Bert, The main reason I mentioned the [Troll] hashtag was because I am really conscious that what I say is far from being mainstream. Hence I consider myself honored that some of the things I say can "rock the boat" a little bit and raise several questions.
To tell it roughly, I consider that practitioners are missing two crucial turns: they are disconnected from the information society (for several reasons, medical confidentiality of course, but also because MD keep seeing information systems as "back office" components, also because they are often individualists very at ease in silos (practice and specialty)) and they are still fully organized for acute care (to put it simply, the medical system is fully upside down and the GP should become an orchestra conductor (what she often dreams she already is) but is stuck in the one-man band role). It could make sense to consider that the first lock (the dead branch of the information society flow) controls the second lock (missing the chronic care turn). This for many reasons: - chronic care means managing risk over a long span of time, - chronic care means genuine team work around a given person (not the fixed team "inside the same box" but the dynamic team of the contributors around a given individual). Translated in technological concepts, my own take is that is means switching: - from a record oriented vision to a project management vision (a record is the place where you optimize your own decision support ability through keeping the signal/noise ratio as high as possible ; a project manager is the place where people build/feed/contribute to a set of shared processes). - from a "care places centered" system (the patient moves from silo to silo, from record to record) to a system "federated by the person" environment. To put it simply, it is a genuine Copernican revolution where individual, instead of having siloed information stored about themselves in every "box" they cross, would own a system in support of their life long holistic vision and ask their services providers to contribute to it (means to join a team). The most important point to consider here is that, when considering the person's bubble, it is really mandatory to be plainly holistic, that's to say to consider health as a project among many other projects (education, employment, social issues, ordinary life projects, etc). It is a place where the term "patient" is prohibited. Finally, to answer your question about "HL7 and Snomed", I see these two components as symptoms of the "medical information plague": they are fully endemic, they are over-complex and prevent innovation (once you have invested 5 years understanding it, your startup is already dead). To make it short, as some claim that maize killed the Maya civilization because it demanded too much energy to grow, I claim that these systems are killing health systems because they keep them stuck in an ancient vision of health. Feel very free to consider this assertion as coming from the edge. Besides, even if I know HL7 and Snomed rather well, I perfectly may miss some points... however, I really hope that, contrary to what you wrote, they are not "the technology for the coming decades" ;-) Best, Philippe Le 14/03/2018 à 01:16, A Verhees a écrit : > 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 > Bert > > Op 13 mrt. 2018 21:55 schreef "Philippe Ameline" > <philippe.amel...@free.fr <mailto:philippe.amel...@free.fr>>: > > 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. > > Best, > > Philippe > > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical@lists.openehr.org > <mailto:openEHR-technical@lists.openehr.org> > > http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org > > <http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org> > > > > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical@lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
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