Philippe, I don't understand why you ask about HL7 and SNOMED in the same
question, they have nothing in common and have a complete other purpose,
nor are they depending on each other. I have no opinion about HL7, which
version, which of the many substandards? It is a too large subject for a
simple question.

I do have opinions about SNOMED and I agree it does not offer a complete
grammar like a natural language does, so to tell a story will be hard in
SNOMED-terms. Do we need that? As far as I can see it can describe every
medical condition, and if it cannot, there is room for several ways of
extending it.

I am sure we have not yet explored all that is possible with SNOMED. It is
the technology for the coming decades.

Allthough it is hard to get traditional software-vendors to implement
SNOMED, it cost money, especially in traditional software architecture this
is expensive, allthough there are reasonable roadmaps described.
But that is okay, let them sleep.

In OpenEhr it is an easier start to adapt it in archetypes. Further steps,
I think, are a SNOMED query-service against a SNOMED terminology service,
combining queries in archetype-repositories, and in data and this way find
data in a intelligent way.

There are usability paradigm shifts coming, clinical software being used by
non-medical educated people, software for small purposes like apps,
software being used by machines, flexibility is needed, and storing and
querying and understanding clinical data for the very long term.

As far as I can see we have the most technologies/tools to support these
new purposes. Now we need the developers to use it. I see a rich future for
software development.

Best regards

Op 13 mrt. 2018 21:55 schreef "Philippe Ameline" <>:

Le 13/03/2018 à 18:01, Bert Verhees a écrit :

> On 13-03-18 17:45, Philippe Ameline wrote:
>> in my own terms, it means that it is not the proper component for
>> modern applications.
> Wasn't it Voltaire who said that the best is the enemy of the good?

Bert, I get your point and I can perfectly understand that if Snomed can
get used to do what you need done, you are plainly entitled to use it,
even if "not perfect".

But the issue could be stated differently: we are living a very specific
moment since, at the same time, we become part of a genuine information
society AND are engaged in a turn from acute to chronic care.
It means that we should all be trashing the "good old systems" and
dedicate ourselves to building risk management systems that allow
multidisciplinary teams to manage patients' health journeys over time.

Do you think that HL7 and Snomed are the proper components for this kind
of innovation or that they are stuck in the ancient world?
Do you think that using endemic technologies (components that only exist
in the medical domain) can be of any use when it comes to health...
that's to say operating in person's "bio-psycho-social bubble", a place
where education, employment, social issues are as important as medical
information, and are all plain contributors to risk management?

It is not about "good" versus "perfect", but about having a whole domain
(and its practitioners) get stuck in a dead arm of the information society.



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