Re: [openhealth] Re: GPs Revolt
Thomas, I consider the openehr repository as a black box, and I don't intend to mix CDA or anything HL7 into it. By approval, I meant that openEHR is fine with transferring data over HL7 CDA. At least that was the impression I got from your comments in your presentation in Ankara some time ago. I'de be glad to hear any comments of yours about this if I am mistaken. I am aware that CDA is for transferring a persisted document. This was meant to say exactly what you say: CDA is not a data model, and I am considering it for data transfer only. It's just that having a backend that consists of an openehr repository instead of a plain database would be fine. I think it will be a pretty common scenario as institutions begin to use openehr repositories and there are many others with HL7 communication capability, so I wanted to get my hands on such a setup, to see how it works. cheers Thomas Beale wrote: Seref Arikan wrote: Hi Tim, Sorry I was not clear about the issue. I was hoping that there is an existing proof of concept application for the mentioned test repository. Since the repository can be the source for a clinical document as referred in the CDA docs, any simple application would do fine. I just wanted to get my hands on a CDA document that belongs to an actual repository.(I mean that represents a persisted record in an openehr repository). I am aware that CDA is for transferring a persisted document. If I am not mistaken, constructing CDA documents for transfer over HL7 is a valid approach, approved by openEHR. well, we are not in a position to approve anything that openEHR does. The fact that we don't use anything from HL7v3 might tell you something though...by the way, CDA was designed as a transfer format, not as a data model for EHR systems. - thomas No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.15.2/559 - Release Date: 11/30/2006
Re: [openhealth] Re: GPs Revolt
Thanks for the information. Nandalal --- David Chan [EMAIL PROTECTED] wrote: PING is now called Indivo (http://indivohealth.org/) and the recent conference generated a lot of interests: http://www.pchri.org/2006/ Best regards, David David H Chan, MD, CCFP, MSc, FCFP Associate Professor Department of Family Medicine McMaster University - Original Message From: Nandalal Gunaratne [EMAIL PROTECTED] To: openhealth@yahoogroups.com Sent: Monday, November 27, 2006 10:41:32 AM Subject: Re: [openhealth] Re: GPs Revolt Why not hand over the keeping of the patient records to patients ( like PING), where clinicians just upload to this, and they also carry it with them in a storage format that is secure and easily accessible? The National Health Card Taiwan http://www.gi- de.com/portal/ page?_pageid= 42,55000 _dad=portal _schema=PORTAL --- Will Ross [EMAIL PROTECTED] org wrote: thomas, i appreciate your concern for what you allege is dr. grove's naivete, but i share dr. grove's concern that when it comes to intelligent health information systems, the perfect is the enemy of the good. in the age of wikis, soa, voip, wifi and rfid there is no reason we cannot leverage existing secure internet transport and composing capabilities to substantially improve the interoperability of existing clinical text and image files. when i look at where dr. grove's fire is directed -- at overpriced enterprise packages that deliberately build new proprietary silos -- i find an ally who is saying the right disruptive things to people who would never listen to me. with best regards, [wr] - - - - - - - - On Nov 26, 2006, at 11:52 PM, Thomas Beale wrote: Will Ross wrote: With regard to the underestimated complexity of Healthcare IT, the recent comments by Andrew Grove are relevant. But a key problem with this plan is the lack of a good medical records system, Grove said. His solution? Not the complicated, expensive medical record-keeping system that many companies and health-care providers are trying to develop, but something much simplerthe use of existing mass-produced technologies. http://news- service.stanford .edu/news/ 2006/november8/ med- grove-110806. html classic complete naivete: Although there's debate about how to create a record that would be accessible to a range of providers and still protect files, Grove presented a simple answer: Keep medical records on a Web-accessible word-processing file. It costs nothing because it's already in place, Grove said. The technology already exists. === message truncated === Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com
Re: [openhealth] Re: GPs Revolt
Thomas Beale wrote: I would like to know if anyone here is interested in being able to play with a demonstration system (located in Australia) over a web-service (published API); currently you would write C# code against a client-side DLL - the idea is to use the openEHR repository as a proper versioned, archetyped, semantically queryable back-end. This would be for the purpose of evaluating openEHR in a hands-on way. I don't want to get into arguments about open source at the moment - today it is closed source, but it will become open source as soon as we find an economic model that pays for what we release before we release it (and in any case, everything that we learn becomes part of the openEHR specifications, and eventually the Java project). So the offer is for people interested in contributing to openEHR / e-Health progress in general, with all feedback (code if wished) being made public. - thomas beale BTW we are already doing this with some universities, and some smart programmers are working on a java/C# bridge, so you can probably assume that if you want to participate in this activity, you can also code in Java. Timing will be in the new year - at this stage I would like to gauge interest. - thomas beale
Re: [openhealth] Re: GPs Revolt
Hi Thanks anyway, having some CDA docs to play around sounded very attractive, at least I tried :) regards Seref Thomas Beale wrote: Seref Arikan wrote: Hi Thomas, At the moment I am working on a project where I need CDA support. Would it be possible to get CDA docs from the repository you've mentioned? Or what can we do to make it happen if it does not exist at the moment? the EhrBank openEHR server just does openEHR at the moment. CDA import is planned, although is not a priority right now... - thomas No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.15.2/559 - Release Date: 11/30/2006
Re: [openhealth] Re: GPs Revolt
Seref Arikan wrote: Hi Thanks anyway, having some CDA docs to play around sounded very attractive, at least I tried :) regards Seref I wonder if you understand that having some CDA docs to play around is not a computable approach? CDA documents are created 'by restriction' which means that you must have the set of rules used to originally create the specific document. This is ok within a closed system. However, exchanging documents between disparate systems is a non-starter without those rules. Cheers, -- Timothy (Tim) Cook, MSc Health Informatics Consultant Jacksonville, FL Ph: 904-322-8582 http://home.comcast.net/~tw_cook/ EMAIL: [EMAIL PROTECTED] SKYPE: timothy.cook Yahoo IM: tw_cook [Non-text portions of this message have been removed]
Re: [openhealth] Re: GPs Revolt
Hi Tim, Sorry I was not clear about the issue. I was hoping that there is an existing proof of concept application for the mentioned test repository. Since the repository can be the source for a clinical document as referred in the CDA docs, any simple application would do fine. I just wanted to get my hands on a CDA document that belongs to an actual repository.(I mean that represents a persisted record in an openehr repository). I am aware that CDA is for transferring a persisted document. If I am not mistaken, constructing CDA documents for transfer over HL7 is a valid approach, approved by openEHR. I was referring to existence of a proof of concept application for transferring a document over HL7 using CDA. This should cover more than one aspect as you have written, and it would be a nice way to contribute to overall semantic interoperability scenario. Do you see anything wrong above? Please correct me if I'm wrong about the issue. Cheers Seref Tim Cook wrote: Seref Arikan wrote: Hi Thanks anyway, having some CDA docs to play around sounded very attractive, at least I tried :) regards Seref I wonder if you understand that having some CDA docs to play around is not a computable approach? CDA documents are created 'by restriction' which means that you must have the set of rules used to originally create the specific document. This is ok within a closed system. However, exchanging documents between disparate systems is a non-starter without those rules. Cheers, -- Timothy (Tim) Cook, MSc Health Informatics Consultant Jacksonville, FL Ph: 904-322-8582 http://home.comcast.net/~tw_cook/ http://home.comcast.net/%7Etw_cook/ EMAIL: [EMAIL PROTECTED] mailto:tw_cook%40comcast.net SKYPE: timothy.cook Yahoo IM: tw_cook [Non-text portions of this message have been removed] No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.15.2/559 - Release Date: 11/30/2006
