GEHR philosophical background info
Hi Sam, BW: This is a really interesting problem space to me. I've been studying HIPAA (the Health care Information Portability and Accountability Act) and have become fascinated with the discussion over how best to balance the needs of the various parties involved in the provision and payment of healthcare services so as to improve the quality and decrease the cost of health care here in the U.S.. Talk about a non-trivial problem! Interestingly, it looks to me like all the nonsense can be traced back to the health record and some fundamental questions about who owns it, who controls access to it, etc. Thanks again for sharing. Hope to hear from you soon. SH: I agree - it is fascinating. Can I point you to our (original work on this - quite philosophical) which I wrote with Len Doyal - a professor of medical ethics in London. http://www.chime.ucl.ac.uk/work-areas/ehrs/GEHR/Deliverables.htm#D8 I hate to ask this, but is there one deliverable you could point me to that contains the philosophical stuff? I'm up to my eyeballs right now and I can see there's a whole bunch of good stuff at the Chime site on GEHR that I'll have to get to asap. Thanks, Bill -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030428/0fc02fa7/attachment.html
GEHR philosophical background info
Hi Paul, I agree completely that the ownership question is fundamental. Until recently I was under the mistaken impression that everybody agreed that the patient owned their medical records and that physicians were simply the stewards. Then I discovered that, as of the early '90's, fewer than one third of the states here U.S. even had laws that required that patients be given access to their records. So yes, I think that clearing up the question of ownership is ultimately necessary. And I'm hoping that the move to electronic form will, at least in part, both precipitate that discussion and facilitate the implementation of what I perceive to be to be the obvious answer. Best regards, Bill - Original Message - From: Paul Juarez To: bill.walton at jstats.com ; openehr-technical at openehr.org Sent: Monday, April 28, 2003 3:04 PM Subject: Re: GEHR philosophical background info I've been following these discussions with a lot of interest. So I guess it's time for me to put in my two bits. While I've seen a couple of references to ownership of the medical record, I havent seen anything definitive that defines it (e.g. patient, provider, legal custiodian of record, etc., or some combination). It seems like this question needs to be clearly agreed on before issues of access can be identified. (It also could be a partial solution to distinguishing between the terms EMR, EHR, EPR). HIPAA aside, it seems that there may be some different legal issues about ownership that would also have implications for access. Any thoughts? Bill Walton bill.walton at jstats.com 04/28/03 12:32PM Hi Sam, BW: This is a really interesting problem space to me. I've been studying HIPAA (the Health care Information Portability and Accountability Act) and have become fascinated with the discussion over how best to balance the needs of the various parties involved in the provision and payment of healthcare services so as to improve the quality and decrease the cost of health care here in the U.S.. Talk about a non-trivial problem! Interestingly, it looks to me like all the nonsense can be traced back to the health record and some fundamental questions about who owns it, who controls access to it, etc. Thanks again for sharing. Hope to hear from you soon. SH: I agree - it is fascinating. Can I point you to our (original work on this - quite philosophical) which I wrote with Len Doyal - a professor of medical ethics in London. http://www.chime.ucl.ac.uk/work-areas/ehrs/GEHR/Deliverables.htm#D8 I hate to ask this, but is there one deliverable you could point me to that contains the philosophical stuff? I'm up to my eyeballs right now and I can see there's a whole bunch of good stuff at the Chime site on GEHR that I'll have to get to asap. Thanks, Bill -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030428/62b6d36a/attachment.html
openEHR security
Hi Thomas, Thomas Beale wrote: /snip/ So. What do we know? - role-based access control is required. To make it work properly in a shared care community context (e.g. a hospital, 50 GPs, aged care homes, nursing care, social workers etc etc) then the roles need to be defined congruently. I seem to remember some Canadian project coming to the conclusion that really the roles need to be defined the same across the entire (national) health care system. I think this is both correct and a the same time unrealistic. With all due respect, Thomas, it it's unrealistic then, IMO, it can't be correct. (Pragmatism R Us ;-) ) I'd like to offer food for thought. The fundamental assumption at work here seems to be that care givers will access the same system, thus driving the need for all users of the system to be assigned roles that are defined congruently. Let's consider an alternative model. When I travel from the U.S. to the U.K., I (the physical being) move from one socio-cultural-legal model to another. That does not change who / what I am, but it does change my behavior because I operate under a different set of norms and mores in the new environment. I accept new forms of interaction and find that familiar forms are no longer available. Why should it be