Hi Fred, Being neither part of the target audience of your book, nor an openEHR user/implementer, allow me to focus on one the factual core statements that was objected to:
> OpenEHR is a [..] approach to applying knowledge engineering principles > to the entire EHR [..]. You might think of Open-EHR as an ontology for EHR > software design. This perception (whether true or not) will probably resonate with the EHR&Interoperabilily community that I'm usually dealing with. The perception is that openEHR is about systems architecture and systems development, whereas that's less true for its "predecessor", the EN/ISO 13606 standard. However, as Thomas points out, to state that openEHRs primary focus on software design wouldn't do it justice: that's a means to an end. The raison d'etre is achieving interoperability. TTYL, -Rene On 2012-02-17 02:12, fred trotter wrote: > Hi, Fred Trotter here, one of the two authors of the book in question. I > wrote the portion covering OpenEHR, so I believe your complaints will > ultimately come to rest with me. > > Generally however, let me put forward a note on how we are thinking at > O'Reilly . This book has been very popular, and we are pretty happy with > it. But it important to understand who this book is targeted to. We > intended the book to be focused towards O'Reilly's primary readership, > which is IT professionals and programmers. People who have no health IT > experience. We have been pleased that clinical types have enjoyed it, > but we were not aiming at them. We are also not currently selling the > book in book stores. It is available only on the web and it has been > overwhelmingly a e-book seller. This is the trend generally at O'Reilly > and has been changing how we think about book publishing. I hope that > give a little context here. > > With that in mind, we wrote the book very quickly and with an aim at > overviewing everything that an IT generalist needs to know about health > IT. That means we intended it to be a mile wide and an inch thick. That > inch needs to right however, and we will be fixing all of the real > errors that we find. O'Reilly has realized that book publishing in the > e-book era is alot more like software publishing than > anything Gutenberg might have envisioned. We use software tools for > revisioning, for tracking errata (bugs) for making changes and for > pushing those changes out automatically to our readers. We also use what > amounts to a free beta release process where we put the manuscript > online for free for people to comment on in its pre-production state. > Our book had the dubious honor of receiving more feedback during this > process than any other O'Reilly book before us. Why? because doing a > comprehensive book on health IT is extraordinarily difficult. We are > covering lots and lots of technology issues that have deeply specialized > medical-technical hybrid experts working on them and those experts, with > all due respect to those of you in academia, are mostly disconnected > from the boots on the ground programmers (which both David and I are) > who have been actually implementing widely used systems for years. We > took a tremendous amount of productive criticism from both sides of that > river and we hope the book was made better for it. > > > Firstly is the claim by one of the authors, David Uhlman, that he was CTO > > of openEHR in 2001 > > - a claim which Thomas Beale denies. > > > Those less likely to believe that we would make outragous resume claims > are quite correct. After much debate late in the book, David and I > decided to go exclusively with the term EHR, rather than EMR. We believe > (and we argue in the book) that the industry uses these terms > interchangeably (whether or not they are right to is another question), > but ONC had been clear... > http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/ > > that they were focused on EHR systems, based on their reasoning that EHR > systems were intended to be interoperable and EMRs were not. (of course > that entirely depends on your definition of the two acronyms). We > decided to bow to the ONC position on the term and replace all mentions > of the term EMR with the term EHR. This decision came very late in the > editing process and I decided to do a find and replace on the text. > Obviously I made a mistake and replaced Davids OpenEMR experience with > OpenEHR. > > In short, this mistake is a typo. Thanks for pointing it out to us. > > I also state in the book: > /OpenGALEN and OpenEHR are both attempts to promote open source ontology > con- > cepts. Both of the projects have been maturing but some view these as > unnecessary > additions or alternatives to SNOMED+UMLS. However, they are available > under open > source licensing terms might make them a better alternative to SNOMED > for certain > jurisdictions./ > > Then I wrote: > /OpenEHR is a controversial approach to applying knowledge engineering > principles > to the entire EHR, including things like the user interfaces. You might > think of Open- > EHR as an ontology for EHR software design. Many health informaticists > disagree on > the usefulness of OpenEHR. Some believe that HL7 RIM, given its > comprehensive > nature, is the highest level to which formal clinical knowledge managing > needs to go./ > > Now, these are complex statements about OpenEHR. I am sure I might