Re: [openhealth] Re: GPs Revolt
Seref Arikan wrote: Hi Tim, Sorry I was not clear about the issue. I was hoping that there is an existing proof of concept application for the mentioned test repository. Since the repository can be the source for a clinical document as referred in the CDA docs, any simple application would do fine. I just wanted to get my hands on a CDA document that belongs to an actual repository.(I mean that represents a persisted record in an openehr repository). I am aware that CDA is for transferring a persisted document. If I am not mistaken, constructing CDA documents for transfer over HL7 is a valid approach, approved by openEHR. well, we are not in a position to approve anything that openEHR does. The fact that we don't use anything from HL7v3 might tell you something though...by the way, CDA was designed as a transfer format, not as a data model for EHR systems. - thomas
Re: [openhealth] Re: GPs Revolt
Thomas Beale wrote: Seref Arikan wrote: Hi Tim, Sorry I was not clear about the issue. I was hoping that there is an existing proof of concept application for the mentioned test repository. Since the repository can be the source for a clinical document as referred in the CDA docs, any simple application would do fine. I just wanted to get my hands on a CDA document that belongs to an actual repository.(I mean that represents a persisted record in an openehr repository). I am aware that CDA is for transferring a persisted document. If I am not mistaken, constructing CDA documents for transfer over HL7 is a valid approach, approved by openEHR. well, we are not in a position to approve anything that openEHR does. of course I meant HL7.
Re: [openhealth] Re: GPs Revolt
I would certainly like to help. Since I am a Surgeon interested in HIT (rather than a HIT specialist interested in surgery!), tell me how I could help, and I most certainly will. Best regards Nandalal --- Thomas Beale [EMAIL PROTECTED] wrote: Will Ross wrote: in other words, in my neighborhood a bunch of electronic clinical documents that are easily organized, securely stored and safely shared is an improvement over the current regime of inaccessible paper and electronic silos. and when semantically interoperable solutions arrive, we can consider them, if they are practical and suit the site level business processes of primary care. I take your point Will, that's completely fair. In terms of what has arrived so far, we actually have proper openEHR systems running now, full archetyping, templating and so on. Ours (Ocean Informatics) is being trialled in a number of countries. Functionally it does about 85% of everything openEHR promises, including templates, supporting archetype-based queries in a new query language (looks like SQL Xpath; this will be published soon), and the other 15% won't be long. I would like to know if anyone here is interested in being able to play with a demonstration system (located in Australia) over a web-service (published API); currently you would write C# code against a client-side DLL - the idea is to use the openEHR repository as a proper versioned, archetyped, semantically queryable back-end. This would be for the purpose of evaluating openEHR in a hands-on way. I don't want to get into arguments about open source at the moment - today it is closed source, but it will become open source as soon as we find an economic model that pays for what we release before we release it (and in any case, everything that we learn becomes part of the openEHR specifications, and eventually the Java project). So the offer is for people interested in contributing to openEHR / e-Health progress in general, with all feedback (code if wished) being made public. - thomas beale Do you Yahoo!? Everyone is raving about the all-new Yahoo! Mail beta. http://new.mail.yahoo.com
Re: [openhealth] Re: GPs Revolt
Thomas Beale wrote: I would like to know if anyone here is interested in being able to play with a demonstration system (located in Australia) over a web-service (published API); Interested, yes. Capable ... perhaps less so. Is Python at all likely? Which end of Australia is it?
Re: [openhealth] Re: GPs Revolt
Hi Thomas, At the moment I am working on a project where I need CDA support. Would it be possible to get CDA docs from the repository you've mentioned? Or what can we do to make it happen if it does not exist at the moment? Regards Seref Arikan Thomas Beale wrote: Will Ross wrote: in other words, in my neighborhood a bunch of electronic clinical documents that are easily organized, securely stored and safely shared is an improvement over the current regime of inaccessible paper and electronic silos. and when semantically interoperable solutions arrive, we can consider them, if they are practical and suit the site level business processes of primary care. I take your point Will, that's completely fair. In terms of what has arrived so far, we actually have proper openEHR systems running now, full archetyping, templating and so on. Ours (Ocean Informatics) is being trialled in a number of countries. Functionally it does about 85% of everything openEHR promises, including templates, supporting archetype-based queries in a new query language (looks like SQL Xpath; this will be published soon), and the other 15% won't be long. I would like to know if anyone here is interested in being able to play with a demonstration system (located in Australia) over a web-service (published API); currently you would write C# code against a client-side DLL - the idea is to use the openEHR repository as a proper versioned, archetyped, semantically queryable back-end. This would be for the purpose of evaluating openEHR in a hands-on way. I don't want to get into arguments about open source at the moment - today it is closed source, but it will become open source as soon as we find an economic model that pays for what we release before we release it (and in any case, everything that we learn becomes part of the openEHR specifications, and eventually the Java project). So the offer is for people interested in contributing to openEHR / e-Health progress in general, with all feedback (code if wished) being made public. - thomas beale No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.19/555 - Release Date: 11/27/2006
Re: [openhealth] Re: GPs Revolt
Will Ross wrote: With regard to the underestimated complexity of Healthcare IT, the recent comments by Andrew Grove are relevant. But a key problem with this plan is the lack of a good medical records system, Grove said. His solution? Not the complicated, expensive medical record-keeping system that many companies and health-care providers are trying to develop, but something much simpler—the use of existing mass-produced technologies. http://news-service.stanford.edu/news/2006/november8/med- grove-110806.html classic complete naivete: Although there's debate about how to create a record that would be accessible to a range of providers and still protect files, Grove presented a simple answer: Keep medical records on a Web-accessible word-processing file. It costs nothing because it's already in place, Grove said. The technology already exists. there's nothing more to say. - thomas beale Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * Your email settings: Individual Email | Traditional * To change settings online go to: http://groups.yahoo.com/group/openhealth/join (Yahoo! ID required) * To change settings via email: mailto:[EMAIL PROTECTED] mailto:[EMAIL PROTECTED] * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
Re: [openhealth] Re: GPs Revolt
mspohr wrote: Simple open systems and open communications standards have the best chance of success. open yes; simple? Only as simple as it can be to still fulfull the requirements (i.e. as simple as possible but no simpler, to quote Einstein). People who refuse to deal with the innate complexity by understanding the problem space properly and then doing good design are doomed to produce failure after failure after failure. Healthcare information representation and management is a hard problem, if you want to go beyond just basic patient registries. Distributed medication management for example sounds simple to a clinical person or the patient, but is full of difficult challenges. - thomas beale
Re: [openhealth] Re: GPs Revolt
