Dear Colleagues, It has been suggested that I should cross-cost my long reply to David More on this list, so here it is. There has been a little further correspondence between us on the blog site since.
Dear David, Thank you for setting up this blog as a window through which to air your concerns. As the primary author of the section of prEN13606-2 that you quote, I am surprised and a little disappointed to find that you are so critical of something which rather transparently admits its limitations and points to the wider challenge of which it is a part. The goal of defining data structures to represent key clinical information in systematic ways is an old one, going back decades, and is vigorously being accelerated now in many national eHealth programmes such as yours (Data Groups etc.). These bodies are finding many of the challenges you describe: how to contain the number of data structures whilst catering for as much of real clinical diversity as is wise, how to bind record structures with new- generation large terminology such as SNOMED-CT, how to define editorial and governance policies and publishing infrastructures for these data structures and data sets, how to maintain them in the light of evolving practice, and how to deliver a coherent set of distributed knowledge services to support authorship and EHR systems. Despite these many challenges, it is recognised that this kind of approach is necessary if we are to aspire towards even modest semantic interoperability of health records. One key problem is that all such sets of defintions internationally use rather ad hoc representation formalisms. Part 2 of 13606 is therefore an important stepping-stone contribution towards harmonisation in this area, drawing as it does on the openEHR Archetype approach. The ability to foster an international standard for how such data structures can be represented and shared has been widely supported by many of the nations who are already building up such data structure libraries (including the UK and Australia, voting positively for 13606-2 in historic ballots). It is recognised that the challenge of building up content needs to be internationally shared, and that vendors (often being global) wishing to exploit such knowledge artefacts would in general prefer a single standarised representation. The truth is that this is an area in which research, standardisation and productisation need to proceed hand in hand. The solutions cannot be found by waiting for research alone to finish, because research needs to learn from wide scale practical experience and vice versa. You will know, I am sure, that 13606 Part 1 does not require the use of archetypes i.e. it is recognised that much useful EHR sharing can and will take place before archetypes become widely used. Part 2 is seeking to standardise that part of the archetype approach that is reasonably well established (a comprehensive representation of what needs to be specified when a data structure is defined). Future standards will be able to address most of the other areas you raise, but we are not yet at a point where best practice is established for those areas. The openEHR Foundation and its Clinical Review Board, and a new Detailed Clincial Models Collaborative of openEHR plus HL7, are seeking to build up an understanding of best practice in these other areas. There are also many running systems (some research and some commercial products) that have adopted an archetype-like approach from which we can learn. And there are substantial national efforts, such as the Dutch work that William refers to, which are identifying important issues and solutions. I hope therefore that you can use your efforts, given that you have taken the trouble to study the field, to help contribute to the future learning we still need to make. If you do have specific rewordings to propose to 13606 Part 2 I am very happy to receive them, and to put them into the consensus standardisation process for consideration. I hope that you and your readers can recognise that the various organisations, be it a national effort like the Australian or Dutch, a standard like 13606 or HL7 Templates, or research like openEHR's or our own at UCL, are all working rather unusually closely and harmoniously towards tackling these difficult challenges. I hope you will also find that, as a community, we are open to constructive critique and to fresh inputs from others. I look forward to your reply. With best wishes, Dipak ________________________________________________________ Dr Dipak Kalra Clinical Senior Lecturer in Health Informatics CHIME, University College London Holborn Union Building, Highgate Hill, London N19 5LW Direct Line: +44-20-7288-3362 Fax: +44-20-7288-3322 Web site: http://www.chime.ucl.ac.uk _______________________________________________ openEHR-clinical mailing list openEHR-clinical at openehr.org http://www.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
