Hi all,
I’ve been a long-time lurker in the lists while doing my PhD and I still try to
keep tabs with what openEHR is doing. I wanted to react and take part in this
discussion particularly because their paper resonated with me in some points
(and not in others). I think the paper has merit and I’m interested (and quite
jealous of too) that they did what I had wanted to do eventually with openEHR
had time been kinder: to look and compare the global openEHR and the local
openEHR(s).
The paper’s finding that you cannot separate social issues from technology is
not new; and there is an inherent tension between a computer system that is
based on simplification and closure (determinate states), from desires of
freedom and flexibility usually associated with the social (yet, has anyone not
felt the functional-driven approach set by bureaucracy without the need of any
technology). So, although their point on the illusion of separation between the
social and technical is correct; it is also true for every information system
there is, past, present, and no doubt, future. This includes the accounting
books from the middle-ages which tried to settle down some concepts (money in;
money out), while giving flexibility to other concepts (varying prices of
cereals; intangible assets, etc.).
When I researched the global openEHR (in contrast to implementing ones), I
found that the project had harnessed open source in ways which made the
modelling of ambiguous requirements possible precisely because there was no
concept of determinacy. I remember a long series of discussion (Nov 2010?)
between Thomas and Ed regarding openEHR’s way of thinking about requirements,
contrasting it with the notion of design by committee behind (relatively)
closed doors. The public space that open source affords openEHR is not just a
trendy word, but it can create what Chris Kelty refers as ‘recursive commons’,
a sort of space that respects certain values and logics (in his study, Free
software) that can function with relative independence from competing logics
that threaten its own existence (in his study, closed software).
As an open source project, openEHR is quite special in what it does. Whereas
open source usually puts the ability for local populations (schools,
architects, etc.) to collaboratively ‘own’ methods of productions (otherwise in
the hands of those who have the key to closed software). openEHR creates this
ownership ability at a conceptual level, necessarily removed (but never quite
so) from local contexts. I remember a discussion between Heather and Ian (in
2010?) on an allergen-related archetype with a doctor who was particularly
concerned for personal reasons and what constituted a ‘good’ archetype relative
to templates and local concerns (thus taking local concerns into account at
this global level).
What ‘good’ means is extremely ambiguous in all cases, but that’s the point and
openEHR’s greatest contribution and greatest challenge: the global project has
purposefully put the definition of ‘good’ in that very public space of the open
source world, and I don’t think it would be inaccurate to say that openEHR has
thought this through already (e.g. governance change) and will continue to do
so (e.g. local ambassadors). In this sense, I don’t see at all that openEHR is
technologically deterministic, on the contrary. Yet the implementation side
requires some forms of simplifications and closures (Luhmann’s concepts, not
mine), not necessarily at odds. The question I think, becomes one of building
bridges between the diverse communities involved (whether level—national, or
context—small clinic, etc.) in processes of community engagement. How this can
take place is extremely challenging involving both strategic and tactical
thinking. Strategic: how to create a coherent whole (e.g. that openEHR’s
mission is shared and adapted by the various levels), and tactical: how to
involve clinicians more easily (e.g. the use of soft systems methodologies to
understand local worlds).
By the way Thomas, I’m really interested in what you have to say regarding the
ABD. There are theories in information systems regarding activity theory and
I’m curious to see if there are any connections with that.
Daniel
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