Hello Bert I think that this is an interesting topic from a number of aspects.
Can I please ask what do you mean by "clinicians create archetypes with unpredictable paths"? Can you provide one or two examples? Also about the "something, that is: PATTERN", David Hay has written an excellent book "Data Model Patterns: Conventions of Thought", which although old (by now), is very well structured. A partial listing of its table of contents so that you get what I am trying to say here: The enterprise and its world Things of the enterprise Procedures and Activities Contracts Accounting The Laboratory Material Requirements and Planning Process Manufacturing Documents The "The enterprise and its world" section outlines basically every "system user" database, I dare say, ever. Are you thinking about taking a look at the healthcare environment and then coming up with openEHR patterns that can commonly address each? I think that this could be done even automatically, given the existence of enough archetypes / templates and the fact that they are machine readable with enough semantics to infer commonalities and structure. All the best Athanasios Anastasiou -----Original Message----- From: openEHR-technical [mailto:[email protected]] On Behalf Of Bert Verhees Sent: 15 February 2018 15:41 To: For openEHR technical discussions Subject: Archetype pattern An interesting wiki from Heather Leslie https://openehr.atlassian.net/wiki/spaces/healthmod/pages/90507705/Archetype+Design+Patterns She concludes that pattern are necessary, I agree with that, and she also concludes that clinicians are better modelers then technicians. Well, that depends, of course it is very important to have domain-knowledge when modeling data, and clinicians have the best domain-knowledge. So from that point of view, she is right. But what we have seen until now is that clinicians create archetypes with unpredictable paths. And that is bad, because it makes it very difficult to find data and it makes it easy to miss important data, because some data were on a path where one did not expect them. OpenEhr works fine to find data which are on a known or predictable path, but what if data are on an unknown path? Let me explain by comparing this to a classical relational health-application. There are similarities. I have seen classical relational systems which experienced a wild-grow in number of tables, I have seen once in a prestigious university-hospital where they had a grown of 7000 tables in 20 years, more then one per day!! No one understood the meaning of all the tables and data, no one dared to use data he did not understand, many data were and still are redundant. Every new development in the ICT starts with designing new tables. How can in such a situation a clinician research a persons medical record, even with the help of the current technical staff, this is often impossible. So, important information can get lost. Adding to this are software-updates which often cause a clean-up, and that clean-up is also done by people who do not always know what they clean up. People live long, and a medical problem they had 30 years ago can be important to find to solve a current problem. So old data, and understand them, and be able to find them, can be important. This can also happen with archetypes. Every new development in a application can start with a new archetype, and at a moment there can be thousands. It is impossible for a clinician to search all possible paths for medical information, even with the help of the current technical staff this can be impossible. The old data-hell situation will not be solved by OpenEhr if there is not something behind it. And that something, that is: PATTERN It is not only a clinical thing to understand how pattern in paths are best modeled, it is in fact also a technical thing. Clinical knowledge is not stable, the thinking about clinical facts change all the time, what now is important is tomorrow maybe not. So the pattern need a technical, mathematical base, that, something like Codd-normalization, but of course then applicable to archetypes. The Wiki from Heather Leslie is a good starting point for the design of pattern and stop the proliferation of paths. I described an approach to solve this problem in a blog, one and a half year ago. http://www.bertverhees.nl/openehr/medical-data-context/ I had some discussion about that, but many had problems against the use of SNOMED in this context. So, maybe read it and forget SNOMED ad find something else to structure the medical data. Bert _______________________________________________ openEHR-technical mailing list [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
