Andrew Patterson wrote: > Does anyone want to respond to this? > > http://aushealthit.blogspot.com/2007/01/archetypically-stupid.html > > David More seems to be going on a bit of a crusade at the moment, > firing shots at all current work in Australian e-health (NEHTA etc). > Some of it is deserved no doubt, but I think he is a bit confused > about exactly what the archetype approach is about.
I agree that David does not have some of the technical details about openEHR archetypes quite right (note that the qualifier "openEHR" is necessary as there are many other uses of the term "archetypes" out there in information management land, some of which predate openEHR/GEHR work and many which are more widely known), although the fact that a smart person like David with plenty of time on his hands hasn't grasped everything about archetypes underlines the fact that they are presented in a rather complex and mystifying manner to someone encountering them for the first time. Not sure how to make it less complex (a really good professional technical writer might be able to help, but they cost a lot to hire) - nevertheless, perceived complexity is the enemy of widespread acceptance, I suspect. However, I basically agree with David's main tenets that it is premature to be pushing for finalised openEHR standards when there are so few deployed examples of true openEHR systems in production (not research) use out there, and when formal (or even informal) documented evaluations of such systems (even of research systems) are so thin on the ground. Pilot openEHR implementations funded by the Australian government may or may not have been formally evaluated, but if they have, the reports have not been published to my knowledge. A Medline/PubMed search for independent peer-reviewed (i.e. not written by Ocean Informatics or UCL staff) evaluations, even anecdotal mentions, of any aspect of openEHR informations systems yields, well, exactly zero papers, when I last looked a few months ago. Have I overlooked something? I suppose what I am saying is that elsewhere in medicine and health care, standards tend to be evidence-based i.e. before a new treatment method or protocol is promulgated as a standard approach, there needs to be a reasonable (not necessarily extensive) set of formal evaluations of that method or technique using scientific methods (typically statistical or epidemiological methods in clinical trials or observational studies for clinical medicine, but that may not be appropriate for evaluation of all aspects of information management systems or methods). That evidence base seems to be lacking for openEHR archetypes. One could say that it is also lacking for other health information management approaches and techniques, and where these are the subject of final standards, I would level exactly the same criticism at them. I know that the openEHR/Ocean Informatics/UCL people, and perhaps some other research groups, believe fervently in the adequacy and practicality of the openEHR approach, but modern health care has just about dispensed with fervent belief. Formal studies in peer-reviewed journals are needed - and yes, those takes time - perhaps a large part of a decade. But the openEHR project has been going form a decade or so now, and the GEHR project for nearly a decade prior to that. What's a few more years? I also agree with David that openEHR archetypes will only be a solution (as opposed to yet another complicated headache, like HL7 already is) if an adequate national or global "intellectual ecosystem" can be established for the definition, sharing and evolution of openEHR archetype and template definitions. David comes from the "centralist control freak" era - I'm an open source person and so am not quite so worried about the ability to impose openEHR Stalinism. However, some form of co-ordination and sharing mechanisms are needed, and these do not happen by accident - they need to be carefully grown and nurtured and even then they may not be sustainable. Certainly, the business model for openEHR repositories is unclear, as it is not in the interest of the large health system providers (including the likes of Microsoft and IBM) to promote such things as true openEHR-mediated interoperability will mean than vendor lock-in will be undermined. Governments should fund such repositories, but will they? Also there are, to my mind, unresolved and rather critical issue with teh way in which openEHR archetypes are licensed. I have raised these concerns repeatedly with the openEHR developers but am happy to share them on this list if anyone is interested. perhaps I am needlessly concerned but I think not. Or have I posted these concerns to this list already? So, my view is: all power and godspeed to the openEHR project, but too soon to be cementing openEHR stuff into final standards. Not too soon for openEHR standards proposals, that will go through dozens of revisions over the next decade, but definitely too soon to be pushing through final standards for something which for the majority of health professionals and health informatics people is largely unproven in a documented fashion and/or through first-hand experience. Tim C _______________________________________________ openEHR-clinical mailing list openEHR-clinical at openehr.org http://www.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
