Heath, I know what you are saying about RIM semantics but aren't the openEHR RM classes, OBSERVATION, INSTRUCTION, EVALUATION, etc. implying a general weak clinical semantic as a framework for hanging stronger semantic archetyping. I can imply certain things about a stored openEHR OBSERVATION based on the openEHR RM definition without knowledge of the archetype applied to it, for a start it is considered an observation not an instruction for instance.
As for terminology binding for consistency we would need to ensure that the use of terminology binding in leaf nodes of archetypes was controlled enough to ensure that the granularity of the concept matched the allowed data constraints at the node and also that concept either did not appear in other archetypes or matched exactly in terms of constraints to data. It is what it is...there are no choices here. We could also ensure that terminology bound child nodes in an archetype definition can be related to the parent terminology binding in a known way; this might be made explicit as a SNOMED-CT hierarchy. Parents and child nodes are related through a relationship this is not explicity stated in archetype definitions at this point. These approaches will show any holes in SNOMED-CT that need addressing and also extend the concepts to include data definitions where appropriate. Regards, Brett Esler -----Original Message----- From: openehr-clinical-boun...@openehr.org [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Heath Frankel Sent: Wednesday, 21 February 2007 3:28 PM To: 'For openEHR clinical discussions' Subject: RE: CCR and openehr Andrew, > > data structure defined by a particular organisation but has no true > > semantics in health, where as a discharge or referral is a > common concept. > > Well, not strictly true - the CCR has semantics that aren't > the same as discharge or referral but they are seemingly > clear to the CCR people > - the CCR is a summary > record that could be used by an (unknown at the time of > composition) future health provider to continue the care of > this patient. If it becomes popular it may become a common > health concept. I don't see any difference in semantics to the Discharge Summary stored in a HealthConnect Record System. > Well, we'd maybe have multiple archetype sets (as opposed to > one set of > archetypes) each defined by different organisations. ASTM, > NHS, NEHTA etc. I don't think we'd even break into the 1000's > if every health standards body defined their own? openEHR does not intended for this to happen. However, this does not mean that organisations can't have local archetypes but they should not semantically overlap with those archetypes that are globally recognised. This is the fundamentals of Archetype Governance which is under development by the openEHR Clinical Review Board. > I thought semantic interoperability was the ability to > computationally recognise the similarities in archetyped data > between systems using terminologies etc, therefore allowing > data to be used across multiple systems. i.e. this is a soap > 'plan' because it is in a section marked with the term > binding for 'plan', and over here in this other completely > different archetype we might have a similar section and > therefore we know they have the same meaning. If semantic > interoperability is just that everyone agrees to use the same > definitions for everything, then we don't really need a fancy > word like semantic interoperability for it. Its like saying > we'd have semantic interoperability if everyone agreed to use > the Medical Director database schema - which is true but > pointless - if everyone agreed in the first place we wouldn't > be worried about the semantics when we go to interoperate. Actually sections are purely organisational only, they do not change the semantics of the entries inside them. What you describe above regarding sematic interoperability is what is attempted by HL7 V3 where the semantics are defined in the RIM. The problem here is that no one can agree on the semantics of the RIM (I am not trying to controversial here, this is from experience as the Modelling Facilitator of the Care Provision domain for many years). It has taken > 2 years (and it continues) to agree on the RIM structures required to semantically define a Problem List and Allergy. We do not have this problem in openEHR as the semantics of the concept are declared by the definition of an archetype and all you have to do is specify the data that you need to capture as part of that concept. What we do is share the concept ID (the archetype ID) which is analogous to sharing SNOMED concept IDs and share the data structure along with that. If you go and define your own data structure and assign your own archetype ID for the same concept then you have just broken your semantic interoperability. You are absolutely correct, if we can agree then we wouldn't need to worry about mapping semantics to interoperate, that is the premise of archetypes. > > I'm not suggesting that every player in the whole health > system would be going around defining archetypes for > everything. But surely we're not suggesting that there would > only be ONE set of archetypes for the whole world (with > templates making the constraints for local variations)? For agreed concepts, yes. Local archetypes can exist (as long as they don't overlap), including specialisation of global archetypes, and they can get promoted to higher levels of as consensus grows around that archetype. Regards Heath _______________________________________________ openEHR-clinical mailing list openEHR-clinical at openehr.org http://www.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical _______________________________________________ openEHR-clinical mailing list openEHR-clinical at openehr.org http://www.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