have > gotten some of the details about OpenEHR wrong here. If I have done > that, then please help correct me. I am all ears. > > Still, I find it interesting how you can claim that they are > "blatantly false statements" and/or "Pot-shots and misstatements" about > OpenEHR. These are just asides regarding OpenEHR. They need to be > correct, and if they are not we are happy to fix them. But OpenEHR at > this stage, only deserves a few paragraphs of coverage in a generalist > focused Health IT book. I am not convinced that OpenEHR is a relevant > technology, and I believe David's assessment would be even more dour. > > Here is the bottom line reality: the Open Source EHR space has matured > dramatically in the last 10 years. There are handful of projects that I > know of that have literally hundreds of installations worldwide: the > VistA variants, OpenMRS, OpenEMR, and ClearHealth. There are some other > important projects that have potential, like Tolven, that I know of, but > they simply have not garnered hundreds of installations. > > I would be very happy to be proven wrong here, but as far as I know, > there is no Open Source EHR that has been installed at even over 100 > sites that has been based on the OpenEHR. I do not really care about > proprietary land, because there are literally hundreds of different ways > to architect an EHR system that are implemented by proprietary vendors. > Again, please correct me if I am wrong, but I believe that means that > the vast majority of EHR installations do not use OpenEHR. Frankly only > a substantial fraction of those know anything about SNOMED/UMLS/RIM. > > Please do not reply to me and tell me "but we are using OpenEHR in my > hospital/clinic/school" that is great for you but that is not anything > like wide-scale adoption. I know that OpenEHR has made inroads to > several of the national systems, and that is really great. It is what > earned OpenEHR a mention in the book at all. But nationalized EHR > systems are a the perfect place to have "standardization for the sake of > itself", which means that while OpenEHR is being used successfully, > there is no compelling reason why they could not just have gone with > some other solution. As far as I am concerned, the nationalized systems > that have adopted OpenEHR really count as a handful of > really enormous installations. > > I respect that you all have worked hard on this and I respect the > careful thinking that you all seem to be doing, but OpenEHR is the kind > of standard that is only really helpful if everyone is doing it. I do > not see that kind of adoption happening. OpenEHR seems to be, in my eyes > and in they eyes of on the ground Health IT implementors as a solution > looking for a problem. > > With that in mind I challenge you to find any health IT book, aimed at > the US market, by a major publisher that even mentions OpenEHR. I know > you guys are working hard and I know you have managed to convince some > impressive technologists to your way of thinking (most notably Tim > Cook). I do not see other books on meaningful use, or health IT in the > US covering you -at all-. I am doing this to hedge my bets. I know I > could be totally wrong about where OpenEHR is heading. Guessing what the > future holds is pretty difficult. > > At this point my mental summary for OpenEHR is one of the many > "technically right but will never be adopted" technology ideas. I cannot > write a book which is intended to warn IT people about all of the > fruitless investments that they should expect to see all over the place > in Health IT and give OpenEHR a free pass because I know and like some > of the founders. Is OpenEHR a relevant technology or an interesting foot > note? It is my job to make that technical decision and then include the > results in the book. Right now, OpenEHR made the cut to get a mention in > the book, but not the cut for me to say "hey this is a good idea". > > With that in mind, I would be happy to have factual corrections > regarding OpenEHR which we can include in the next update to the book. I > would also be happy to have someone on this list convince me that I am > wrong about my assessment of OpenEHR. It is difficult because I see so > much of what I have concerns about already mirrored on the OpenEHR list: > > http://www.openehr.org/mailarchives/openehr-implementers/msg00880.html > > Again, you do not need to convince me that you are "right" about the > OpenEHR designs, you need to convince me that OpenEHR is "relevant". > Being right, sadly, has little to do with adoption. For instance, I am > typing on a QWERTY keyboard right now, but I am convinced that this lady > is technically right: > http://workawesome.com/productivity/dvorak-keyboard-layout/ > > I am just convinced that she is relevant. > > -FT > > > > > > > > > > > > > -- > Fred Trotter > http://www.fredtrotter.com > > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- ------------------------------------------------------------ Rene Spronk Cell: +31 (0)655 363 446 Senior Consultant Fax: +31 (0)318 548 090 Ringholm bv The Netherlands http://www.ringholm.com mailto:Rene.Spronk at ringholm.com twitter:@Ringholm skype:rene_ringholm Ringholm is registered at the Amsterdam KvK reg.# 30155695 ------------------------------------------------------------ Ringholm bv - Making Standards Work - Courses and consulting