any different for the information about me than it is for me? If we work from a perspective that posits that health information will move from system to system and be used / modified based on the rule sets in place within the various systems, does that make the problem more amenable to solution? I think we will be able to find ways of having diversely defined roles without every health care facility having incompatible definitions of consultant, treating physician etc. Bernd's work on this area is pretty detailed. I thank Bernd for opening my eyes to what should have been obvious to me at a much earlier stage. The security problem with EHR systems is fundamentally the same problem faced in OLAP databases. Or perhaps I should say that it's the OLAP security problem with a twist. At least OLAP databases are typically confined to one environment / business. It's clear that the EHR problem is more difficult in that EHR's must, IMO, be capable of moving between environments. Perhaps, by requiring a more generalized solution, the EHR problem will actually be easier to solve. I don't know if you've checked out Mike Mair's paper but it implicitly poses a very interesting question. Is a biologically-based security model fundamentally better aligned with the needs of an information system about biological entities than alternative models? I'm hopeful the list will have some comments on Mike's paper. I think the question is worth some thought / discussion. /snip/ Best regards, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
GEHR philosophical background info
Hi Paul, I can't tell where you're located but if you're here in the U.S., HIPAA's Privacy Rule went into effect on the 14th of this month and went a long way toward resolving this problem. Your case is a good example of the reason HIPAA was instituted. Although it doesn't clearly address the ownership question, it's pretty comprehensive in terms of the use and disclosure of individually identifiable health information. I'm not an attorney but, from my reading of HIPAA, the situation you describe would have a different outcome in the U.S. today. Best regards, Bill - Original Message - From: Paul Juarez To: bill.walton at jstats.com ; openehr-technical at openehr.org Sent: Monday, April 28, 2003 3:48 PM Subject: Re: GEHR philosophical background info Bill, Without federal legislation or some consensus upon formally adapted professional standards there will be much room for interpretation of ownership of patient records. I was in a situation about two years ago where I was working with a university affiliated primary clinic in which the university claimed ownership of the records and wanted open access to all patient records (they were on a fishing expedition). Clinic staff took the position that any access to the medical records other than where there was a right to know (e.g. defined audit) required patient consent. The judge ruled in favor of the University and levied a hefty fine against clinic staff (myself included) for blocking access to the University's records My point is that until the issue of ownership is clearly spelled out, questions of access are going to be left to the discretion of judges and attorneys! Paul Juarez Bill Walton bill.walton at jstats.com 04/28/03 01:32PM Hi Paul, I agree completely that the ownership question is fundamental. Until recently I was under the mistaken impression that everybody agreed that the patient owned their medical records and that physicians were simply the stewards. Then I discovered that, as of the early '90's, fewer than one third of the states here U.S. even had laws that required that patients be given access to their records. So yes, I think that clearing up the question of ownership is ultimately necessary. And I'm hoping that the move to electronic form will, at least in part, both precipitate that discussion and facilitate the implementation of what I perceive to be to be the obvious answer. Best regards, Bill - Original Message - From: Paul Juarez To: bill.walton at jstats.com ; openehr-technical at openehr.org Sent: Monday, April 28, 2003 3:04 PM Subject: Re: GEHR philosophical background info I've been following these discussions with a lot of interest. So I guess it's time for me to put in my two bits. While I've seen a couple of references to ownership of the medical record, I havent seen anything definitive that defines it (e.g. patient, provider, legal custiodian of record, etc., or some combination). It seems like this question needs to be clearly agreed on before issues of access can be identified. (It also could be a partial solution to distinguishing between the terms EMR, EHR, EPR). HIPAA aside, it seems that there may be some different legal issues about ownership that would also have implications for access. Any thoughts? Bill Walton bill.walton at jstats.com 04/28/03 12:32PM Hi Sam, BW: This is a really interesting problem space to me. I've been studying HIPAA (the Health care Information Portability and Accountability Act) and have become fascinated with the discussion over how best to balance the needs of the various parties involved in the provision and payment of healthcare services so as to improve the quality and decrease the cost of health care here in the U.S.. Talk about a non-trivial problem! Interestingly, it looks to me like all the nonsense can be traced back to the health record and some fundamental questions about who owns it, who controls access to it, etc. Thanks again for sharing. Hope to hear from you soon. SH: I agree - it is fascinating. Can I point you to our (original work on this - quite philosophical) which I wrote with Len Doyal - a professor of medical ethics in London. http://www.chime.ucl.ac.uk/work-areas/ehrs/GEHR/Deliverables.htm#D8 I hate to ask this, but is there one deliverable you could point me to that contains the philosophical stuff? I'm up to my eyeballs right now and I can see there's a whole bunch of good stuff at the Chime site on GEHR that I'll have to get to asap. Thanks, Bill -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030428/abb5f672/attachment.html
