Thomas,
This is quit usable critique and I will certainly draw from it
in future revisions of the work.
You make the argument that OpenEHR is primarily for interoperability, and I
can accept that fundamental argument. It is difficult to swallow however,
when I hear the HL7 v3 wonks talking about how HL7 RIM is the solution to
semantic interoperability. Are they confused or are you confused, because
you are saying basically the same thing. From my perspective as in
implementer it looks awefully like a blueray vs HDDVD war and it looks like
OpenEHR is losing. But at the same time I keep hearing that HL7 RIM is
"compatible" with and might be "merged" with HL7 RIM.
Very confusing, and I have yet to see something compelling that can be done
in OpenEHR that cannot be done with HL7 RIM.
Having said that, HL7 RIM is a proprietary ontology/model and OpenEHR, is
not. That gives OpenEHR some usefulness even as an alternative model. Is
that where I should see the value? Here is an information model that
delivers semantic interoperability but is not proprietary?
On Fri, Feb 17, 2012 at 6:15 AM, Thomas Beale <
thomas.beale at oceaninformatics.com> wrote:
>
> Hi Fred,
>
> I think you are missing the point. The key thing we are working on in
> openEHR is *interoperability*, not open source. Open source health
> applications have historically not made any difference to interoperability,
> intelligent computing or anything else - they are the same as closed source
> systems that don't do any of these things. This is not to say that they
> aren't better quality software / solutions in other ways - some are very
> nice. But in general they have the same proprietary data formats and
> service interfaces as commercial solutions (making such definitions openly
> available doesn't change anything).
>
> Solving interoperability and intelligence in e-health (as for other
> domains) is very hard indeed, and solutions based on simple approaches only
> have marginal benefit. What matters to clinical people and actual health
> delivery is interoperability, regardless of closed or open source: open
> standardised (= widely agreed) information models, service interfaces and
> knowledge formalisms. Of course open source, done the right way does have a
> lot to offer, and can make the economics better, but it doesn't
> specifically address the interoperability problem.
>
> What I think you will see in the future is intelligent health computing
> platforms based on openEHR, or something like it (as you noted, Tolven also
> does not have much penetration today, but it also is a sophisticated
> solution that takes semantic interoperability seriously). See the CIMI
> forum <http://informatics.mayo.edu/CIMI/index.php/London_2011> to get
> some idea of the international backing for knowledge-driven architecture.
> Without these kind of model-driven architectures, semantic interoperability
> will remain a dream, as will any serious industry around decision support,
> business intelligence and data-based medical research, and any other
> application wanting to use computable patient-centred health data. Because
> of the time it has taken to mature the openEHR - and other related, and
> even competing - health computing platforms, solutions based on these
> platforms are only just starting to make serious inroads.
>
> I have no problem with your view of openEHR in terms of limited
> penetration (today), but what I think would be a little more positive would
> be for the open source sector to actually take part in solving
> interoperability, rather than continuing to add to the problem. There are
> real synergies to be explored. Much of the new work in openEHR and related
> architectures is coming out open source. It would be great if existing open
> source health application developers were to get involved - e.g. by working
> with us and others (e.g. HL7 HSSP, IHE etc) on e-health service
> models<http://www.openehr.org/wiki/display/spec/openEHR+Service+Model>.
> We on the other hand have a lot to learn about e-health applications.
>
> Finally, I would guess that e-health is about 10% of the way to a truly
> useful full-featured intelligent and open e-health platform of the future.
> That means that books like yours should potentially be educating readers on
> the likely future, not the status quo.
>
> - thomas
>
>
>
> On 17/02/2012 01:12, 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 listopenEHR-technical at
> openehr.orghttp://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical
>
>
>
> --
> [image: Ocean Informatics] *Thomas Beale
> Chief Technology Officer, Ocean Informatics<http://www.oceaninformatics.com/>
> *
>
> Chair Architectural Review Board, *open*EHR
> Foundation<http://www.openehr.org/>
> Honorary Research Fellow, University College
> London<http://www.chime.ucl.ac.uk/>
> Chartered IT Professional Fellow, BCS, British Computer
> Society<http://www.bcs.org.uk/>
> Health IT blog <http://www.wolandscat.net/>
> *
> *
>
> _______________________________________________
> openEHR-technical mailing list
> openEHR-technical at openehr.org
> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical
>
>
--
Fred Trotter
http://www.fredtrotter.com
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