Dear All,while there may be some benefit in cross pollination between SNOMED CT and archetypes, and while there also may be some low-hanging fruit in bridging the semantics of both models (pre- or post-coordinated laterality would be an often mentioned example) in general I'm a skeptic for a few reasons :
* the use cases are not the same - ontologies represent universal truths about the world, archetypes represent record keeping requirements * ontologies and archetypes have different "reasoning" requirements and thus different representation languages, algorithms etc. (the ontology-information model separation is a divide-and-conquer approach) * for ontologies to compute meaningfully, a larger degree of consistency is needed, archetypes may be (and are being) developed and used with such a need
(ontologies here refer to (at least) DL ontologies in general, archetypes to any information modeling framework)
/Daniel On 2016-04-29 16:01, Ian McNicoll wrote:
Hi Bert, This is going to sound controversial but ...I am a big fan of SNOMED-CT and at some pint in the far distant future, what you are proposing (or something like it) will happen. However, I have seen endless similar proposals/projects in the UK and beyond, entranced by the potential of post-coordination, repeatedly falling over, wasting huge amounts of resource and energy and achieving nothing. That includes CIMI, which has, IMO, been largely stalled by setting itself the goal of labelling all CIMI nodes as SNOMED terms, and for archetypes being 'iso-semantic' with post-coordinated SNOMED expressions.Whilst this is a laudable goal, it is hugely complex and it is, I think significant that where progress has been made (openEHR and FHIR) both have largely taken a prgamatic and limited approach to use of SNOMED-CT.SNOMED is a primarily an ontology of biomedical fact, not of clinical practice/documentation. Used@Erik - we have only just been asked to resume discussion with IHTSDO. The view of the MB is that it is not our place to police the use of SNOMED-CT by end-user systems. All SNOMED-CT bindings in openEHR artefacts are optional mappings. We are happy to add a boilerplate license to each archetype (as for any third-party IP) that implementers must ensure that any use of SNOMED-CT is allowed. There is no intention to otherwise adapt or strip-out content for unlicensed consumers, as I think you were suggesting. If IHTSDO feel the need to enforce more onerous terms than a simple boilerplate "Please respect IP" statement, I think we might find that very problematic.Regards, Ian Dr Ian McNicoll mobile +44 (0)775 209 7859 office +44 (0)1536 414994 skype: ianmcnicoll email: [email protected] <mailto:[email protected]> twitter: @ianmcnicollCo-Chair, openEHR Foundation [email protected] <mailto:[email protected]>Director, freshEHR Clinical Informatics Ltd. Director, HANDIHealth CIC Hon. Senior Research Associate, CHIME, UCLOn 29 April 2016 at 15:45, Bert Verhees <[email protected] <mailto:[email protected]>> wrote:Thanks Erik, for your reply. I did some more thinking in the meantime. In SNOMED you have disorders, and they have attributes, and we all know there are thousands of them. Writing so many archetypes is impossible, and probably not necessary, but when you take in account to limit the number of used paths, (this helps also limiting the length key-index for a key value store), and you really think smart how to do it, so it can be generated. Because SNOMED is in fact a description of many clinical meanings with post-coordinate expressions and allowable attributes, just like archetypes are a way to describe the same, it seems quite a potential, especially because it can be used to generate archetypes, I had never thought of the idea until yesterday. So I haven't worked it out. I don't know which part is of high quality and how you define high quality, (or do "they" define it?), and also to consider, are archetypes always of high quality? Archetypes are version-able, so, they could follow SNOMED versions. You cannot build the world in one day. It has to grow, but a lot of work can be done in one major blow. In the Netherlands we can use SNOMED for free, so that is a good thing. By the way, the semantics which are baked in the OpenEHR RM make it a bit more difficult. I think that a data-storage, modeled like CEN13606 would make it easier to do this. But it may also be possible in OpenEHR, we must work it out, to find it out. Bert On 29-04-16 14:15, Erik Sundvall wrote:You can do some very clever things with Snomed CT especially if using "post-coordination" in a good way. Sadly many current EHR-systems can't utilize that power of Snomed CT fully. Clever archetyping with e.g. some built in post-coordination-generating logic combined with some extended (AQL?)querying-capabilities in openEHR storage systems could help openEHR-based systems jump ahead of a lot of the EHR competitors regarding efficient Snomed CT use... It is often good to look at Snomed CT when designing archetypes. Especially the high quality parts of Snomed CT (there is constant maintenance and cleanup going on). I believe this is happening more already when designing archetypes today. Regarding licensing I believe there has been a discussion going on between IHTSDO and the openEHR foundation for a long time, perhaps the management board has an update? I believe we might need to add a function to repositories/CKMs that removes Snomed bindings/codes from archetypes if downloaded by non-licensed users. (A lot of the structure/content itself is based on (non protected) general medical knowledge and I believe IHTSDO concludes it can be partly reused without license, thus not stopping global use of Snomed-inspired archetypes.) Others will surely add more to the discussion. //Erik Sundvall Sent from mobile... fredag 29 april 2016 skrev Bert Verhees <[email protected] <mailto:[email protected]>>: Part two is of course, generating templates, and we almost have the GUI's in place. It is the enormous collection of medical datastructures which can be the source of many generated EPD-software. Bert On 29-04-16 08:50, Bert Verhees wrote: Hi, I got an idea when reading the nice story from Heather on LinkedIn. In fact it is hers idea, but in a opposing way. https://www.linkedin.com/pulse/journey-interoperability-part-i-heather-leslie https://www.linkedin.com/pulse/journey-interoperability-part-ii-heather-leslie I wonder in how far it is feasible and useful to create archetypes from SNOMED concepts, it would be possible to generate them, with attributes and so on. In a few hours time, one would have a complete forest with archetypes, including ontology in more languages. Maybe some smart handling, filtering, combining can create a better collection, also looking at the paths, so that there are similar paths for similar situations, to keep the number of different datapoints low, which can help creating a faster key-value storage. I don't know how it is about copyright, with members, and licensing, that should be looked at. The argument that SNOMED is fragmented should not count, I think (however without having an expertise on this), because, when working with handwritten archetypes will always be incomplete and fragmented. Bert _______________________________________________ openEHR-technical mailing list [email protected] http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org-- Sent from mobile._______________________________________________ openEHR-technical mailing list [email protected] <mailto:[email protected]> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org_______________________________________________ openEHR-technical mailing list [email protected] <mailto:[email protected]> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org _______________________________________________ openEHR-technical mailing list [email protected] http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
-- Daniel Karlsson, PhD, sr lecturer Department of Biomedical Engineering/Health informatics Linköping university SE-58185 Linköping Sweden Ph. +46 708350109, Skype: imt_danka, Hangout: [email protected]
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