Hi Seref, Have you published this interesting document somewhere except your weblog? I want to cite this in an article.
Best Regards Pariya MSc; PhD Candidate Department of Computing Science and Engineering Chalmers University of Technology http://www.chalmers.se/cse/EN/people/kashfi-hajar On Nov 2, 2010, at 1:32 PM, Seref Arikan wrote: > Hi Pablo, > A very useful insight into the issues indeed. This is one topic that may end > up being a quite long discussion, but I feel it is a topic that is worth > laying out, not only today, but every couple of years or so, to see where we > are. > > I'll provide my personal views here. openEHR is not a small specification. It > is not a simple one either. Considering the problem it is trying to solve, I > do not expect it to be. Therefore, the complexity of implementation is > significant. The nature of the problem openEHR is trying to solve inevitably > creates the blind men and the elephant situation > http://en.wikipedia.org/wiki/Blind_men_and_an_elephant > In explaining what openEHR is, we are faced with the problem of communicating > the whole picture. In my experience, partial views or decriptions of openEHR > lead to confusion, even if every bit of information provided is correct. > Technical people and clinicians alike have a hard time seeing the big > picture, and who can blaim them? The picture is really, really big. > > Be warned: the kind of statements I've just started to make are usually > perceived so that one gets the message "this needs to change". No. When I say > openEHR is complex, openEHR is big, openEHR is not easy to implement, I don't > mean openEHR is more complex than it needs to be, or openEHR is bigger than > it needs to be, or openEHR is harder than it should be to implement. > > We are attempting to solve a huge problem, and complexity of the solution > will enevitably rise in response. The instinct to simplify the solution > usually cripples the solution by pruning its support for less frequently > required features, but most of the time, this leads to an unsatisfactory > outcome. Surprisingly, everyone seems to follow the instinct. > > In my opinion, tooling and education are the two most important fronts we > need to make progress. The mechanics of an MRI is very complex, and yet, due > to way it was implemented, it is a practical, useful clinical tool. The > implementation of the very complex solution is designed so that without > knowing anything about the underlying mechanics, it can be used. > > Clinicians and developers need tooling to take control of complex concepts, > and not having enough tooling is leading to lots and lots of angels and > pinheads type of discussions. The chain of problems go like this: not enough > tooling -> not enough implementation -> not enough understanding & feedback > -> lots and lots of hypothetical discussions. > > So if (at least according to me) the biggest problem is tooling, why not > build the tools and solve the problem? Because no one is paying for it. > Whatever we have out there in terms of actual tools and implemenation is > mostly out there thanks to good intentions and hard work of people. I've > opened up the code I'm writing for my PhD, Ocean, Zilics, and people Rong > Chen and Tim Cook are doing the same, but with limited resources it is hard > to trigger a mass adoption. > > We are moving forward, no doubt, but people staying up in the middle of the > night are usually paying the steepest price, and the most interesting thing > in all this is that the expectations are huge. Please do not get me wrong, > I'm not saying this in response to your analysis, but most of the time, when > people encounter openEHR, they are amazingly expecting a piece of software to > install, which will deliver everything openEHR can deliver, out of the box. > And of course they want it to be open source. When they can't find this, they > say it is not there yet. I think this is also related to education; > personally I think that we need to stop people from having unrealistic > expectations, and clearly explain what the offer is, and what it takes to > turn that offer into value added. > > Anyway, this is a big topic, and I can't put everything I have in my mind > into one e-mail. Still wanted to say these bits. BTW, I've written about > openEHR almost two years ago, trying to explain it to novice, though my own > understanding at the time was not very clear. > http://www.serefarikan.com/?p=97 may be of help, next time you're trying to > describe what it is, at least some of it. > > Best Regards > Seref > > > 2010/11/2 pablo pazos <pazospablo at hotmail.com> > Hi Thomas, > > My opinion is the grade of adoption of a standard depend in some aspects of > goverment agencies, in some of the industry and some of the academy. > > DICOM is a good example of an open standard heavily supported by the > industry, that's the point of it success. Can't be OpenEHR a de-facto > standard for EHRs? Like DICOM is for imaging. I think yes, but the progress > of OpenEHR to solve real the problems and make it usable, is slow. > > I think OpenEHR is strong on the academy area. It has poor industry > penetration (I mean enterprises developing tools and aplying a good part of > the OpenEHR specification in their systems, and that these systems where used > in some hospitals). I don't know what's the penetration of OpenEHR on > goverment agencies. There are some open tools but there is some stillness on > making improvements on them. > > > For example, here in Latin America, almost nobody knows about OpenEHR in the > industry area, and very very few knows about it in the academy area. > > There are some ideas that may help the difusion and adoption of OpenEHR: > > - I think that regional OpenEHR communities are needed to empower the > adoption and spreading of the standard. In 2009 I send a message to the > mailing lists, but I get no answer from the community (this mail is below). > Now we have 36 members from Uruguay, Argentina, Chile, Colombia, Spain, and > more. They work on goverment agencies, big enterprises (like IBM), developers > and physicians. I