VistA knowledge / comments
Is anyone here familiar enough with the open source VistA system here in the U.S. to offer any comments about it in general and specifically about it's storage subsystem? There's info on VistA at http://www.va.gov/vista_monograph/ Thanks, Bill -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030423/824d3089/attachment.html
HISTORY DATA SET IN EPR
Hi Christopher, Christopher Feahr wrote: For this reason, the Institute of Medicine content recommendations (reflected in the present version 1.0 of the HL7 EHR ballot) includes 4 main care settings: in-patient, out-patient, nursing home, and personal health record. The last is the patient's view of the record... I think I'm a little lost here. I've read HIPPA, the regs and the preample, and my understanding is that the patient now has a legal right to copies of his medical record and a right to contest the contents of that record. Are you saying that the IOM / HL7 are taking the position that the physician can decide to withhold portions of that record? Where can I find out more about this? Best regards, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
What HIPAA means to you - a brief description
Hi Thomas, Thomas Clark wrote: /snip/ It was enacted to keep the payers happy and not the Patients. I've studied both the HIPAA regs and the Preambles and come away with a completely different impression. It's probably OT for the list but I'd be interested in going offline to get your perspective on this. I've included my email address below. /snip/ BTW: Findlaw is used as a reference, however bad, for the current state of the interpreted law within the US. I know. That's why I felt compelled to write the editors about the article. Your response is right on and should illustrate the need for a Uniform Model Code for ElHRs especially since this scenario will be repeated in many countries across the globe. If the US can have national and international model codes for Commerce it should have the same for Healthcare and EHRs. In essence the governments need a guiding light lest they visit another one like HIPAA on the populace! With respect to the US, I don't disagree about the need for uniform treatment and definitions. HIPAA is, IMO, a good start on that. Not perfect by any means, but at least it raises the debate to the national level. HHS has charged HL7 and HIMSS with taking the next step; identifying those things (functions and data) that are essential vs. desirable components of an EHR system. I think, though, that we should expect these things to evolve over time. The debate has just started. With respect to the international scene, I respectfully disagree about the desirability of a uniform set of rules. The norms and mores of a medical community must be in synch with those of the larger culture within which that community exists. I value diversity as a generator of alternative, competing solutions. Best regards, Bill bill.walton at jstats.com - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Access controls and Audit trails (was Re: openEHR security)
Hi Thomas, Thomas Beale wrote: Bill Walton wrote: BW: Further, it looks like the EHR access history should include reads as well as writes. That way, the trail would lead to the providers that have, with permission, made copies of the EHR within their own systems. SH: True - it will only be able to be stored as an HTML rendition unless there is an extract in openEHR - but you are right - this could be saved - this is difficult to police. Oops! I'd assumed there would be extracts in openEHR. HIPAA specifies, under the Transaction Rules that go into effect in October of this year, a number of EDI transactions between systems that would require this. HTML will not be sufficient. Can anyone clarify this bit of the debate - I have lost track of what is being said here! I was inquiring about the audit trail capabilities intended to be incorporated in v1.0 of openEHR and Sam was very graciously trying to enlighten me. His commment re: HTML made me expand the question to extracts. I'm not sure I was sufficiently clear about my line of questioning, and comments by others make me wonder whether or not I should take this off-line. I am specifically trying to ascertain the applicability of openEHR to the emerging requirements here in the U.S. and do not wish to infringe on the group's bandwidth if there is a less intrusive way to handle my questions. Please let me know how you'd like me to proceed. And thank you all for your patience to date. Best regards, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Patient Privacy: Impact of Outsourcing
