Subject: Re: single model, was Re: Care2x classtree and archetypes and shared data models
Date: Mon, 01 Mar 2004 23:55:34 +0000
From: J. Antas <[EMAIL PROTECTED]>
Reply-To: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Thomas Beale wrote:
Others here and elsewhere of course have thought about the problem (for many years) of making data models that really do work for all of the domain,
Rationally I do agree with you. I am sure that they are better models. But my problem in the first place was: How are they doing in real life, do they really work? At which hospitals, clinics are they doing their work? People using them like to use it? Are those models generalizable? At which countries are they working?
and it is the main goal of openEHR (with which I am involved) to do this for health records (EHRs);
I did not included it because, I must confess, I had a hard time trying to create a "user model" of it... and I gave up. Either it is because I am not a native english speaker and I cannot fully understand some of the concepts beneath it, or it is because my own neural network was not able to "catch" it. In any case I think that it is authors fault. The bait was not god enough. It should be easier to understand. Or it is already easier enough and it is my own fault. It is like when we find a new surgical technical in a just arrived magazine and we simply fail to understand how to do it. We realize that it could be interesting, but we simply fail to understand how to master it (We know that sometimes by own experience because as we go and stay at that author team we suddenly talk to them, see how they do it... and suddenly we realize how simple and clever that was...)
Andrew's OIO product has a similar goal; the HL7v3 RIM is another such model;
These are two lines of thought that we are trying to "assimilate". OIO because it is beautifully simple way to code a very complex concept. Real hard work must have been done to make it such "simple".
HL7 v.3, because it could, finally, be the start of a new era. But they do not have a good past record. It still has behind all those boys that make a living from "babelonizing" it. Look at what HL7 achieved in almost 20 years...
The point is that models which are initially conceived to satisfy many users across the spectrum (rather than a single product or kind of use)
And this is certainly the case. I see here that we are only talking about EHR (maybe CCR also) models. But we are even "worse", because besides the gargantuan task of modeling a EHR, we dare to reach others and try to make the hospital "plain", i.e.: a. Clinical, b. Administrative & Operational c. Financial
And that is, I assure you, HUGE! So, you see, we must be pragmatic, we acknowledge that there is a beautiful way to make cars working on hydrogen fuel cells, we will most certainly try it in the future, but right now we are making vehicles moved on plain fossil, 100 year old gasoline technology.
Show us a reliable, working, hydrogen motor and we will use it and will give you all the credits for it too.
Has it a good conceptual model?J, I think it has an excellent data model.
I do not. I am not still satisfied with it. In fact I am far from that.
Instead, the issue is how can a single data model be excellent for every hospital and every living, breathing group of healthcare workers?
It can't. But we deal with a complex world and so far we only managed to make imperfect tools. But it works. (boy, this sounds a lot like the Galilean "e per si muove")
Accuracy is never the issue. The biggest issue, when it comes to living, breathing, symbiotic software (from my biased perspective), is change management / adaptability.
So far, 20 countries. How do we evaluate Health IT FLOSS? They are using in languages that I cannot write or even pronounce.
The openEHR reference model for example only has 3 generic Entry types - Observation, Evaluation, and Instruction; and about a dozen other major types. Encounter is not one of them.
I see that it has the potential to be more flexible and accurate. But we do not know yet how to do it. How are your users doing with it? How do people use it in India, or in Libya, or in Brasil, or in Germany? I could tell you how are they doing in 16 more countries with Care2x.
I admit that I am still amazed, because to me it is only an "invertebrate" kind of HIS organism.
Instead, you have to adopt a different strategy. One such strategy is 'two-level modelling', which I described in some detail.
Detail. Yes. Understandable? Well... No. Be patient, I am still from the "baby boomer" generation. Maybe my neurons are not functioning properly anymore... Perhaps if you could you provide metaphors, better pictures, real life examples.
Or better yet, a real piece of code to include in Care2x and see how people accept it. ;-) Say you have this marvelous new antibiotic. And it is supposed to make wonders for people. Say that at Care2x we are still using penicillin. But we use it in a large network of hospitals. Would you care for a clinical trial? In the end lets see who kills more bugs. But I must warn you that if we find your antibiotic better we may drop ours and immediately start using yours. So, you see, this is pragmatism at work, there is no "my baby" syndrome. It is plain earth-to-earth "if yours is better and if it comes with no strings attached (read if it it is FLOSS) we will use it". That has been the most constant thing in the Care2x project and perhaps one of its greatest strengths: if someone comes along with a *working* better approach, we drop ours and just adapt to the new code. We may even find some mutants along the way, but the only way to know if they are "adaptative" or not is... to try them. And I assure you, we do try a lot.
Now...of course this is not the only attempt to solve this problem, but generically speaking, it seems to be the right kind of approach.
I do agree with you. It seems to be good.
hope this helps,
What? The fact that you have been graciously sharing with us your knowledge and experience? You bet it helps us! Thanks for sharing your thoughts with us,
J. Antas - Care2x Project
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