Hi Phillipe and Graham,

This may help your discussion:


Unfortunately, it only gives a high level view of where SNOMED CT is used, for 
example, if you look at the map, it mentions, “Leeds Teaching Hospitals decided 
to embrace SNOMED CT in their Emergency Department”.   However, I wonder, why 
the many other departments in that hospital are not using SNOMED CT too?  I 
would really like to know where the true successful implementations of SNOMED 
CT are?  Where I mean an implementation, I don’t mean for example a just a 
mapping from one terminology to another, like mapping READ codes to SNOMED CT, 
but also using the post coordination functionality of SNOMED, and making full 
use of the hierarchical structure of SNOMED CT.

I am get the impression that SNOMED CT is hard to implement, and therefore 
wondered if we are at some kind of tipping point, like where HL7v3 was a few 
years ago, and some bright spark came along, and now we have FHIR that is 
gaining great traction in the health community due to the ease at which it can 
be implemented.


John George
Technical Modeller
Interoperability and Architecture/ Paperless 2020
0113 397 4193 | 07770 408306


NHS Digital provides information and technology for better health and care.
Find out more about us: www.digital.nhs.uk<http://www.digital.nhs.uk/> | 

From: openEHR-technical <openehr-technical-boun...@lists.openehr.org> On Behalf 
Of Philippe Ameline
Sent: 13 March 2018 10:57
To: openehr-technical@lists.openehr.org
Subject: Re: [Troll] Terminology bindings ... again


What you state is plainly valid, and the "it exists" argument is not to be 
considered lightly.

However, as an engineer and a developer, I always try to measure the payload of 
a component when I consider using it. Where does it fit in the "pair of wings" 
to "dead horse" range?
IMHO, HL7 and Snomed are not on the right side and adopting such components is 
like drilling in concrete: it never becomes easier.

When it is about considering costs, I can argue that something that is "not 
well born" will cost considerably more than necessary during its entire life 
span. Any such technique is hard to build, hard to integrate and hard to 
maintain. As a guy that built and operate a self made 54000 atomic terms 
ontology, I can tell you that addressing this issue in the proper way can save 
considerable amount of money and (this is the most important part of it) free 
considerable energy that can be invested in reinventing health instead of 
plaguing practitioners with new burdens.

My aim with this "troll" was just to tell that this kind of questioning exists 
and also that some "fools" are currently joining to create what they think 
could be "well born components".

I have the feeling that it is high time we "leapfrog" in being able to 
"organize the journey" from the patient's "bio-psycho-social bubble" instead of 
getting dedicated to "siloed care center boxes"... and that HL7 and Snomed will 
keep their users in the wrong reference frame.

Time will tell... but interesting times ahead!


Le 13/03/2018 à 11:05, Grahame Grieve a écrit :
hi Philippe

No one who's actually tried to use Snomed CT could think that in it's current 
form it's the answer to everything.
But anyone who's tried to work on real terminologies must also be aware of just 
how much work is involved in these things.

So there's very much a glass half full/empty thing here. I understand not being 
thrilled with Snomed CT as a choice, but as the french government, for 
instance, actually confronted how much more it will cost to do something else?

There's more than one kind of club to have that wastes money....

I've had a quick look at Meriterm... like all good rdf, it's not easily 
penetrable. But it looks like the authors are not informed about Cimino's 
desiderata... which brings us back to the wasting money thing...


On Tue, Mar 13, 2018 at 8:19 PM, Philippe Ameline 
<philippe.amel...@free.fr<mailto:philippe.amel...@free.fr>> wrote:

Pablo, I wish you sincerely all the best.

IMHO, the question is not really to enroll but to deliver... and considering 
the tremendous amount of money that was invested in HL7 and Snomed (both to 
elaborate and try to implement) and the actual societal return, there is such a 
discrepancy that the hypothesis that, due to missing the "information society" 
turn, health systems are entering terrible crisis times is to be considered 

In current "information society", you have two options when considering "health 
information systems":
1) You dedicate yourself to "medical information systems" instead, and can 
freely build for (inter-connected) silos,
2) You consider "health" in its genuine meaning and you have to realize that it 
is a complex domain fully opened to all other societal issues... hence should 
ban components that are endemic to medicine.

Maybe (and I really mean it for Latin America), it should be high time to 
leapfrog, not to join the "dollars wasting club" ;-)


Le 12/03/2018 à 18:17, Pablo Pazos a écrit :
In Latin America is all the contrary, more countries are becoming SNOMED 
members and adopting SNOMED at the govt level.

On Mon, Mar 12, 2018 at 10:18 AM, Philippe Ameline 
<philippe.amel...@free.fr<mailto:philippe.amel...@free.fr>> wrote:
Le 12/03/2018 à 01:38, Pablo Pazos a écrit :

> IMO we should focus on SNOMED.


There is currently some kind of interesting momentum against Snomed.

It can come from governments that refuse to pay for it (current mood in
France), of from practitioners who, after having been asked by their gov
to "sort out their Snomed subset" came to the conclusion that it doesn't

<Troll>Some also predict that the most certain result of keeping up
trying to build systems using such shitty fully endemic components is to
have medical doctors disappear from missing the "information society"

Have some of you been aware of the Meriterm (European) project?



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