Dear Gerard Something that persists and is attested may be called a document. However as we ascend the CDA level hierarchy (levels 1 through 3) and the CDAs become 'template enhanced' (to borrow Tom Beale's phrase), they might be thought of as a more versatile than documents. They will contain machine processable data entities, such as archetypes. Once the R MIM, HMD etc. processes are sorted out, they would serve as messages as well.
The virtual CDA idea was introduced in a paper on 'Seamless Care and the CDA' at the Berlin CDA conference by Timo It?l? and Aino Virtanen (see http://www.hl7.de/cda2002/progoverz.html ) They say that they are implementing it for 40% of the population of Finland. The CDAs are evoked on request, but need not otherwise exist. The hallmarks of the CDA are 'persistence, wholeness, stewardship, and potential for authentication', and when taken together are the same as 'attestation'. The commitment to turn out CDAs on demand implies a process of attestation and persistence in the participant systems, but a CDA based standard need not tell them how to do that. We might get further with a virtual kernel turning out CDAs, than with a kernel that does have a standard specification, but which is not widely adopted. Its a less ambitious vision than the total EHR concept, and might itself only be stage on the way, but it would be a start. Regards, Mike Mair Sent: Tuesday, December 10, 2002 3:35 AM Subject: Re: Model CEN/TC251 13606 > Dear Mike, > > > What sets aside a document from a message? > What is recorded in a EHR system? > > > A document is the information a healthcare provider attests by signing it. > It contains a set of information in a clear context. > > What is submitted in a EHR system has to be a set of documents, in my view. > > Next to the set of documents other information is part of the record: lab > tests, etc. > > In my view documents are persistent and reflect those parts of the recorded > and exchanged information that the healthcare provider attested. > Documents are not virtual at all and always exist. > > Gerard > > On 2002-12-04 14:00, "Mike Mair" <mikemair at es.co.nz> wrote: > > > Dear Gerard, David > > > > One definition of the GEHR 'kernel' is that of 'record engine'. I wondered > > what your view of the CDA was now in this role, after the Berlin CDA > > conference? The succession of CDAs can be turned out by any suitably > > equipped record system, and the CDAs used as a common currency for them. > > Sometimes these CDAs might not actually exist unless created for their > > communicative role between systems, in which case they are virtual CDAs, and > > the record engine entirely 'virtual'. This substitutes a 'virtual kernel' > > for the GEHR product, and does the same job of providing a communality of > > process between participant record systems without the specifics of the GEHR > > kernel, but it still would permit use of GEHR type components such as > > archetypes. > > > > Regards > > > > Mike Mair > > > > ----- Original Message ----- > > From: "David Lloyd" <d.lloyd at chime.ucl.ac.uk> > > To: <openehr-technical at openehr.org> > > Sent: Tuesday, December 03, 2002 8:40 PM > > Subject: Re: Model CEN/TC251 13606 > > > > > >> Gerard > >> > >> Several points: > >> 1.Specifically, openEHR proposes a number of Reference Models, > > supplemented > >> by Archetype Models. > >> > >> 2. You seem to use the word 'Kernel' as a synonym for Reference Model. If > >> this is not so, please will you explain your use of the word Kernel? > >> > >> 3. The Reference Models proposed by openEHR are just sufficient to meet > > the > >> set of published requirements (e.g. ISO 18308) for an EHR and apply to > >> _any_ EHR. It is necessary to delineate various levels in the Architecture > >> in order to be able to place Classes, Attributes, and Functions > >> appropriately to meet the requirements. > >> > >> 4. The Reference Models are indeed generic, in the usual sense that they > >> are not prescriptive about what _information_ must be in an EHR, but make > >> possible the representation of all those kinds of information known to > >> exist in (or be necessary for future) EHRs. > >> > >> 5. For each Reference Model there will be a corresponding Archetype Model > >> (only the Data Types Archetype model has so far been released). Authors of > >> actual Archetypes, conforming to the Archetype models, will be able to > >> impose the required constraints of their domains to guide the construction > >> of instances of EHRs. > >> > >> 6. To my way of thinking, everything about the Reference Models is > >> _generic_. Archetypes provide the means of using the models to construct > >> EHRs for particular, i.e. non-generic, domains. > >> > >> I hope this helps to resolve what appears to be a fundamental difference > >> between us! > >> > >> With best wishes > >> > >> David > >> > >> > >> At 21:02 02/12/2002 +0100, you wrote: > >>> Dear colleagues, > >>> > >>> The last week I had a discussion with some colleagues of me at TNO. > >>> They studied the OpenEhr proposal for a model for the EHR. > >>> > >>> It is their opinion, and I agree with it, that the Kernel is not generic > >>> enough because it contains things like the structure of the document > >>> (folder, transaction, etc) > >>> Even things like an organiser archetype must become a real archetype and > > be > >>> not a part of the kernel. > >>> > >>> With regards, > >>> > >>> Gerard > >>> > >>> > >>> > >>> > >>> -- <private> -- > >>> Gerard Freriks, arts > >>> Huigsloterdijk 378 > >>> 2158 LR Buitenkaag > >>> The Netherlands > >>> > >>> +31 252 544896 > >>> +31 654 792800 > >>> > >>> > >>> - > >>> If you have any questions about using this list, > >>> please send a message to d.lloyd at openehr.org > >> > >> > >> * David S.L. Lloyd, Technical Consultant > >> * CHIME - Centre for Health Informatics and Multiprofessional > >> Education, at UCL > >> * E-Mail: d.lloyd at chime.ucl.ac.uk Tel: +44 (0)20 7288 3364 > >> * Web: www.chime.ucl.ac.uk/~rmhidsl#contact > >> > >> > >> - > >> If you have any questions about using this list, > >> please send a message to d.lloyd at openehr.org > >> > > > > > > -- <private> -- > Gerard Freriks, arts > Huigsloterdijk 378 > 2158 LR Buitenkaag > The Netherlands > > +31 252 544896 > +31 654 792800 > > > - > If you have any questions about using this list, > please send a message to d.lloyd at openehr.org > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