Hi Tom, I'm not sure I'd call this a dead horse. The HIPAA Security Rule talks a bit about the need for sanctions as a component of achieving compliance at 68 FR 8347 (first column). The sanction policy is a required implementation specification because -- (1) the statute requires covered entities to have safeguards to ensure compliance by officers and employees; (2) a negative consequence to noncompliance enhances the likelihood of compliance; and (3) sanction policies are recognized as a usual and necessary component of an adequate security program. Surely, moving the protected health information to a location and putting it in the control of people outside U.S. jurisdiction compromises the ability to impose sanctions in the event that security is compromised. Especially since the outsourcer would be a Business Associate and, under the HIPAA rules, Kaiser would not be held responsible for their actions. The downside is that the Security Rule doesn't go into effect until April 20, 2005. On the other hand, Kaiser's moving that data offshore might be seen as a preemptive move to avoid the Security Rule and, given that Health Care is likely to be an issue in the upcoming Presidential campaign, it might be something the politicians here would latch on to. I think Kaiser covers about 50 million Americans. That's a lot of potentially pissed off voters. Hmmm. Might be a Cause here. Best regards, Bill - Original Message - From: lakew...@copper.net To: openehr-technical at openehr.org Sent: Saturday, May 17, 2003 2:08 AM Subject: Patient Privacy: Impact of Outsourcing Hi All, The following link is to an article appearing in the San Francisco Chronicle online version, May 14, 2003 entitled: LAZARUS AT LARGE Kaiser exporting privacy http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/05/14 /BU307139.DTLtype=tech Unfortunately this has been predicted by many. Rushing out to contact members of the US congress requesting a new privacy and security bill would be too late and probably wasted effort. It should highlight the need for very stringent security mechanisms and procedures that continually monitor and track data transmission and storage at a minimum. In previous emails 'Secure Data Store' facilities have been mentioned. This is just one example why they are needed. -Thomas Clark - If you have any questions about using this list, please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Modelling Episodes in openEHR
Hi Thomas, Thomas Beale wrote: Someone could come along later in the same institution, and define a new kind of episode, and retrospectively create all the Folders for that kind of episode in certain EHRs. This also won't change any of the underlying data. Episode Folders could also be removed, renamed, their references added to or removed - none of this changes any of the data either. Do you envision this being done manually? Or is there a programmatic solution? The question this thread has raised in my mind is well illustrated by your comment below. I think any institution has to have a firm model for what it thinks an episode is Assuming that different institutions will adopt models that differ, what are the implications for the exchange of data and the creation of a lifelong EHR? Thanks, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Open source implementation?
Sam Heard wrote on Wednesday, January 14, 2004 2:50 PM: Subject: RE: Open source implementation? Vincenzo The workplan in Australia has been delayed due to hefty negotiations and the extension of a trial to involve 3 hospitals and 100 general practices. The contract still involves Java based work and is still to be published as open source material - hopefully under openEHR. This large contract should be signed this week. I am not sure of the time line to release of the code, exactly what code will be released - we should know when the contract is finally signed. So...hold your breath! Cheers, Sam Hi Sam, What's the status of this?Has the contract been signed? The decisions reached? I'm potentially interested in constructing an automated test suite once the code's released. Has that already been accounted for? Thanks, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Latest ADL workAtlanta bench and Clinical Archetype Editor
Hi Thomas, Thomas Beale wrote: Bill Walton wrote: /snip/ You are right, and actually, having someone think about test plans and construct test cases / procedures would be a very useful thing. Excellent. Count me in. We would need to dicuss how to do this exactly Development of the Test strategy should always, IME, be given explicit attention. Would you like to have that discussion here or offline? Also, please let me know if it would be helpful to you and/or the team to have a copy of my resume. I'll be happy to send it along. /snip/ or debugging help pages (or maybe even writing them?) Count me in here too. On either or both fronts. I look forward to participating in these and any other areas where I might be able to provide some small value. Best regards, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Latest ADL workAtlanta bench and Clinical Archetype Editor