Hi Thomas, It is really interesting to see the same discussion going on all around the world; and USA is not immune from it either. I've been following the discussions in USA for a while, and http://www.emrupdate.com/forums/thread/37654.aspx is a good place to see the difference in interpretation of subject you have mentioned. Don't have a clue for how it will end for the states though. Regards Seref Arikan Thomas Beale wrote: mspohr wrote: Simple open systems and open communications standards have the best chance of success. open yes; simple? Only as simple as it can be to still fulfull the requirements (i.e. as simple as possible but no simpler, to quote Einstein). People who refuse to deal with the innate complexity by understanding the problem space properly and then doing good design are doomed to produce failure after failure after failure. Healthcare information representation and management is a hard problem, if you want to go beyond just basic patient registries. Distributed medication management for example sounds simple to a clinical person or the patient, but is full of difficult challenges. - thomas beale No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.409 / Virus Database: 268.14.17/553 - Release Date: 11/27/2006
Re: [openhealth] Re: GPs Revolt
thomas, i appreciate your concern for what you allege is dr. grove's naivete, but i share dr. grove's concern that when it comes to intelligent health information systems, the perfect is the enemy of the good. in the age of wikis, soa, voip, wifi and rfid there is no reason we cannot leverage existing secure internet transport and composing capabilities to substantially improve the interoperability of existing clinical text and image files. when i look at where dr. grove's fire is directed -- at overpriced enterprise packages that deliberately build new proprietary silos -- i find an ally who is saying the right disruptive things to people who would never listen to me. with best regards, [wr] - - - - - - - - On Nov 26, 2006, at 11:52 PM, Thomas Beale wrote: Will Ross wrote: With regard to the underestimated complexity of Healthcare IT, the recent comments by Andrew Grove are relevant. But a key problem with this plan is the lack of a good medical records system, Grove said. His solution? Not the complicated, expensive medical record-keeping system that many companies and health-care providers are trying to develop, but something much simpler—the use of existing mass-produced technologies. http://news-service.stanford.edu/news/2006/november8/med- grove-110806.html classic complete naivete: Although there's debate about how to create a record that would be accessible to a range of providers and still protect files, Grove presented a simple answer: Keep medical records on a Web-accessible word-processing file. It costs nothing because it's already in place, Grove said. The technology already exists. there's nothing more to say. - thomas beale Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - - Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * Your email settings: Individual Email | Traditional * To change settings online go to: http://groups.yahoo.com/group/openhealth/join (Yahoo! ID required) * To change settings via email: mailto:[EMAIL PROTECTED] mailto:[EMAIL PROTECTED] * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
Re: [openhealth] Re: GPs Revolt
My views haven't changed. Obviously the patient can't do it him/herself. This typically requires an agent involved, but the patient is a key ingredient of the process. The patient doesn't have the record in his/her possession although they are likely to have a copy updated to a certain point in time. The idea we proposed would work across international boundaries. It basically has a mechanism to identify a patient and then link multiple records together dynamically to create a view of the medical record that could be used in multiple locations for different purposes. The patient would have the ability to control access to the information. The author of the data (presumably the GP) would have control over the viewing of the data they generated until they sign off on it. Dave Nandalal Gunaratne wrote: 10 years ago! Do you think that is still valid, now? Have you changed your views since then? If the patients record is held in different places, how does the patient keep up with the changes? Is it his responsibility to keep it completed and upto date? Maybe he should carry the version wth him in a e-card of some sort, especially in this era, when people are moving from country to country and suddenly need their records in a strange land! --- David Forslund [EMAIL PROTECTED] mailto:forslund%40mail.com wrote: Absolutely not! I do want the patient to be in control of his/her data, with GPs assisting. I believe in a distributed EMR with control by the patient. Sometimes we called this a Virtual Medical/Patient Record (about 10 years ago in a journaled publication). Dave Nandalal Gunaratne wrote: IT would seem to me that, what you favour is a system where, all patients will have their EMR with their GPs and nobody else and nowhere else. What is done in a hospital encounter, for example a Urological Surgery, Cardioloical tests, CT scan reports, will be sent to the GP for inclusion in the EMR. For this these must be interoperable with each other. Making the GP the crux of EMR development, recording and storing, makes sense as it is patient based. He will decide as to whom he will provide access? HE has also to ensure access without fail to the patient in an emergency, which may happen in another country at an ungodly hour. Unfortunately not every country has such a well developed, GP based system, as in the UK. Nandalal --- Adrian Midgley [EMAIL PROTECTED] mailto:amidgley2%40defoam.net mailto:amidgley2%40defoam.net wrote: David Forslund wrote: I tend to think that my notes, made by me, and sitting where they currently sit, upstairs in my Practice building, mean something. It is clear to me that anyone else who gets to read them, now or later, makes their own judgement about what they mean and to what degree of relevance and reliability, and so do I for others' notes. So providing the means for other people to negotiate access to my stored notes seems sensible, they will interpret them in the light of whatever is going on, and the next person will do _their_ own thing. Pushing them all into one heap, or passing them around into everyone's heap until none of us know which are ours and which are some school-leaver's is a different and semantically inferior process. -- A
Re: [openhealth] Re: GPs Revolt
Why not hand over the keeping of the patient records to patients ( like PING), where clinicians just upload to this, and they also carry it with them in a storage format that is secure and easily accessible? The National Health Card Taiwan http://www.gi-de.com/portal/page?_pageid=42,55000_dad=portal_schema=PORTAL --- Will Ross [EMAIL PROTECTED] wrote: thomas, i appreciate your concern for what you allege is dr. grove's naivete, but i share dr. grove's concern that when it comes to intelligent health information systems, the perfect is the enemy of the good. in the age of wikis, soa, voip, wifi and rfid there is no reason we cannot leverage existing secure internet transport and composing capabilities to substantially improve the interoperability of existing clinical text and image files. when i look at where dr. grove's fire is directed -- at overpriced enterprise packages that deliberately build new proprietary silos -- i find an ally who is saying the right disruptive things to people who would never listen to me. with best regards, [wr] - - - - - - - - On Nov 26, 2006, at 11:52 PM, Thomas Beale wrote: Will Ross wrote: With regard to the underestimated complexity of Healthcare IT, the recent comments by Andrew Grove are relevant. But a key problem with this plan is the lack of a good medical records system, Grove said. His solution? Not the complicated, expensive medical record-keeping system that many companies and health-care providers are trying to develop, but something much simplerthe use of existing mass-produced technologies. http://news-service.stanford.edu/news/2006/november8/med- grove-110806.html classic complete naivete: Although there's debate about how to create a record that would be accessible to a range of providers and still protect files, Grove presented a simple answer: Keep medical records on a Web-accessible word-processing file. It costs nothing because it's already in place, Grove said. The technology already exists. there's nothing more to say. - thomas beale Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - - Yahoo! Groups Links Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com
Re: [openhealth] Re: GPs Revolt