think the international OpenEHR community needs to support > these regional communities, providing guidelines, general objectives, and > following their work. Here in South America, only few people know about > OpenEHR, that's a shame. People in goverment are making decissions, without > knowing that are good and open standards out there. > > - Formal training and education in OpenEHR is needed. It's very hard to the > newcomer to understand how to use OpenEHR, and people interested on the main > ideas of OpenEHR may be dissapointed when they try to use it in a real-world > software application. People in the industry must be trained, but how many > OpenEHR trainers are out there? > > In Set-2010 I've done a hands-on OpenEHR tutorial in Argentina, and people > (medics and TIC people) where amazed about building their archetypes and > having a tool that generates the EHR (this is my degree project). This was > done in the context of the "Argentine Congress of informatics and Health > 2010". Now, the organizers want to make more time to discuss OpenEHR and its > posibilities. This is just an example that great things can happen if someone > has interest. > > Regional OpenEHR communities can build courses fucused on the regional needs, > may be made some money to support the open tool development (*). > > - Building and supporting open tools. The current tools have no regular > updates. We need developers to build new tools and improve the current tools. > We can use the money of the training courses (*) to pay developers to do this > job. If this depends only on the free time we have, tools just can die before > they are implemented. > > - In order to help any goverment adoption of OpenEHR, the decission makers > have some questions that today OpenEHR can't answer. > - What is the state of the standard? > - Is it stable? > - Wich parts are stable? > - Is there any return of investment study done on efective use of OpenEHR? > - Or just, how much time and money I have to spend to effectively use > OpenEHR in a real world application? (I have to train people to make things > happen, not in an investigation project, but in a production project) > - What real world products are using OpenEHR? > - How these products are using OpenEHR? (they adopt the RM? the AOM? the > SM?) > > There is page on "who is using OpenEHR" in the portal, but it is outdated. My > proposal is to do regular polls on the community in order to know: who is > working on what, and how they're using OpenEHR. > > - Formal links with "formal" SDOs are needed. I think that OMG is in tune > with the way OpenEHR do things. They have the COAS standard, and OpenEHR RM > is mapped to COAS. This is a good starting point to have something in common. > > I think there are very good posibilities in the OpenEHR adoption on the > industry adn goverment areas, but we need to build improve the lines of > action of the community to reach that. > > > Just my humble opinions. > Best regards, > - Pablo. > > -------------------------------------------- > Hi, > > We're trying to build an spanish-speakers community about openEHR , I just > create a google group: http://groups.google.com/group/openehr-es > > We want to translate some docs and presentations to generate enough knowledge > to spread the word about OpenEHR, and other EHR related concepts between > latin-american and spanish people. > > > Best regards > Pablo Pazos Gutierrez > http://pablo.swp.googlepages.com/ > > > Date: Fri, 22 Oct 2010 20:19:29 +0100 > From: thomas.beale at oceaninformatics.com > To: openehr-technical at openehr.org > Subject: Re: Articles on Healthcare, Complexity, Change, Process, IT and > the role of openEHR etc > > > Hi Derek, > > it is very simple. Not being an official standard has been a real problem for > government agencies, obsessed with official standards. > > - thomas beale > > > On 22/10/2010 17:12, Derek Meyer wrote: > Tony, > > This is very impressive piece of work. Every since I first came across > openEHR I have intuitively felt that it is closer to the 'solution' than more > static attempts at standardization. So why is progress so slow? I've appplied > some lateral thinking to this, and come up with what many people on this list > may (at best) think contrarian - but at the risk of being flamed.... > > The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. > > (I'll go get my hard hat now...) > > Best wishes, > > Derek. > > On 22/10/10, "Shannon Tony (Leeds Teaching Hospitals NHS Trust)" > <tony.shannon at nhs.net> wrote: > Late last year I said I would work on some material to help explain openEHR > in the wider context of healthcare change during 2010. > > It has taken me longer that I originally planned but I've recently shared > some articles online towards that end. > http://frectal.com/book/ > > The articles explore issues such as > Healthcare under pressure, > Complexity of healthcare+management+IT, > Change and the elements within > Aligning process improvement efforts with IT > > In the final articles I explore healthcare change going forward, the need for > better IT and particularly why I believe openEHR has the potential to tackle > the complexity and diversity of healthcare.. > http://frectal.com/book/healthcare-change-the-way-forward/ > http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%e2%80%99s-potential-to-handle-complexity-diversity/ > > In the spirit of evolutionary change, they are up in draft form for now, so > comments on any article are welcome.. > > Hope you find it of some interest/value in explaining openEHR's place in the > wider world. > Please feel free to share.. > > Kind regards > > Tony > > Dr Tony Shannon > Consultant in Emergency Medicine, Leeds Teaching Hospitals > Clinical Lead for Informatics, Leeds Teaching Hospitals > Chair, Clinical Review Board, openEHR Foundation > tony.shannon at nhs.net > +44.789.988.5068 > > ******************************************************************************************************************** > > This message may contain confidential information. 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