Peter, Elkin, Peter L., M.D. wrote: Also, I would recommend taking a look at the ebXML registry which is a federated Open Source registry which is currently available. Also, Sun is implementing OWL support within the registry (which may be handy for users interested in direct reasoning from Archetypes). Sorry for not responding to this sooner. In all honesty, I didn't 'get' your point at first. Heck, I may still not be getting it ;-) But having given it some thought and *trying* to understand it, I do have some thoughts and questions. Before I get started, though, let me ask for clarification on a couple of things. As I read the ebXML.org site, they do not have a registry currently available. What they have available is a *specification* for a registry. The way I read the site, they expect others to actually implement registries. If I've missed something, could you point me to it? Were you citing the ebXML registry as a mechanism we should look at using? If so, in what way? Again as I read the site, what the ebXML registry registers is companies and information about them that allows other companies to identify them for the purpose of doing business with them electronically. Sellers publish their Collaboration Protocol Profile or CPP as defined by [ebCPP] to the Registry. The CPP describes the seller, the role it plays, the services it offers and the technical details on how those services may be accessed. ... The buyer browses the Registry ... to discover a suitable seller. For example the buyer may look for all parties that are in the Automotive Industry, play a seller role, support the RosettaNet PIP3A4 [Purchase Order business protocol] process and sell Car Stereos. The buyer discovers the seller's CPP and decides to engage in a partnership with the seller. (p. 16, OASIS/ebXML Registry Services Specification v2.5) The definition and registry of the *protocols* (think Archetypes) used by the companies registered within an ebXML registry is a seperate issue, handled by organizations like RosettaNet. It seems to me that the next issue we'll face (perhaps very soon) WRT Archetypes is more like the one tackled by RosettaNet than the one tackled by ebXML. The ebXML-type provider registry looks like an issue that won't come up until after the first one is resolved. I'd apprecite hearing your thoughts. Best regards, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Age
Hi Thomas, Thomas Beale: Bill Walton wrote: It seems to me, although I'm not a physician, that there are, or we might learn that, there are medical problems that crop up later in life that are related to whether or not a person was born full-term or not. If so, or it it's a possibility, then perhaps that needs to be recorded. Is there some sort of problem, either technical or philosophical, with recording both DOB and [estimated] DOC? Sam says that rather than estimated DOC, estimated date of delivery should be actually recorded, since if a DOC is estimated then recorded and it turns out that e.g. the father was known to still be in Canada that week on business, it can create all kinds of problems - when the explanation is probably compltely innocent. So he suggests that estimated DOC should be always computed from estimated DOD, rather than being stored. But the result is the same at the application level - a 0-offset age from the (approximate) moment of conception (for those patients for whom this is relevant obviously). Please forgive my density ;-) I understand what Sam's saying, but I don't see how that provides the information to which I was referring. Specifically, how would it be recorded that a person was born at something (perhaps significantly) less than full-term? Thanks, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Fwd: Msg #1 - Software Archetypes - single vs double systems
Software Archetypes - single vs double systemsGreetings, The posting below showed up on the hardhats list this morning. I responded (after a brief, confirmatory exchange with Thomas) with a brief, high-level explanation of what archetypes bring to the party. That triggered a couple of additional exchanges with another poster (the original poster has yet to respond). As you'll see, the additional exchanges led to a committment on my part to ask the experts (that's you folks). I'll be forwarding those postings here in hopes you can / will answer some of the questions and so educate both them and me on the importance / value of using archetypes. Best regards, Bill - Original Message - From: Lorie Obal To: hardhats-members at lists.sourceforge.net Sent: 2006-04-10 12:12 AM Subject: [Hardhats-members] Software Archetypes - single vs double systems Can anyone clarify/comment on the architecture principles called archetypes and two-level methodologies used in the openEHR project and openVistA? See: http://www.openehr.org/publications/archetypes/archetypes_beale_oopsla_2002.pdf The openEHR docs imply that this is a significant departure from previous methodologies. I'm trying to compare/contrast this with vistA in a comparison framework. Any enlightenment appreciated. More info on openEHR archetypes can be found at: http://www.openehr.org/publications/archetypes/t_archetypes.htm -Lorie -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060410/c1a4884b/attachment.html
Fwd: Msg#2 - Software Archetypes - single vs double systems