Will Ross wrote: thomas, i appreciate your concern for what you allege is dr. grove's naivete, but i share dr. grove's concern that when it comes to intelligent health information systems, the perfect is the enemy of the good. in the age of wikis, soa, voip, wifi and rfid there is no reason we cannot leverage existing secure internet transport and composing capabilities to substantially improve the interoperability of existing clinical text and image files. well, that is just IHE/XDS, i.e. computing with no semantics - the interoperability is only between humans, not computable. So, yes, the information is a bit more avialable, but it is not integrated, searchable (beyond simplistic meta-data), computable (in the sense of being able to do longitudinal queries on an EHR or across EHRs), it is not versioned, mergeable...in short, it is not any kind of patient-centric EHR, just a bunch of documents. when i look at where dr. grove's fire is directed -- at overpriced enterprise packages that deliberately build new proprietary silos -- i find an ally who is saying the right disruptive things to people who would never listen to me. sure - proprietary silos are of no interest, no doubt about that. But just saying let's use all the modern technology isn't going to solve anything much. It has to be applied in a solution that actually addresses the problem. - thomas Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * Your email settings: Individual Email | Traditional * To change settings online go to: http://groups.yahoo.com/group/openhealth/join (Yahoo! ID required) * To change settings via email: mailto:[EMAIL PROTECTED] mailto:[EMAIL PROTECTED] * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
[openhealth] Re: GPs Revolt
Thomas, I agree that one shouldn't oversimplify but we are currently so far into building systems that are way too complex that I don't think there is a danger in oversimplification... yet. Actually, basic patient registries are very difficult to build properly when you consider the difficulties of uniquely identifying patients. A simple system would avoid a patient registry and use the presence of the patient as identification. However, Dr. Grove's idea of using basic text tools for and EMR is very good. It could be made less simple (and more useful) by adding some basic XML tags along the lines of the CCR. Most of the complexity of the EMR is in trying to structure the information and the nomenclature and coding. This is a difficult problem but it is somewhat artificial in that it does not address how patient information is actually used in practice (but does carry benefits for research, AI, and public health). Distributed data is definitely the way to go with the patient-carried record being very viable (web backup would be good). Patients are very reliable custodians of their medical records and having a web backup would take care of disasters and forgetful patients (rare). /Mark --- In openhealth@yahoogroups.com, Thomas Beale [EMAIL PROTECTED] wrote: mspohr wrote: Simple open systems and open communications standards have the best chance of success. open yes; simple? Only as simple as it can be to still fulfull the requirements (i.e. as simple as possible but no simpler, to quote Einstein). People who refuse to deal with the innate complexity by understanding the problem space properly and then doing good design are doomed to produce failure after failure after failure. Healthcare information representation and management is a hard problem, if you want to go beyond just basic patient registries. Distributed medication management for example sounds simple to a clinical person or the patient, but is full of difficult challenges. - thomas beale
Re: [openhealth] Re: GPs Revolt
thomas, if there already were facile electronic heath record software with semantically rich interoperability and a user interface that my physicians want then i would be madly installing it. if it exists and i don't know about it, please tell me. until then i plan to continue rooting for projects like yours to bring semantically advanced solutions to market while i install merely facile solutions which lack rich semantic interoperability. i can't speak for other communities, but i can speak authoritatively for rural california when i say that the current medical EHR software options are clearly underwhelming to 90% of physician practices of 5 or fewer providers, which is where 60% of our primary care takes place. and which is why EHR adoption is still anemic even after 20 years of TEPR. besides, the EHR software already installed in the larger care delivery settings is not semantically interoperable anyway, or at least not without an unjustifiable dose of infrastructure and complexity (such as IHE/XDS, an old paradigm with as much baggage as HL7). meanwhile, substantial administrative simplification can be achieved in ordinary clinical care work flow simply by organizing medical communities to collaborate intelligently and to leverage off the shelf internet technology that can improve the practice of medicine even if the clinical charting is still paper based. in other words, in my neighborhood a bunch of electronic clinical documents that are easily organized, securely stored and safely shared is an improvement over the current regime of inaccessible paper and electronic silos. and when semantically interoperable solutions arrive, we can consider them, if they are practical and suit the site level business processes of primary care. with best regards, [wr] - - - - - - - - On Nov 27, 2006, at 1:17 PM, Thomas Beale wrote: Will Ross wrote: thomas, i appreciate your concern for what you allege is dr. grove's naivete, but i share dr. grove's concern that when it comes to intelligent health information systems, the perfect is the enemy of the good. in the age of wikis, soa, voip, wifi and rfid there is no reason we cannot leverage existing secure internet transport and composing capabilities to substantially improve the interoperability of existing clinical text and image files. well, that is just IHE/XDS, i.e. computing with no semantics - the interoperability is only between humans, not computable. So, yes, the information is a bit more avialable, but it is not integrated, searchable (beyond simplistic meta-data), computable (in the sense of being able to do longitudinal queries on an EHR or across EHRs), it is not versioned, mergeable...in short, it is not any kind of patient-centric EHR, just a bunch of documents. when i look at where dr. grove's fire is directed -- at overpriced enterprise packages that deliberately build new proprietary silos -- i find an ally who is saying the right disruptive things to people who would never listen to me. sure - proprietary silos are of no interest, no doubt about that. But just saying let's use all the modern technology isn't going to solve anything much. It has to be applied in a solution that actually addresses the problem. - thomas Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - -
Re: [openhealth] Re: GPs Revolt
Having the shared EHR literally at the GP clinic is unlikely to be a good approach for technical reasons, even though the GP will in many cases be the best gatekeeper. A better solution is on secure servers at about the level of the primary care trust (UK) - in principle it needs to be at a level not much higher than where most patient information movements are likely to occur, while being at a level where economies of scale can be applied to the technical infrastructure. GP clinics and other providers are all likely to retain their own private EMRs of course, but this is not same as the patient-centric EHR. - thomas Nandalal Gunaratne wrote: IT would seem to me that, what you favour is a system where, all patients will have their EMR with their GPs and nobody else and nowhere else. What is done in a hospital encounter, for example a Urological Surgery, Cardioloical tests, CT scan reports, will be sent to the GP for inclusion in the EMR. For this these must be interoperable with each other. Making the GP the crux of EMR development, recording and storing, makes sense as it is patient based. He will decide as to whom he will provide access? HE has also to ensure access without fail to the patient in an emergency, which may happen in another country at an ungodly hour. Unfortunately not every country has such a well developed, GP based system, as in the UK. Nandalal --- Adrian Midgley [EMAIL PROTECTED] wrote: David Forslund wrote: I tend to think that my notes, made by me, and sitting where they currently sit, upstairs in my Practice building, mean something. It is clear to me that anyone else who gets to read them, now or later, makes their own judgement about what they mean and to what degree of relevance and reliability, and so do I for others' notes. So providing the means for other people to negotiate access to my stored notes seems sensible, they will interpret them in the light of whatever is going on, and the next person will do _their_ own thing. Pushing them all into one heap, or passing them around into everyone's heap until none of us know which are ours and which are some school-leaver's is a different and semantically inferior process. -- A Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com Yahoo! Groups Links -- ___ CTO Ocean Informatics (http://www.OceanInformatics.biz) Research Fellow, University College London (http://www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org)
