEHR Foundation +44.789.988 5068 tony.shannon at nhs.net On 10/05/2011 08:03, Athanassios I. Hatzis, PhD wrote: > According to HL7 RIM there are four core classes > > Entity, Role, Participation Act > > Then one can relate healthcare domain concepts such as visit, admission, > patient, health care professional, health care organization, > observation, procedure based on these core classes. > > If there are standard, common, general, archetypes then obviously one > can use them in such a way to model clinical process ! > > I am not sure what is the equivalent of HL7 RIM core classes in openEHR > to model clinical process and how one can use archetypes in that respect. > > Athanassios > > PS: > > Athanassios: Why not implementing these standard archetypes with > classes-objects at programming level, if we agree the names of the > attributes (features) ? > > Thomas: Because this is exactly what we want to get away from; that is > the road to disaster - it is the 1980s approach where everything in the > domain becomes a class and/or a relational table. > > Fortunately there is a better approach that is emerging, whereby these > classes/XSDs/etc can be generated from templates, in such a way that the > data created can always be converted back to canonical form. > > Athanassios: I simply cannot imagine how one can escape completely from > defining the overall picture at conceptual (programming level), i.e. > defining standard, common, general ?archetypes? (core classes depending > on the problem to use). I suppose in many cases one would like to build > a completely new clinical information systems based on these core > classes and I expect highly complex business logic behind that to > capture both online and offline, dynamic and static, clinical, > administrative processes. So If there is indeed such a different way to > view software engineering as you mentioned, I think it will have to > become more understandable and common across developer communities > including RIMBAA and others. > > *From:*openehr-clinical-bounces at openehr.org > [mailto:openehr-clinical-bounces at openehr.org] *On Behalf Of *Colin Sutton > *Sent:* Tuesday, May 10, 2011 5:21 AM > *To:* 'For openEHR clinical discussions' > *Subject:* RE: on the possibility of 'one information model' in e-health > > Is there a ?healthcare workflow? ontology? > > E.g an ?encounter? archetype showing the possible interactions with the > EHR, specialised into ?Visit a GP?, ?Nursing housecall?, ?Hospital Grand > Rounds?, ?Specialist? templates etc. > > If these use cases could be agreed they could be a basis for separate > compatible implementations. > > Regards, > > Colin Sutton > > P.S. my interest is in including clinical trial registration and > feedback of clinical trial conclusions and systematic reviews into the > processes. > > *From:*openehr-clinical-bounces at openehr.org > [mailto:openehr-clinical-bounces at openehr.org] *On Behalf Of *pablo pazos > *Sent:* Tuesday, 10 May 2011 9:46 AM > *To:* openehr clinical > *Subject:* RE: on the possibility of 'one information model' in e-health > > Hi Ian, > > As I see the issue, the medical record internal structure (as a model) > could be an instance of "the healthcare ontology", and if some of these > models do not follow the general semantic rules of the ontology, then we > can say that they are bad defined. I mean that the ontology shouldn't > model the internal structure of the medical records, I think it have to > model the big record entities (maybe compositions, sections and > entries), and other related entities like persons, organizations, roles, > resources, processes, etc. There's one (bad) thing we do over and over > again while modeling clinical records: separating the clinical process > from the record of the process. If this "almighty healthcare ontology" > can be created some day, I think we must model the clinical process > first, and then the clinical record that tells the story of one > excecution of the process (because the record is just that, information > about an instance of the clinical each process). > > Just my grain of sand :) > > -- > Kind regards, > Ing. Pablo Pazos Guti?rrez > LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez > Blog: http://informatica-medica.blogspot.com/ > Twitter: http://twitter.com/ppazos > > ------------------------------------------------------------------------ > > From: Ian.McNicoll at oceaninformatics.com > Date: Mon, 9 May 2011 14:03:18 +0100 > Subject: Re: on the possibility of 'one information model' in e-health > To: openehr-clinical at openehr.org > > Hi Pablo, > > At a very high-level you may be correct but the big problem with most > medical record structures is that they are currently too variably > defined used and understood to be ontologised. Try thinking about the > challenges of ontologising the structures of governments across perhaps > Europe and you will get a flavour of the challenge. One of the benefits > of the archetype approach is that it allows us to focus on small areas > but with a broad audience to try and get small pockets of usable > consensus. Perhaps in the future much of this will be 'true' enough to > define ontological relationships but we are a long way from that position. > > 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 <mailto:ian.mcnicoll at > oceaninformatics.com> > > Clinical Modelling Consultant, Ocean Informatics, UK > openEHR Clinical Knowledge Editor www.openehr.org/knowledge > <http://www.openehr.org/knowledge> > Honorary Senior Research Associate, CHIME, UCL > BCS Primary Health Care www.phcsg.org <http://www.phcsg.org> > > On 9 May 2011 13:51, pablo pazos <pazospablo at hotmail.com > <mailto:pazospablo at hotmail.com>> 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. 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. > > -- > Kind regards, > Ing. Pablo Pazos Guti?rrez > LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez > Blog: http://informatica-medica.blogspot.com/ > Twitter: http://twitter.com/ppazos > > ------------------------------------------------------------------------ > > Date: Thu, 5 May 2011 17:20:59 +0100 > From: thomas.beale at oceaninformatics.com > <mailto:thomas.beale at oceaninformatics.com> > To: openehr-technical at openehr.org > <mailto:openehr-technical at openehr.org>; openehr-clinical at openehr.org > <mailto:openehr-clinical at openehr.org> > > > 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 <mailto:openEHR-clinical at openehr.org> > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical at openehr.org <mailto:openEHR-clinical at openehr.org> > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > > > _______________________________________________ openEHR-clinical mailing > list openEHR-clinical at openehr.org <mailto:openEHR-clinical at openehr.org> > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > > ------------------------------------------------------------------------ > > This e-mail message has been scanned for Viruses and Content and cleared > by *MailMarshal * > > ------------------------------------------------------------------------ > ------------------------------------------------------------------------ > > IMPORTANT NOTICE: This e-mail and any attachment to it are intended only > to be read or used by the named addressee. It is confidential and may > contain legally privileged information. No confidentiality or privilege > is waived or lost by any mistaken transmission to you. The CTC is not > responsible for any unauthorised alterations to this e-mail or > attachment to it. Views expressed in this message are those of the > individual sender, and are not necessarily the views of the CTC. If you > receive this e-mail in error, please immediately delete it and notify > the sender. You must not disclose, copy or use any part of this e-mail > if you are not the intended recipient. > > ------------------------------------------------------------------------ -- ******************************************************************************************************************** This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. 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