- Original Message - From: Gregory Woodhouse To: hardhats-members at lists.sourceforge.net Sent: 2006-04-10 7:03 AM Subject: Re: [Hardhats-members] Software Archetypes - single vs double systems On Apr 9, 2006, at 10:12 PM, Lorie Obal wrote: Can anyone clarify/comment on the architecture principles called archetypes and two-level methodologies used in the openEHR project and openVistA? See: http://www.openehr.org/publications/archetypes/archetypes_beale_oopsla_2002.pdf The openEHR docs imply that this is a significant departure from previous methodologies. I'm trying to compare/contrast this with vistA in a comparison framework. Any enlightenment appreciated. More info on openEHR archetypes can be found at: http://www.openehr.org/publications/archetypes/t_archetypes.htm -Lorie I'm really mot familiar with this approach (frankly, I find the presentation hard to follow, though the longer paper http://www.deepthought.com.au/it/archetypes/archetypes.pdf, is easier to follow), but the problem is certainly a familiar one. A significant problem with VistA (and just about any other EHR) is that domain specific knowledge is embedded into code or intermixed with operational data all over the place.VistA has attempted (with some success) to add a layer of abstraction using mechanisms such as protocols, templates, or even options. Personally, I think VistA would very much benefit from a mechanism such as this (though from the technical side, I still have questions). This is my (quite possibly incorrect) take on archetypes: In many ways, they are similar to the class models familiar from object oriented languages like Java or Python, but go further. Classes, such as Person, LaboratoryTest, or Organization are traditionally defined in terms of attributes and methods (functions). Attributes are well understood (a person has a name, test results must be measured in some units), but that's not enough, we need to be able to express how these concepts or classes are interrelated. In traditional object oriented development, this kind of knowledge (!) is encoded in methods written in a conventional programming language. For example, 4 and 5 may be members of the Number class, but to deduce that 4 5 (4 is less than 5), you need to use something like a compareWith method, which will most likely just be a wrapper around the usual comparison operator in the underlying language, so you're back to using code to express relationships. Of course, ultimately, you do need to resort to writing code (programmer's jargon for writing programs in some language), but the question is whether you should do it sooner rather than later. In mathematics, for example, we have the concept of a total order. A relationship is a total order if 1. It is not true that a a (irreflexivity) 2. If a is not equal to be (often written a != b or a /= b), then either a b or b a (trichotomy) 3. If a b and b c, then a c (transitivity) These rules (axioms) represent what a programmer might call a constraint. Constraints are usually enforced by requiring some bit of code to evaluate to true. But there are problems with this approach: it is not very reusable, it is typically hidden deep in the implementation, and perhaps most importantly, it is difficult to reason formally about code. It is by abstracting away from the (very general) concept of relationship and asking how constraints can actually be built (constructed) that we are able to reason more formally about them. In fact, this is just what programming language types are. Starting with basic types like Number, Boolean, Character, etc. we can use familiar type constructors like Pair, List, Function to get types like Pair(Number, Number), List(Character) or Function(Number,r Number), and it turns out that types provide a very powerful method of reasoning about computer programs that can generally be performed automatically (which has obvious implications for program reliability). Perhaps a more familiar example of the same concept is what is sometimes called dimensional analysis in chemistry or physics. We're all familiar with Newton's second law, F = ma. Can a given quantity be a force? Well, we know that mass is measured in kilograms (dimensions of mass) and acceleration is measured in units of meters per second squared (with dimensions of length/time^2), so the dimensions of force must be just the product mass*length/time^2. Now, suppose I work out that some number, say T, is the elapsed time between the moment I get up in the morning (guess what time of day it is here) and the time I arrive at the office. The dimensions of T are time, so if I write an equation setting it equal to a force, then something has obviously gone wrong. But despite all its usefulness, dimensional analysis is still only a special case of the more general concept of type inference. Another example of a constraint is that
Fwd: Msg#3 - Software Archetypes - single vs double systems
Software Archetypes - single vs double systems - Original Message - From: Bill Walton To: hardhats-members at lists.sourceforge.net Sent: 2006-04-10 9:02 AM Subject: Re: [Hardhats-members] Software Archetypes - single vs double systems Hi Lorie, Archetypes provide a capability that's very familiar to programmers, but take it to the next level. At the most basic level, it's about decoupling. An RDBMS shields programs from the need to know about the underlying structure of the data. A program needs only know about the db schema. Views provide another level of abstraction, shielding programs from changes in the schema. Archetypes (which I believe do not depend on an RDBMS implementation) provide a similar capability, but take it to the domain level. When working with an archetype-enabled system, programs / programmers work directly with domain concepts like blood pressure or height or weight. The underlying data is stored / accessed through the archetype. A trivial example of the benefits would