Re: [openhealth] Re: GPs Revolt
Thomas Beale wrote: Having the shared EHR literally at the GP clinic is unlikely to be a good approach for technical reasons, even though the GP will in many cases be the best gatekeeper. A better solution is on secure servers at about the level of the primary care trust (UK) ** Stability ** We just lost 400 of those! I trained in a general practice which was then in its third century of continuous provision of medical care in its district. It had not been computerised so long, but since then it has changed systems, perforce, once already. (It also had a different building, different partners, and different patients, although significantly it had some of the same families on the list, I do not doubt.) General practices endure. Hospitals likewise. Health service administrative organisations are changed a little slower than underwear, but are far from constant. And the persistence of information between two avatars of essentially the same admin-org is similar to that on underwear. And that is the way the admindroids taking control of each new spasm like it - each wheel is reinvented, every 3 to 5 years. I agree about the technical reasons, but continuity is a huge merit.
Re: [openhealth] Re: GPs Revolt
Adrian Midgley wrote: Health service administrative organisations are changed a little slower than underwear, but are far from constant. And the persistence of information between two avatars of essentially the same admin-org is similar to that on underwear. And that is the way the admindroids taking control of each new spasm like it - each wheel is reinvented, every 3 to 5 years. I agree about the technical reasons, but continuity is a huge merit. no argument there; I am thinking about: a) security: the main mode of information theft/hacking is physical theft of media/computers. Easy to do in many GP surgeries b) 24x7 IT support, OS tool upgrading, backup, disaster recovery, etc. Too hard for many practices to do reliably. c) the level at which tools and services are paid for. Each individual GP clinic could do it, but one level up is likely to be better. My view would be to make PCTs do the job we want them to do in the new world - thomas
Re: [openhealth] Re: GPs Revolt
I presume you mean that holding it at the GP level is far more stable for the patient? Admin/manager changes can vary, and their approach to change as well. THerefore it all depends. As for change in underwear, this could vary as well, if you listen to this story :-) A customs officer was checking the bags at an airport, and there were three persons in a row. The first one had just one underwear, and the officer asked, just one? with some surprise. I wash it daily said the first person. The second had seven, and he said One for each day of the week. The third was a lady, really impressive having a dozen, until she said One is for January, One is for February Similarly, the changes in administration is not directly proportional to system changes and therefore to stability. The GP may not be good at keeping his data safe and if he is running windows without updating his virus guard, the EHR could just be gone with the wind --- Adrian Midgley [EMAIL PROTECTED] wrote: Thomas Beale wrote: Having the shared EHR literally at the GP clinic is unlikely to be a good approach for technical reasons, even though the GP will in many cases be the best gatekeeper. A better solution is on secure servers at about the level of the primary care trust (UK) ** Stability ** We just lost 400 of those! I trained in a general practice which was then in its third century of continuous provision of medical care in its district. It had not been computerised so long, but since then it has changed systems, perforce, once already. (It also had a different building, different partners, and different patients, although significantly it had some of the same families on the list, I do not doubt.) General practices endure. Hospitals likewise. Health service administrative organisations are changed a little slower than underwear, but are far from constant. And the persistence of information between two avatars of essentially the same admin-org is similar to that on underwear. And that is the way the admindroids taking control of each new spasm like it - each wheel is reinvented, every 3 to 5 years. I agree about the technical reasons, but continuity is a huge merit. Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com
Re: [openhealth] Re: GPs Revolt
With regard to the underestimated complexity of Healthcare IT, the recent comments by Andrew Grove are relevant. But a key problem with this plan is the lack of a good medical records system, Grove said. His solution? Not the complicated, expensive medical record-keeping system that many companies and health-care providers are trying to develop, but something much simpler—the use of existing mass-produced technologies. http://news-service.stanford.edu/news/2006/november8/med- grove-110806.html - - - - - - - - [wr] - - - - - - - - On Nov 25, 2006, at 6:05 AM, ivhalpc wrote: I presumed then and still presume that Mr. Gates like just about everyone else grossly estimates the difficulty of Healthcare IT. Optimism in this business is a disease that infects even those who should know better such as faculty at schools of health informatics. For example, classic software project management techniques are taught as gospel and adhered too rigorously despite a demonstrated high failure rate. I suppose you have to teach something. -- IV --- In openhealth@yahoogroups.com, Adrian Midgley [EMAIL PROTECTED] wrote: The driving force for the programme was, so far as I can tell, a pitch by Sir William Gates 3 over lunch at number 10 to the outgoing prime minister, and therefore, in the nature of these things, as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. -- Midgley Not by any means an astute political commentator, but occasionally known to get it right. Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - - Yahoo! Groups Links * To visit your group on the web, go to: http://groups.yahoo.com/group/openhealth/ * Your email settings: Individual Email | Traditional * To change settings online go to: http://groups.yahoo.com/group/openhealth/join (Yahoo! ID required) * To change settings via email: mailto:[EMAIL PROTECTED] mailto:[EMAIL PROTECTED] * To unsubscribe from this group, send an email to: [EMAIL PROTECTED] * Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
[openhealth] Re: GPs Revolt
I find Dr. Grove's approach interesting. He focuses on the keep is simple (KISS) principle and is rightly worried about huge spending on unproven information systems. He also proposes the widespread deployment of simple walk-in clinics to lower the cost and improve access to medical care. These ideas have a lot to recommend them. Large software projects almost always fail in one way or another... often spectacular failure. There is a limit to how much you can change in any system and these large projects change everything. Add to that the fact that they are often poorly designed and administered and they are destined to fail. On information systems... Adopting complex proprietary systems is also a recipe for failure. My brother in law is working for a group of hospitals on their IT conversion. He recently related that a project where three proprietary vendors were supposed to work together had failed to achieve any of its goals and they were in an advanced state of finger-pointing. They were supposed to set up proprietary communication among the three proprietary systems (each of them complex applications) and it wasn't working. No surprise here. If they had started with simpler open systems and open standard communication protocols, this would have given the project a chance of success and they could have called in new vendors when the original contractors failed to deliver. As it is now, they are stuck throwing good money after bad or just abandoning the project. Simple open systems and open communications standards have the best chance of success. You also want a distributed system which can grow with small successes and not be hindered by the failure of central choke points to perform. This is much like the Internet itself where you have simple open communication protocols and distributed development. If ATT had been given a lot of money to develop the Internet, they would have designed a project like that in the UK (centralized control and proprietary standards) and it would have failed. The Internet has been spectacularly successful because it was designed with simple open communication protocols and it could be implemented in a distributed manner. People who could get it together to follow the simple protocols were successfully connected and they weren't impeded by those who couldn't follow simple directions. /Mark --- In openhealth@yahoogroups.com, Will Ross [EMAIL PROTECTED] wrote: With regard to the underestimated complexity of Healthcare IT, the recent comments by Andrew Grove are relevant. But a key problem with this plan is the lack of a good medical records system, Grove said. His solution? Not the complicated, expensive medical record-keeping system that many companies and health-care providers are trying to develop, but something much simplerthe use of existing mass-produced technologies. http://news-service.stanford.edu/news/2006/november8/med- grove-110806.html - - - - - - - - [wr] - - - - - - - - On Nov 25, 2006, at 6:05 AM, ivhalpc wrote: I presumed then and still presume that Mr. Gates like just about everyone else grossly estimates the difficulty of Healthcare IT. Optimism in this business is a disease that infects even those who should know better such as faculty at schools of health informatics. For example, classic software project management techniques are taught as gospel and adhered too rigorously despite a demonstrated high failure rate. I suppose you have to teach something. -- IV
