Gerard, This is fine, and I agree that the Archetypes/Templates solution is to be preferred.
However there is one fundamental weakness in it: It is based on the assumption that everybody runs an archetype / Templates enabled system. This is definitely not the case now. One of the major weaknesses of the "Messaging solution" is that it takes 3 years to get going: true. I guess we must accept the fact that an "Archetypes/Templates solution" might take even more than that. Greetings from Vienna, Stefan Sauermann Von: openehr-clinical-bounces at openehr.org [mailto:openehr-clinical-bounces at openehr.org] Im Auftrag von Gerard Freriks Gesendet: Montag, 23. Juni 2008 10:38 An: For openEHR clinical discussions Betreff: Re: One compelling use case is enough On 21, Jun, 2008, at 23:13 , Thomas Beale wrote: This is the situation in which we find ourselves today. We obviously need to deal with existing messages, e.g. HL7v2 and EDIFACT, but hand-building messages is not an appropriate strategy for the future. It creates the situation where the definition of the 'line packet' now dictates to systems what their data should be, and in an inflexible , non reusable way. - thomas And killing any innovation. Use case: - Dr X and the diabetic nurse Y and the Specialist Z decide to test whether a new regime of new therapy and coordination works better than the previous regime. They want to improve their key figures they have to report to the insurance company each year. Each of them will take care in slightly different ways of the treatment of all diabetics they are responsible for. A new clinical pathway is designed, reflecting the new responsibilities and ways to cooperate. Each has an EHR-system produced by a different vendor. Messaging solution: Each addresses its own vendor. Since each vendor in the country receives hundreds of request for new messages and all a bit different, almost each request is turned down. It takes far to many resources to produce a message for all those local groups of cooperating healthcare providers. The venders united in an organisation decide to get consensus between all clinicians involved. This takes 1 year to produce a new message specification. Together the venders start the IHE process. So it takes 1.5 years to have one new implementable and tested specification. After another six months all healthcare providers get a new version of the diabetic clinical pathway. Most healthcare providers feel unhappy with a message that is not reflecting the local arrangements for cooperation. And more so since in these 3 years new medications and preferred regimes have been reported in the literature. They decide to leave things as they are and wait for better times with better IT solutions. Archetypes/Templates solution: Each of them has an other vendor but with a system conforming to EN13606/openEHR, the National-, European- and International standard. They use Clinical Modelling Tools based on the European EHR standard and openEHR implementable specifications. And produce the collection of templates they need in order to support their local new clinical pathway. The European Institute for Health Records together with the openEHR organisation host the European collection of Archetypes. The Dutch ProRec center is responsible for the Dutch Archetypes. Archetypes express what clinicians want to document about any clinical (and non-clinical) topic. Templates define what at the local level needs to be documented, retrieved and exchanged. The templates they need are produced using these essential shared resources. Within seconds these new templates are implemented in all systems. After an evaluation after one week, they decide that certain aspects need to be more fine tuned. That same hour all their systems have implemented those changes. Each month they produce a report with the figures they have to report on later that year. After 6 months things are improving, they are on the right track. I hope that this is a compelling use case many will understand. Gerard Electronic Record Company B.V. Distributor of Ocean Informatics for Europe and the Middle East Leidsevaart 594-596 NL-2014HT Haarlem PO Box: 376, NL-2300AJ Leiden the Netherlands M: +31 620347088 E: g.freriks at e-RecordCompany.EU -- <private> -- Gerard Freriks, MD Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252544896 M: +31 620347088 E: gfrer at luna.nl Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety. Benjamin Franklin 11 Nov 1755 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20080623/ddb5ec3d/attachment.html>