be lbs. vs. kgs.. In an archetype-enabled system, the program has no knowledge of the unit-of-weight measure used to store the data. Programs access the data store with statements like (no representation made re: syntax) store_weight(220, lbs) and patient_weight = retrieve_weight(patient_id, kgs). You might want to take a look at http://oceaninformatics.biz/archetypes/MindMap/ArchetypeMap.html for a better, high-level understanding of the above. This, and a good deal of the related stuff, will be migrated shortly to the openEHR site. Be happy to provide / get you more in-depth info if desired. hth, - Original Message - From: Lorie Obal To: hardhats-members at lists.sourceforge.net Sent: 2006-04-10 12:12 AM Subject: [Hardhats-members] Software Archetypes - single vs double systems Can anyone clarify/comment on the architecture principles called archetypes and two-level methodologies used in the openEHR project and openVistA? See: http://www.openehr.org/publications/archetypes/archetypes_beale_oopsla_2002.pdf The openEHR docs imply that this is a significant departure from previous methodologies. I'm trying to compare/contrast this with vistA in a comparison framework. Any enlightenment appreciated. More info on openEHR archetypes can be found at: http://www.openehr.org/publications/archetypes/t_archetypes.htm -Lorie -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060410/bf8b39d5/attachment.html
Fwd: Msg#4 - Software Archetypes - single vs double systems
- Original Message - From: Greg Woodhouse gregory.woodho...@sbcglobal.net To: hardhats-members at lists.sourceforge.net Sent: 2006-04-10 10:46 AM Subject: Re: [Hardhats-members] Software Archetypes - single vs double systems What I find most frustrating about discussion of archetypes is that it is so often vague and intuitive in nature, making it rather hard to decipher. --- Bill Walton bill.walton at charter.net wrote: Software Archetypes - single vs double systemsHi Lorie, Archetypes provide a capability that's very familiar to programmers, but take it to the next level. At the most basic level, it's about decoupling. An RDBMS shields programs from the need to know about the underlying structure of the data. A program needs only know about the db schema. Views provide another level of abstraction, shielding programs from changes in the schema. Archetypes (which I believe do not depend on an RDBMS implementation) provide a similar capability, but take it to the domain level. By domain do you mean application domain? Or are you referring to domains in their technical sense in database theory (as a set of values)? At any rate, it is clear that you are trying to abstract away from a particular set of units, treating the quantity itself as a value (not how it might be represented). When working with an archetype-enabled system, programs / programmers work directly with domain concepts like blood pressure or height or weight. The underlying data is stored / accessed through the archetype. But what does this mean? It suggests that an archetype is realizable as a computational object (much as a schema may be realized as a set of relations, or a class instantiated to form an object). I suspect that this is the point at which an important concept is missing: The integers are a ring, but when I add two numbers, I'm not using the + operation of the category Ring, but rather of a specific member of that category, namely Z. A trivial example of the benefits would be lbs. vs. kgs.. In an archetype-enabled system, the program has no knowledge of the unit-of-weight measure used to store the data. Programs access the data store with statements like (no representation made re: syntax) store_weight(220, lbs) and patient_weight = retrieve_weight(patient_id, kgs). Okay, here is some concrete syntax, but what are you really doing? Is kgs a flag or map (or something else altogether)? From a mathematical point of view, it's natural to think of it as a scaling transformation (a map). But that's confusing, too, because it implies the existence of some reference instance out there (say kilograms) that is somehow privileged among other possible choices, and that your kgs flag is simply the scaling factor (isomorphism) you need to apply to get your chosen representation. You might want to take a look at http://oceaninformatics.biz/archetypes/MindMap/ArchetypeMap.html for a better, high-level understanding of the above. This, and a good deal of the related stuff, will be migrated shortly to the openEHR site. Be happy to provide / get you more in-depth info if desired. hth, === Gregory Woodhouse gregory.woodhouse at sbcglobal.net It is foolish to answer a question that you do not understand. --G. Polya (How to Solve It) --- This SF.Net email is sponsored by xPML, a groundbreaking scripting language that extends applications into web and mobile media. Attend the live webcast and join the prime developer group breaking into this new coding territory! http://sel.as-us.falkag.net/sel?cmd=lnkkid=110944bid=241720dat=121642 ___ Hardhats-members mailing list Hardhats-members at lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
experience / opinions
Does anyone have any experience with / opinions about the suitability of Ruby and Rails as implementation platforms for openEHR? Thanks, Bill -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060202/48d2138d/attachment.html
experience / opinions