Re: [openhealth] Re: GPs Revolt
10 years ago! Do you think that is still valid, now? Have you changed your views since then? If the patients record is held in different places, how does the patient keep up with the changes? Is it his responsibility to keep it completed and upto date? Maybe he should carry the version wth him in a e-card of some sort, especially in this era, when people are moving from country to country and suddenly need their records in a strange land! --- David Forslund [EMAIL PROTECTED] wrote: Absolutely not! I do want the patient to be in control of his/her data, with GPs assisting. I believe in a distributed EMR with control by the patient. Sometimes we called this a Virtual Medical/Patient Record (about 10 years ago in a journaled publication). Dave Nandalal Gunaratne wrote: IT would seem to me that, what you favour is a system where, all patients will have their EMR with their GPs and nobody else and nowhere else. What is done in a hospital encounter, for example a Urological Surgery, Cardioloical tests, CT scan reports, will be sent to the GP for inclusion in the EMR. For this these must be interoperable with each other. Making the GP the crux of EMR development, recording and storing, makes sense as it is patient based. He will decide as to whom he will provide access? HE has also to ensure access without fail to the patient in an emergency, which may happen in another country at an ungodly hour. Unfortunately not every country has such a well developed, GP based system, as in the UK. Nandalal --- Adrian Midgley [EMAIL PROTECTED] mailto:amidgley2%40defoam.net wrote: David Forslund wrote: I tend to think that my notes, made by me, and sitting where they currently sit, upstairs in my Practice building, mean something. It is clear to me that anyone else who gets to read them, now or later, makes their own judgement about what they mean and to what degree of relevance and reliability, and so do I for others' notes. So providing the means for other people to negotiate access to my stored notes seems sensible, they will interpret them in the light of whatever is going on, and the next person will do _their_ own thing. Pushing them all into one heap, or passing them around into everyone's heap until none of us know which are ours and which are some school-leaver's is a different and semantically inferior process. -- A __ Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com http://voice.yahoo.com __ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com
Re: [openhealth] Re: GPs Revolt
The structured mess in the bucket approach. It does appear to be within our capabilities. -- Midgley
Re: [openhealth] Re: GPs Revolt
Gregory, Sun purchased SeeBeyond last year. http://www.seebeyond.com/ It in now part of Sun's Healthcare and Life Sciences business unit. With best regards, [wr] - - - - - - - - On Nov 25, 2006, at 10:24 AM, Gregory Woodhouse wrote: On Nov 22, 2006, at 5:51 AM, Seref Arikan wrote: Hi Will, I'd be very much interested in hearing more about SeeBeyond going open source. Would you please share any news on this one? I seem to recall an interface engine being renamed SeeBeyond some years ago, but I don't think it had anything to do with Sun. is this the same thing? Gregory Woodhouse [EMAIL PROTECTED] We may with advantage at times forget what we know. --Publilius Cyrus, c. 100 B.C. [Non-text portions of this message have been removed] Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - -
RES: [openhealth] Re: GPs Revolt
Updated information can be found at http://www.sun.com/software/javaenterprisesystem/integration_suite/index.xml Regards, John _ De: openhealth@yahoogroups.com [mailto:[EMAIL PROTECTED] Em nome de Will Ross Enviada em: domingo, 26 de novembro de 2006 16:54 Para: openhealth@yahoogroups.com Assunto: Re: [openhealth] Re: GPs Revolt Gregory, Sun purchased SeeBeyond last year. http://www.seebeyon http://www.seebeyond.com/ d.com/ It in now part of Sun's Healthcare and Life Sciences business unit. With best regards, [wr] - - - - - - - - On Nov 25, 2006, at 10:24 AM, Gregory Woodhouse wrote: On Nov 22, 2006, at 5:51 AM, Seref Arikan wrote: Hi Will, I'd be very much interested in hearing more about SeeBeyond going open source. Would you please share any news on this one? I seem to recall an interface engine being renamed SeeBeyond some years ago, but I don't think it had anything to do with Sun. is this the same thing? Gregory Woodhouse gregory.woodhouse@ mailto:gregory.woodhouse%40sbcglobal.net sbcglobal.net We may with advantage at times forget what we know. --Publilius Cyrus, c. 100 B.C. [Non-text portions of this message have been removed] Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - - [Non-text portions of this message have been removed]
Re: [openhealth] Re: GPs Revolt
Nandalal Gunaratne wrote: IT would seem to me that, what you favour is a system where, all patients will have their EMR with their GPs and nobody else and nowhere else. Not so. The principle generalises and scales well. What is done in a hospital encounter, for example a Urological Surgery, Cardioloical tests, CT scan reports, will be sent to the GP for inclusion in the EMR. Messaging (sent to the GP) is one approach, and one that has had a lot of effort and money applied to it. I'd suggest that if the urologist holds his notes, and the labs hold their results, and the imaging stays stored in the radiology dept (as it currently does in UK hospitals, actually) then the problems of network outages and congestion may be reduced, and the problem of gaining access to other components of the medical record resolves to one of knowing who is who, and where (list of places) records of a given patient may be found and should be sought. A master index is probably an asset for that, but one could ask the patient and one could broadcast an enquiry, there are many ways to do it and a lesson of the Internet is that simple systems can produce good results. For this these must be interoperable with each other. At some fundamental low level, yes, but Berners-Lee solved that one I think. Making the GP the crux of EMR development, recording and storing, makes sense as it is patient based. He will decide as to whom he will provide access? HE has also to ensure access without fail to the patient in an emergency, which may happen in another country at an ungodly hour. Well, as for other countries, the present plan in the UK doesn't really give access between Scotland and England and Wales, in fact the division of England into five regions each with a main contractor very quickly settled down from the regions being expected to interoperate through a common network layer the spine into interoperation within each region, and a restricted subset of messages passable from one to another. A node-based system using the patient as a token (I am John Smith, I was your patient, I am with Dr Brown here, I want him to have access to my notes, please - automated if need be) scales to the world, and beyond, provided the network is there. Emergencies uncommonly require notes for unanticipatable detail, but the UK lost all stored data access for 80 separate Trusts (think hospital plus community services) for several days from a failed UPS earlier this year... Distributed systems fail more gracefully than centralised ones, althoguh it may be less common for every node to be running on them. Unfortunately not every country has such a well developed, GP based system, as in the UK. Don't worry, the UK is working on conforming to the wider standard.
