Dear all, It's great to see some healthy debate over these issues of openEHR vs "the rest" of open source in healthcare.
I know enough of Fred Trotters writings to know he must be a good guy, raising awareness of open source in healthcare for the common good. Equally I've been an advocate of openEHR for some years now. While some of the issues raised may make some uncomfortable there is no value in shooting the messenger here at all and I appreciate this discussion. So Fred thank you for making the effort to mail this list, honestly admitting some issues with your original article and usefully exposing other key issues here... ..such as, why many folks (including ourselves!) may not yet easily understand the right place for openEHR in the world. Fred and Tom have already had a useful exchange which illustrates some of the gap between those who promote open source and openEHR. That there is any gap in understanding across these niche fields illustrates how early this informatics science is. We all need to communicate the place of open source and openEHR better. Please see my related articles here which I hope are a help. (Further feedback welcome and I'll make these easier to find from openEHR.org) http://frectal.com/book/healthcare-change-the-way-forward/ Healthcare Informatics needs to pursue not just the holy grail of semantic interoperability at an international/ national level, but a better fit with the complexity of healthcare and core clinical processes at the frontline. Furthermore better usability, scalability and maintainability of locally/nationally developed solutions are all required. My original involvement in openEHR stemmed from these interests in healthcare improvement and the people process & technology issues within. As I've looked at the diverse Complex Adaptive System that is healthcare, amidst the many teams I work with I see common patterns in process everywhere... such that I believe healthcare needs a generic, clinical process oriented, service oriented architecture platform, which I believe openEHR and its two-level modelling can offer. http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%e2%80%99s-potential-to-handle-complexity-diversity/ This complex system & people/process/technology approach is key for me in explaining both the value of openEHR and open source. On the other hand if we make the case for openEHR as key to semantic interoperability alone, the layman would be rightly confused as semantic interoperability currently has several other champions (HL7/IHTSDO etc)). In the past the openEHR archetype & template paradigm has usefully allowed me to design clinical templates for chest pain, abdominal pain, head injury pathways that reuse the same clinical components (archetypes). Yet I would be the first to accept Freds useful criticism that openEHR designs (inc my own) have not yet been usefully/widely implemented at the frontline. So I've come to the view that there is a key gap between the eHealth standards efforts (inc. openEHR et al) and innovators at the frontline.... which I believe open source and related tooling will be key to bridging. Which is one of the reasons I've more lately turned to more pragmatic frontline efforts (such as a local open source clinical portal development). http://frectal.com/2011/10/21/leeds-takes-a-lead/ So I share the view that open source is a key ingredient required in the healthcare ecosystem. However I'm aware that a myriad of open source efforts may just perpetuate the disconnect in healthcare, i.e. open source approaches are not enough to address healthcares problems alone. Therefore I suggest that open source and openEHR efforts should be compared/aligned/combined where possible. Therefore the way forward should not be about choosing between pragmatic open source efforts (eg NHIN Direct/Connect) and a more purist openEHR way. We simply need to align the efforts of those tackling frontline challenges with pragmatic open source efforts and the long term goal that openEHR serves. Such is the approach we are now taking here in Leeds, where we are planning to align our open source clinical portal effort with a small number of clinically useful openEHR archetypes (ie Adverse Reaction, Diagnosis etc) within our Service Oriented Architecture plans. Finally I would not wish to see openEHR explained as a rare and purist aspiration, nor open source as a cheap shortcut - but both offering key useful elements into the healthcare ecosystem that we are all trying to improve. Hope that helps, Kind regards, Tony Dr. Tony Shannon Consultant in Emergency Medicine, Leeds Teaching Hospitals NHS Trust Clinical Lead for Informatics, Leeds Teaching Hospitals NHS Trust Honorary Research Fellow, University College London Director, Frectal Ltd. +44.789.988 5068 www.frectal.com Date: Sat, 18 Feb 2012 23:09:36 +0000 From: Thomas Beale <thomas.beale at oceaninformatics.com<mailto:[email protected]>> Subject: Re: Meaningful Use and Beyond - O'Reilly press - errata To: openehr-technical at openehr.org<mailto:openehr-technical at openehr.org> Message-ID: <4F402FB0.6010706 at oceaninformatics.com<mailto:4F402FB0.6010706 at oceaninformatics.com>> Content-Type: text/plain; charset="iso-8859-1" Fred, that's pretty much it. We can disagree whether we should solve the sem-interop problem now (us; harder, longer) or later (you; get more going faster), but that's not a real debate - in some places our view makes more sense, in others yours is the practical sensible approach. Our main aim is to enable /intelligent computing/ on health data; doing that means semantic interoperability has to be solved. Otherwise, there is no BI, CDS or medical research based on data. My only worry about not taking account of semantic / meaning issues now is that it will cost more later, than if it were included now. I still think that there is synergy to be explored in the coming 12m-2y between the openEHR community and the open source health Apps community (if I can call it that). - thomas On 18/02/2012 20:55, fred trotter wrote: > > > > (please, no flame wars, below I am just trying to explain _my_ > point of view to Fred;-) > > > There is no need to worry about a flame war. I am certainly dubious, > but I take what you guys are doing and saying very seriously. > It seems like you are taking a totally different approach to semantic > interoperability than I generally favor. > > My view is that semantic interoperability is simply a problem we do > not have yet. It is the problem that we get after we have > interoperability of any kind. This is why I focus on things like the > Direct Project > (http://directproject.org<https://web.nhs.net/owa/redir.aspx?C=e070771f1cb04f3c913c799823a7b732&URL=http%3a%2f%2fdirectproject.org>) > which solve only the > connectivity issues. In my view once data is being exchanged on a > massive scale, the political tensions that the absence of "true > meaning" creates will quickly lead to the resolution of these types of > problems. > > The OpenEHR notion, on the other hand, is to create a core substrate > within the EHR design itself which facilitates interoperability > automatically. (is that right? I am trying to digest what you are > saying here). Trying to solve the same problem on the "front side" as > it were. > > Given that there is no way to tell which approach is right, there is > no reason why I should be biased against OpenEHR, which is taking an > approach that others generally are not. > > If that is the right core value proposition (and for God's sake tell > me now if I am getting this wrong) then I can re-write the OpenEHR > accordingly. > > Regards, > -FT > * ******************************************************************************************************************** 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. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. NHSmail is the secure email and directory service available for all NHS staff in England and Scotland NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients NHSmail provides an email address for your career in the NHS and can be accessed anywhere For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail ********************************************************************************************************************