Hi Tim, Tim Cook wrote: I *do* think it makes sense to use existing, tried and tested frameworks/components as part of an infrastructure where possible. Do you include Ruby/Rails in your list of components/frameworks that make sense to use? Best regards, Bill
Lifestyle: substance_use archetype
Hi Sam, Could you say more about the need for 'substance use' archetypes? I'm not sure I understand why it would be a good idea to record alcohol consumption differently from, for example, consumption of herbal teas. Or prescription drugs for that matter. I'm sure I'm missing something. Thanks, Bill - Original Message - From: Sam Heard To: Openehr-clinical Sent: Tuesday, May 09, 2006 10:54 PM Subject: Lifestyle: substance_use archetype Dear All I have been working on the archetypes for lifestyle and have approached them with trepidation. I am aware that there are lots of things that a person might like to record, and a lot of preferences. So we need to have a rich model for these things. The first one I have published is substance use and as designed includes alcohol, tobacco, caffeine and others - it is possible to nominate the others and have as many as you wish. The substance archetype is on the Ocean site: http://oceaninformatics.biz/archetypes/openEHR-EHR-OBSERVATION.substance_use.v1.html There is a link to the ADL on that page (second row) You will notice that I have not completed the descriptions in places, apologies. The question I have is whether it is best to deal with this as a broad archetype (deals with a number of substances although each slightly differently) or as specialisations. The current archetype is the former, but it would be possible to deal with these as three archetypes: Substance use \ _Alcohol \_Tobacco The advantage would be that you could look in the same place for the information and then see what the substance was, while the specialisation would provide the different recordings favoured for the different substances. The problem with this latter approach is that many people would probably use the unspecialised archetype for everything, and it would be difficult to get meaningful data about the most common substances leading to harm. For this reason, and the simplicity of use for software (templates mean that there could be three different templates that provided the same functionality), I favour the inclusive approach. I am interested in your thoughts, Sam -- Dr. Sam Heard MBBS, FRACGP, MRCGP, DRCOG, FACHI CEO and Clinical Director Ocean Informatics Pty. Ltd. Adjunct Professor, Health Informatics, Central Queensland University Senior Visiting Research Fellow, CHIME, University College London Chair, Standards Australia, EHR Working Group (IT14-9-2) Ph: +61 (0)4 1783 8808 Fx: +61 (0)8 8948 0215 -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060510/909b9f1c/attachment.html
Lifestyle: substance_use archetype
Hi Karsten, Karsten Hilbert wrote: Recording substance use is more intended to record a *fact* about the lifestyle of an individual rather than an *intent to treat* as with prescription drugs. There's a fine line as always: herbal teas, OTC drugs etc may or may not have been intended to be treatment by the provider. However, disambiguating such in a given case is at the discreetion of the provider/patient in question. OpenEHR needs to provide facilities for both. It seems to me that 1) we want to provide a mechanism for recording _all_ substances used, and 2) for each, we want to record who 'prescribed' it. Patients intend to treat when they ingest herbal teas, OTC drugs, etc.. While I definitely see the value in recording the 'prescriber', I still don't see the value in creating a seperate archetype for 'substances' that are not provider prescribed. In fact, it seems to me to create unnecessary complexity. Example... A patient is undergoing chemotherapy. The patient finds that smoking marijuana helps control the nausea. If the patient lives in California their physician can prescribe the use of marijuana. It they live in Texas, its use cannot be prescribed. Another example... A patient wants to quit smoking cigarettes. The physician prescribes Nicorette gum. Then the FDA approves Nicorette for OTC sale. What would be the information value of recording this information with different archetypes? What would seperate archetypes allow me to do that I couldn't do as easily with a single archetype with a 'prescriber' attribute that could accomodate a value of 'self'? Thanks, Bill
Lifestyle: substance_use archetype
Gerard Freriks wrote: snip Irrespective of a regular drug, herbal tea, food additive, smog, self medicated, prescribed, or taken by an involuntary action one always want to record the same things. Isn't it? My sentiments, precisely. So why not a generic Archetypes: Observation: Substance Use Because, IMHO, the information would be more appropriately recorded under Medications. The other Observation archetypes are much different than the Substance Use archetype. I can see where it would be appropriate to include info on 'substances' in that section when, for example, a urine test for the presence / absence of that substance needs to be recorded. But in lieu of test results, it seems to me that 1) the info Sam's included in the archetype isn't the same type of info as that included in the other Observation archetypes, and 2) adding this info to the EHR using the Medications archetypes would be both natural and a simple matter. Just my $0.02. Best regards, Bill