[openhealth] Re: GPs Revolt
I presumed then and still presume that Mr. Gates like just about everyone else grossly estimates the difficulty of Healthcare IT. Optimism in this business is a disease that infects even those who should know better such as faculty at schools of health informatics. For example, classic software project management techniques are taught as gospel and adhered too rigorously despite a demonstrated high failure rate. I suppose you have to teach something. -- IV --- In openhealth@yahoogroups.com, Adrian Midgley [EMAIL PROTECTED] wrote: The driving force for the programme was, so far as I can tell, a pitch by Sir William Gates 3 over lunch at number 10 to the outgoing prime minister, and therefore, in the nature of these things, as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. -- Midgley Not by any means an astute political commentator, but occasionally known to get it right.
Re: [openhealth] Re: GPs Revolt
Absolutely not! I do want the patient to be in control of his/her data, with GPs assisting. I believe in a distributed EMR with control by the patient. Sometimes we called this a Virtual Medical/Patient Record (about 10 years ago in a journaled publication). Dave Nandalal Gunaratne wrote: IT would seem to me that, what you favour is a system where, all patients will have their EMR with their GPs and nobody else and nowhere else. What is done in a hospital encounter, for example a Urological Surgery, Cardioloical tests, CT scan reports, will be sent to the GP for inclusion in the EMR. For this these must be interoperable with each other. Making the GP the crux of EMR development, recording and storing, makes sense as it is patient based. He will decide as to whom he will provide access? HE has also to ensure access without fail to the patient in an emergency, which may happen in another country at an ungodly hour. Unfortunately not every country has such a well developed, GP based system, as in the UK. Nandalal --- Adrian Midgley [EMAIL PROTECTED] mailto:amidgley2%40defoam.net wrote: David Forslund wrote: I tend to think that my notes, made by me, and sitting where they currently sit, upstairs in my Practice building, mean something. It is clear to me that anyone else who gets to read them, now or later, makes their own judgement about what they mean and to what degree of relevance and reliability, and so do I for others' notes. So providing the means for other people to negotiate access to my stored notes seems sensible, they will interpret them in the light of whatever is going on, and the next person will do _their_ own thing. Pushing them all into one heap, or passing them around into everyone's heap until none of us know which are ours and which are some school-leaver's is a different and semantically inferior process. -- A __ Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com http://voice.yahoo.com
Re: [openhealth] Re: GPs Revolt
On Nov 22, 2006, at 5:51 AM, Seref Arikan wrote: Hi Will, I'd be very much interested in hearing more about SeeBeyond going open source. Would you please share any news on this one? I seem to recall an interface engine being renamed SeeBeyond some years ago, but I don't think it had anything to do with Sun. is this the same thing? Gregory Woodhouse [EMAIL PROTECTED] We may with advantage at times forget what we know. --Publilius Cyrus, c. 100 B.C. [Non-text portions of this message have been removed]
Re: [openhealth] Re: GPs Revolt
--- Adrian Midgley [EMAIL PROTECTED] wrote: as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. I hope not! In the sense that the NHS forgets about plans for EMR. Maybe a more sensible and practical approach will result? Nandalal -- Midgley Not by any means an astute political commentator, but occasionally known to get it right. Yahoo! Music Unlimited Access over 1 million songs. http://music.yahoo.com/unlimited
Re: [openhealth] Re: GPs Revolt
Thomas, Can you elaborate on the design flaw you see in a message based National e-Health Grid? Is a message based grid inherently flawed? Or is the design flaw contained in the CFH implementation of a message based e-Health Grid? That is, can a message based grid be implemented correctly? With best regards, [wr] - - - - - - - - On Nov 23, 2006, at 9:46 AM, Thomas Beale wrote: Adrian Midgley wrote: The driving force for the programme was, so far as I can tell, a pitch by Sir William Gates 3 over lunch at number 10 to the outgoing prime minister, and therefore, in the nature of these things, as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. just based on what we read in the Guardian, it appears to be on a knife-edge anyway. But there has been substantive spending - CFH has already spent many millions (I would think many times £100m) on message development and other work that blithely assumes the central message bank idea, without taking any account of how health record systems work, where they might be and how they should be integrated with each other. Some extremely competent people working in CFH today are living with the terrible choices of a few years ago (a message-based design conception of a national e-Health grid), and are trying to do their best in those circumstances. - thomas beale -- __ _ CTO Ocean Informatics (http://www.OceanInformatics.biz) Research Fellow, University College London (http:// www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org) Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - -
Re: [openhealth] Re: GPs Revolt
I'm not sure what Thomas' view is, but here are my $.02. Thinking of messaging tends to distract one from trying to solve the real problem. The idea seems to be that sending messages around is good and people will eventually be able to figure out what they mean. One needs to worry more about semantic integration and leave the technology underlying this aside. Messaging is a particular technological approach rather than a semantic integration approach. This, IMHO, has been the weakness of HL7 in that it has blurred the boundary of technology and semantics too much. Dave Will Ross wrote: Thomas, Can you elaborate on the design flaw you see in a message based National e-Health Grid? Is a message based grid inherently flawed? Or is the design flaw contained in the CFH implementation of a message based e-Health Grid? That is, can a message based grid be implemented correctly? With best regards, [wr] - - - - - - - - On Nov 23, 2006, at 9:46 AM, Thomas Beale wrote: Adrian Midgley wrote: The driving force for the programme was, so far as I can tell, a pitch by Sir William Gates 3 over lunch at number 10 to the outgoing prime minister, and therefore, in the nature of these things, as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. just based on what we read in the Guardian, it appears to be on a knife-edge anyway. But there has been substantive spending - CFH has already spent many millions (I would think many times £100m) on message development and other work that blithely assumes the central message bank idea, without taking any account of how health record systems work, where they might be and how they should be integrated with each other. Some extremely competent people working in CFH today are living with the terrible choices of a few years ago (a message-based design conception of a national e-Health grid), and are trying to do their best in those circumstances. - thomas beale -- __ _ CTO Ocean Informatics (http://www.OceanInformatics.biz http://www.OceanInformatics.biz) Research Fellow, University College London (http:// www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org http://www.openEHR.org) Yahoo! Groups Links [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - Getting people to adopt common standards is impeded by patents. Sir Tim Berners-Lee, BCS, 2006 - - - - - - - -
Re: [openhealth] Re: GPs Revolt
Nandalal Gunaratne wrote: I hope not! In the sense that the NHS forgets about plans for EMR. Maybe a more sensible and practical approach will result? Nandalal Not unless the current one falls apart. Apropos of which, when/if it does, I need something better to present...
Re: [openhealth] Re: GPs Revolt
IT would seem to me that, what you favour is a system where, all patients will have their EMR with their GPs and nobody else and nowhere else. What is done in a hospital encounter, for example a Urological Surgery, Cardioloical tests, CT scan reports, will be sent to the GP for inclusion in the EMR. For this these must be interoperable with each other. Making the GP the crux of EMR development, recording and storing, makes sense as it is patient based. He will decide as to whom he will provide access? HE has also to ensure access without fail to the patient in an emergency, which may happen in another country at an ungodly hour. Unfortunately not every country has such a well developed, GP based system, as in the UK. Nandalal --- Adrian Midgley [EMAIL PROTECTED] wrote: David Forslund wrote: I tend to think that my notes, made by me, and sitting where they currently sit, upstairs in my Practice building, mean something. It is clear to me that anyone else who gets to read them, now or later, makes their own judgement about what they mean and to what degree of relevance and reliability, and so do I for others' notes. So providing the means for other people to negotiate access to my stored notes seems sensible, they will interpret them in the light of whatever is going on, and the next person will do _their_ own thing. Pushing them all into one heap, or passing them around into everyone's heap until none of us know which are ours and which are some school-leaver's is a different and semantically inferior process. -- A Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com
Re: [openhealth] Re: GPs Revolt
Nandalal Gunaratne wrote: --- Thomas Beale [EMAIL PROTECTED] mailto:Thomas.Beale%40OceanInformatics.biz wrote: It is also a bad idea in terms of security, as Ross Anderson and others have repeatedly pointed out. In short, it is doomed to failure. Bad start for HIT if this so happens. Governments may be reluctant to spend on such developments, quoting this as an example. And what happens to all that money, in billions of doomed Sterling Pounds?? Little substantive spending has happened - various admin types appointed, but the contracts only pay if it happens. So the likely course would be for it to be divided between the Treasury for general purposes, and general healthcare services in the NHS. Currently the chancellor is about to take over as prime minister - that is the second lord of the treasury becoming the first lord, and various parts of the NHS are overspent and becoming embarrassing. The driving force for the programme was, so far as I can tell, a pitch by Sir William Gates 3 over lunch at number 10 to the outgoing prime minister, and therefore, in the nature of these things, as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. -- Midgley Not by any means an astute political commentator, but occasionally known to get it right.
Re: [openhealth] Re: GPs Revolt
Adrian Midgley wrote: The driving force for the programme was, so far as I can tell, a pitch by Sir William Gates 3 over lunch at number 10 to the outgoing prime minister, and therefore, in the nature of these things, as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. just based on what we read in the Guardian, it appears to be on a knife-edge anyway. But there has been substantive spending - CFH has already spent many millions (I would think many times £100m) on message development and other work that blithely assumes the central message bank idea, without taking any account of how health record systems work, where they might be and how they should be integrated with each other. Some extremely competent people working in CFH today are living with the terrible choices of a few years ago (a message-based design conception of a national e-Health grid), and are trying to do their best in those circumstances. - thomas beale -- ___ CTO Ocean Informatics (http://www.OceanInformatics.biz) Research Fellow, University College London (http://www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org)
Re: [openhealth] Re: GPs Revolt
Thomas Beale wrote: Adrian Midgley wrote: The driving force for the programme was, so far as I can tell, a pitch by Sir William Gates 3 over lunch at number 10 to the outgoing prime minister, and therefore, in the nature of these things, as The Rt Hon Mr Anthony Blair MP steps back to being a back bench MP, the plan is likely to fall apart. just based on what we read in the Guardian, it appears to be on a knife-edge anyway. But there has been substantive spending - CFH has already spent many millions (I would think many times £100m) on message development and other work that blithely assumes the central message bank idea, without taking any account of how health record systems work, where they might be and how they should be integrated with each other. Some extremely competent people working in CFH today are living with the terrible choices of a few years ago (a message-based design conception of a national e-Health grid), and are trying to do their best in those circumstances. The knife edge appears to be to its throat, I agree with the above, I'm afraid I've fallen into the trap of thinking of a few tens of millions as not really much, compared to the yawning abyss of spending that was being presented as a plan. I'd be a bit surprised if another order of magnitude above it had actually been spent, as opposed to insincerely promised, planned, scheduled or announced though.
Re: [openhealth] Re: GPs Revolt
just based on what we read in the Guardian, it appears to be on a knife-edge anyway. But there has been substantive spending - CFH has already spent many millions (I would think many times £100m) on message development and other work that blithely assumes the central message bank idea, without taking any account of how health record systems work, where they might be and how they should be integrated with each other. Some extremely competent people working in CFH today are living with the terrible choices of a few years ago (a message-based design conception of a national e-Health grid), and are trying to do their best in those circumstances. - thomas beale We're about to embark on the plan for a e-Health Research Network for Asia. These unfortunate case studies come in handy as lessons learnt elsewhere that we will pay special attention to. One of OSHCA's proposed projects would look at interoperability issues in relation to data interchange and open standards. We hope to get together to talk about this as soon as we can put together some funding for it. Naturally we hope to be able do this as part of the e-Health Research Network. Molly
